The epidemic of opioid abuse in the United States has put hospital ERs on the front line, with staffers increasingly battling infections tied to the problem.
ERs are seeing an increasing number of patients seeking care for severe infections resulting from injected use of heroin, fentanyl, oxycodone and the like, new research shows.
ER radiologists are often the first to diagnose such complications, using X-rays, MRIs, CT scans and ultrasounds to spot infections that typically result from the use of non-sterile needles, the researchers said.
Insights into how the opioid epidemic is playing out in the ER stem from a 12-year analysis that focused on more than 1,000 substance abuse patients who sought care for related complications between 2005 and 2016.
The findings reflect the fact that “the opioid epidemic is a national emergency,” said study author Dr. Efren Flores. He’s an ER radiologist at Massachusetts General Hospital in Boston.
“The results of this study,” he said, “are consistent with our daily practice, where we continue to observe an increase in the number of patients with substance use disorders that present to the emergency department for evaluation of complications related to their illness.”
What’s more, Flores said, many of these patients — at an average age of 36 — “are young adults who are in the beginning of their productive lives.”
Though not a member of the study team, Dr. Paul Petersen noted that “this increase in infections related to IV [intravenous] drug abuse has been expected and is not surprising to the medical community as the opioid epidemic continues to rise in the United States.”
Petersen is a core faculty member of the emergency department at Mount Sinai Medical Center in Miami Beach, Fla.
“IV drug abuse can cause local infections at the injection site, either from bacteria mixed in the drug, on a dirty needle or on dirty skin through which the needle passes,” he explained. “The bacteria can also grow in the bloodstream and prefer to accumulate and grow on the heart valves, causing valvular heart disease.”
“In addition, from the valves, these vegetative infections or clumps of growing bacteria shoot downstream, commonly to the lungs, brain and spine, where they continue to grow and cause disease,” Petersen said.
Complications from these infections are severe, he said. “They are often fatal and commonly cause chronic debilitating diseases of the spine, lungs, heart or brain, requiring multiple surgeries and long-term and/or institutionalized care,” he added.
Two-thirds of the patients in the latest analysis were men, and 78 percent were white.
Most of the complications seen during the study time frame involved localized soft-tissue infections at needle injection sites, according to the researchers. Sometimes the issue was a bacterial infection such as cellulitis. Other cases involved the onset of abscesses.
In some instances, pieces of broken needles were found buried under the surface of a patient’s skin. Bacteria-infected blood vessel blockages known as septic emboli, which have the potential to move into the lung or brain, were another observed concern.
Ultimately, 1 in 10 patients who had radiological screening while in the ER died from the complications.
“Our research validates the severity of this epidemic and uniqueness of this patient population,” Flores said. ER radiologists need to embrace their front-line position by proactively devising ways to increase the likelihood that those who do make it out of the ER stay out going forward.
For example, he suggested that radiologists should consider promoting needle-exchange programs while helping to direct patients into addiction recovery programs once they leave the ER.
Petersen seconded the importance of needle exchange programs and the need to prevent new infections down the road. But he suggested that the epidemic’s front line is actually out in the community, rather than in the ER.
Petersen places his stock in those who have the “greatest exposure to these patients” — social workers, family practitioners, homeless shelter staff members, community clinic workers and urgent care providers. It’s those individuals, he said, who are best placed to teach at-risk individuals about the most effective ways to limit their infection risk.
Flores and his fellow researchers were to present their findings Thursday in Chicago at the Radiological Society of North America’s annual meeting. Research presented at meetings is considered preliminary because it has not been subjected to the rigorous scrutiny given to research published in medical journals.
The U.S. National Institute on Drug Abuse has more on the opioid epidemic.