Hidden Illness: Bacterial infection adding to opioid epidemic death toll

BOSTON -- It is the epidemic behind the epidemic.  A killer condition that takes its victims in sometimes brutal ways.

It's called endocarditis.

It's a heart infection most commonly seen in older people, but now showing up in teens and young adults in alarming numbers and it’s all related to the opioid epidemic.

Before administering an injection, health care workers routinely swab the skin with a disinfectant that kills bacteria that could be pushed into the body by a needle. Opioid drug users may not be so careful and that's caused a rise in many endocarditis cases.

“On any given day we have half a dozen young people who are suffering from this,” Dr. Sarah Wakeman, medical director of the Substance Use Disorder Initiative and the Addiction Consult Team at Massachusetts General Hospital, said.

Endocarditis is a bacterial infection of the valves of the heart.

”It basically forms like a little clump of bacteria that grows over time and that infection can get very serious and in fact be life-threatening if not treated,” said Wakeman.

Cheryl Molloy-Emerson's younger sister, Tina, developed endocarditis back in 2016 after years of unrelenting opioid abuse that included the frequent injection of heroin. looking through pictures on her couch of her younger sister, Tina.

“She could have gone to college if she wanted to” said Molloy-Emerson. “There was just so much potential that was lost."

Cheryl shared pictures of Tina with Boston 25 News.

“She had been complaining about the chest pain, the swelling in her legs” said Molloy-Emerson, ”Her hair was falling out. She'd start crying."

Tina, who died at the age of 31, was a beauty pageant teen who once exuded confidence, poise and promise. In her final days she was kept alive by a respirator.


Injecting opioids, such as heroin, increases the risk for endocarditis for a simple reason:

“Bacteria are living on your skin. Every time you inject, there's a chance of introducing bacteria into your bloodstream,” said Dr. Christopher Rowley, a physician of the Infectious Disease Division at Beth Israel Deaconess Medical Center.

Endocarditis is treatable using a lengthy regimen of intravenous antibiotics. In severe cases, surgery to replace the damaged valves may be needed.

But there's one major problem.

”If we don't treat the opioid use disorder which led to the infection then we've only done half the job,” said Rowley, “It could cause you to have a stroke, could lead you to have heart failure.”

He co-authored a recent study on the growing incidence of endocarditis related to injectable drug use.

”We sent out a survey recently to infectious disease providers nationwide and had over 500 people respond to us and say that they are frequently seeing cases of endocarditis,” said Rowley

How many cases is unclear, but a 2016 Tufts University study found hospitalizations due to injectable drug-related endocarditis more than doubled between 2000 and 2013 to more than 8500 cases. The study also found a rising proportion of those cases were found in young adults ages 15 to 34.

“These are people with decades more of life ahead of them and that's what makes this so tragic,” said Wakeman.

The Massachusetts Senate is considering a bill to legalize safe injection sites, some experts think these facilities could help curb injection infections as they would ensure the use of sterile techniques.