Costly and dangerous heroin-related infections have risen sharply in Minnesota since 2010, a frightening but little-noticed byproduct of the state’s opioid epidemic that is presenting local hospitals with patients who need lengthy and expensive treatment.
Since 2010, for example, admissions at Minnesota hospitals for heart valve infections among drug users have more than quadrupled, from 18 to at least 81. While the full impact on Minnesota’s health care system stemming from injecting opioids is unclear, doctors report a growing number of grave infection cases — patients who require up to six weeks of intravenous antibiotic therapy.
Concerned by the trend, state and county health officials are intensifying efforts to reduce needle-borne infections.
The state is also recording an increase in highly contagious bacterial infections that are resistant to common antibiotics, according to the Minnesota Department of Health. That finding was echoed by a recent federal study which concluded that people who inject drugs are 16 times more likely to develop antibiotic-resistant infections.
“This is beyond anecdotal — this is happening,” said Dr. Gavin Bart, director of addiction medicine at Hennepin Healthcare in Minneapolis.
In addition to the familiar dangers of powerful injected drugs, sharing needles with others — and even re-use of a needle by the same person — introduces harmful bacteria into the bloodstream, setting the stage for severe infections that can spiral into heart valve failure or spinal infections.
“I have had clients in the hospital for six weeks from … using the same needle over and over again [or] injecting unsafely,” said Stephanie Devich, a counselor at the Brooklyn Park clinic Valhalla Place, which provides addiction and mental health treatment. One client required knee surgery because the infection had spread that far.
In states hit harder by the opioid epidemic, public health officials are reporting hundreds of cases of needle-borne infections, including 200 cases a year in Kentucky and 600 cases at a southeastern Pennsylvania hospital system that also serves West Virginia.
A federal study of North Carolina’s hospitals found a 20-fold increase in the costs associated with drug-related heart valve infections, from $1.1 million in 2010 to $22.2 million in 2015.
“When bacteria gets into the bloodstream, patients can get really sick,” said Dr. Jonathan Alpern, a HealthPartners infectious disease physician who practices at Regions Hospital in St. Paul. “We see these fairly regularly in the hospital.”
To many public health officials, the development is a reminder of the way that unsafe needle use has long been a pathway for spreading HIV and hepatitis C.
Health advocates say the human and financial toll of these infections can be reduced through simple interventions, including providing clean needles, that proved effective as a response to the AIDS crisis.
State and local public health agencies are stepping up these efforts, known as harm reduction, with services such as providing drug users with the overdose-reversal drug Narcan (or naloxone), treating wounds associated with needle use and directing users to resources for food, housing and drug treatment.
“It has been known for decades now that access to clean needles reduces infections,” said Bart. “We know there are interventions and we know that they work, but we just have to get them out there more.”
Needle-exchange and harm reduction projects, which can be highly controversial, have mostly been conducted by private organizations or street volunteers.
Devich knows how difficult it is to make it into and through treatment. She used crack cocaine, even when it cost her custody of her children and after she overdosed, waking up in handcuffs and shackles.
She was released, but “at the end of the day I got out, I got high,” she said.
Devich says the people she works with want to quit. They no longer feel the euphoric effects of the drugs and instead use them to stave off the painful effects of withdrawal, which are especially bad for opioid users.
But she also knows that people won’t seek treatment, or return to treatment, until they are willing. Until that time, Devich believes it is important to help them stay safe and alive and give them someone to trust.
“When you do want help, where are you going to go? Probably the person you trusted enough at a vulnerable moment to get a syringe,” Devich said.
Southside Harm Reduction Services, which runs mostly on private donations, conducts street outreach at various locations, including the Midtown Greenway in south Minneapolis and the large homeless encampment near Franklin and Hiawatha avenues.
“People are not trying to die, they don’t want to overdose,” said Brit Culp, a volunteer with the group. People who engage in syringe exchange programs are five to seven times more likely to seek treatment, she said.
The state Health Department recently funded six organizations to support syringe exchange services under a 2016 change to federal law that had previously barred any federal financial support for the practice. Using federal HIV prevention funds, the state has awarded $650,000 in grants for 2018.
“We want to reduce the transmission of infectious disease,” said Anne Barry, director of St. Paul-Ramsey Public Health, which began a program in July using state money.
“People who exchange their syringes have less chance of getting diseases and less chance of spreading diseases,” Barry said.
Hennepin County and the city of Minneapolis have both made harm reduction a priority as they respond to the opioid epidemic.
“Not injecting drugs obviously is the best way to prevent infections,” Alpern said. “We see many individuals who are not able to do that. We should be encouraging them to use proper hygiene and trying to change behavior so they decrease their risk of developing infection.”