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“It’s Not Just an Opioid Epidemic – It’s an Overdose Epidemic”

Study Shows Infections are a Common “Side Effect” of Intravenous Drug Use

Infectious Diseases Fellow, Laura Marks MD, PhD sees it all too often: rising intravenous drug use leads to startling and often life-threatening infections. On the one hand, 130 Americans die every day from an opioid overdose however, on the other, Dr. Marks sees the issue as more than merely an “opioid epidemic”. “It’s really an overdose epidemic,” she says.

During her training at Washington University in St. Louis and residency at Barnes-Jewish Hospital, Marks says she has seen more and more young persons who inject drugs coming in with higher and higher rates of life-threatening infections.

How bad is the problem?

For every patient who overdoses from intravenous drug use, studies show that an additional four persons who inject drugs also have a severe infection. These can include infection of the heart, abscesses at the injection site, or bacteria in the bloodstream landing on bones or joints and Hepatitis A, B or C.

“In as little as three months, this type of infection can have a 10% mortality rate,” says Marks. “This is something we’re not talking about and for which we need immediate intervention.”

She adds that treating the infection in isolation with antibiotics isn’t enough.

Through funding from the Centers for Disease Control (CDC), Marks and her team, which includes Marks’ mentor, Institute Faculty Scholar, Michael Durkin MD, MPH, and Faculty Scholars Alex T. Ramsey PhD; Keith Woeltje MD, PhD;  Abigail Barker PhD; Rupa Patel MD, MPH; and, Laura Beirut MD, among others, have studied this syndemic and have developed a “care package” of treatment, which impacts patients in amazing ways, treating the whole, rather than just a part of the problem.

Through team-based support, such as infectious disease doctors, psychiatrists, toxicologists, peer counselors and researchers all working together, Marks says, “We can ensure that the interventions we’re developing here at WashU are designed to treat not only the drug use and infection but the underlying issue. Plus, we want to be sure that these comprehensive interventions are just as effective for patients in the city who use Fentanyl as they are for those in rural areas who use Methamphetamine.”

Dr. Marks knows that no matter what drug you inject, the risk of infection is great, so the team’s interventions are designed to help multiple types of people using multiple types of drugs, not just opioids. “That’s why we refer to this as an “overdose crisis” rather than just an “opioid crisis”, she says.

The team’s 18-month “CDC SHEPheRD Project” aims to insure that patients receive comprehensive care: medical care with additional support for their underlying problem so that they don’t return to the doctor with more severe infections or at worst, die from infection. “We’re also linking patients to clinics near their home so they can get preventative care and treatments such as immunizations against additional infections like hepatitis A and B, as well as PrEP; a daily pill to prevent HIV.” The CDC grant provides for most of these treatments free and patients are engaged in their own care decisions.

Dr. Marks and team continue to stress that a team approach (case managers, addiction clinics, psychiatrists, peer recovery specialists, and infectious disease physicians) is necessary to help solve the “overdose crisis” because, “it’s not just a one-stop problem. It takes a team.” She hopes to receive additional funding in the future to help continue this vital effort.