With U.S. emergency rooms being overrun with opioid patients, the national epidemic is putting pressure on myriad aspects of healthcare delivery. Infection prevention is no exception.

As we have previously reported in Hospital Infection Control & Prevention, the opioid epidemic overlaps with the longstanding problem of addicted healthcare workers diverting drugs such as fentanyl, sometimes causing hepatitis outbreaks among patients by contaminating vials and syringes.

In addition, opioid-addicted patients admitted to hospitals have seeded their own infections by spiking their IV lines with street drugs.

Moreover, investigators recently reported that opioid use predisposes people to invasive pneumococcal disease.

They analyzed patient records and pharmacy prescriptions, finding a connection between opioid use and infection as defined by the isolation of Streptococcus pneumoniae from a normally sterile site. Opioid use is a “novel risk factor for these diseases,” they concluded.¹

In another disturbing development, first responders and frontline nurses have had to be revived by an opioid antidote after coming in contact with contaminated opioid patients.

Some of this is thought to occur because street drugs are being cut with powerful synthetic opioids, some many times more potent than anything typically used in a hospital.

The opioid epidemic has reached unprecedented levels, with an estimated 63,000 overdose deaths in 2016, the Centers for Disease Control and Prevention recently reported.²

“We’re currently seeing the highest drug overdose death rates ever recorded in the United States, driven by prescription opioids and by illicit opioids such as heroin and illicitly-manufactured fentanyl,” Anne Schuchat, MD, CDC acting director, said at a recent news conference.

“This means that, on average, 115 Americans died each day from an opioid overdose involving prescription or illicit opioids in 2016.”

In data reported from July 2016 through September 2017, the CDC found that emergency department visits in 45 states showed that opioid overdoses are increasing across all regions.

“Out of 91 million emergency department visits, there were 142,557 suspected overdoses involving opioids,” Schuchat said.

“Opioid overdose emergency department visits increased about 30% overall in this national system,” she added.

“We saw increases in cities and towns of all types from the third quarter 2016 to the third quarter 2017.”

While the overdose deaths are shocking, the nonfatal cases have considerable impact as well, she noted.

“For every fatal case there are many more nonfatal cases, each one with its own emotional and economic toll,” she said. “Research shows that people who have had at least one overdose are more likely to have another.”

The CDC is working with hospital EDs to refer these surviving addicts for subsequent treatment.

“Take steps toward preventing a repeat overdose, ideally [by] alerting community partners to opportunities to improve prevention in the surrounding areas,” she said.

On a personal note, U.S. Surgeon General Jerome Adams, MD, MPH, said his brother has struggled with addiction for decades.

“I often contemplate the fact that it could have been me,” Adams said at the press conference.

Getting the opioid antidote naloxone in the hands of first responders and community members is an immediate priority, followed by public education and destigmatization of addiction, he said.

REFERENCES

1. Wiese AD, Griffin MR, Schaffner W. Opioid Analgesic Use and Risk for Invasive Pneumococcal Diseases: A Nested Case-Control Study. Ann Intern Med 2018; Feb. 13: doi: 10.7326/M17-1907. [Epub ahead of print]
2. CDC. Opioid Overdoses Treated in Emergency Departments. Vital Signs March 2018: http://bit.ly/2HrNROm.