Tip Sheets

Covering opioids and infectious diseases

By Bara Vaida

As the opioid crisis has deepened – about 10.3 million Americans reported that they misused opioids in 2018 – there has been a surge in bacterial and viral infections that threaten to make the crisis worse.

The rise includes an increase in bacterial infections caused by Staphlococcus aureus, a pathogen that is often resistant to antibiotics – and a climb in new HIV, hepatitis and sexually transmitted diseases.

“This is like HIV all over again,” Judith Feinberg, an infectious disease expert at West Virginia University told Nature, in explaining that the current opioid crisis is similar to the challenge initially faced by public health officials in the 1980’s and 1990’s, with AIDS. Like that time period, she says that those addicted to opioids are “are stigmatized; they don’t feel they deserve to live.”

In the past two decades, the use of opioids, which includes prescription pain medications, heroin, methamphetamines and synthetic drugs like fentanyl and carfentanil, has exploded, leading to a big increase in overdose deaths and depressing national life expectancy figures for three years in a row.

In 2018, there were a reported 67,071 drug overdose deaths, up almost 300% from 1999, according to the Centers for Disease Control and Prevention. The epidemic has impacted life expectancy, which in 2017 [the most recent data] was 78.6 years, compared with 78.9 years in 2014, according to the Journal of the American Medical Association (JAMA).

The biggest increase in the death rate occurred between those 18 and 64 and researchers say that overdoses, and a rise in infections are likely among the many factors that are resulting in untimely deaths.

Among the surge in infections associated with opioids has been a large increase in hepatitis A and C cases. The incidence in hepatitis A, a vaccine-preventable condition that can be transmitted through poor sanitation practices and unprotected sex, jumped 140% between 2011 and 2017. The number of new hepatitis C cases, which can be transmitted via unsterile needles, more than doubled between 2010 and 2017, the CDC said. Untreated, hepatitis can cause liver infections and potentially cancer.

Progress on reducing HIV infections has also stalled. There are around 38,000 new HIV infections each year in the US, and that number has remained steady over the past five years, after years of large declines, because prevention and treatment aren’t reaching those most at risk, like intravenous drug users, according to the CDC. There are currently about 1.1 million Americans living with HIV.

Combined cases of the sexually transmitted diseases, syphilis, gonorrhea and chlamydia, reached an all-time high in 2018, said the CDC. While antibiotics can cure these diseases, left untreated, they can cause infertility, ectopic pregnancy, increased HIV risk. Untreated syphilis can cause miscarriage and stillbirth in pregnant women, as well as lifelong physical and neurological problems. The agency said drug use, poverty, stigma and unstable housing, decreased condom use, and cuts to STD programs are factors in the increases.

Endocarditis is another opioid-related infection, which involves heart valves. When people share needles, S. aureas bacteria can get into the blood stream and move to the heart, damaging the valves. In the worst cases, a person may need a heart transplant to survive. Infectious disease doctors are reporting an increasing number of endocarditis cases among drug users.

Long-term opioid use can also leave people more vulnerable to respiratory diseases. A January 2019 study concluded that veterans who took opioids at medium to high doses for chronic pain were significantly more susceptible to pneumonia, suggesting the drug may suppress the immune system.

As a result, researchers have been working on ways to improve diagnosis and treatment of infections in opioid users. Public health officials are urging physicians and addiction counselors to watch for infectious diseases and to be more aware of the connection between opioid misuse and the potential for people to become sick from a pathogen.

Story ideas to consider:

  • Check in with your public health department and find out if any of the diseases mentioned above are spiking

  • Find people who have misused opioids and developed an infectious disease and tell their story

  • There are 48 counties, Washington, D.C., Puerto Rico and seven states getting new money from the Trump administration to boost efforts to prevent and treat HIV. Do you report in one of those communities and what might these funds mean for reducing the opioid epidemic and infections?

  • Are any public officials in your community considering safe injection sites to lower infectious disease risks?

  • Spend a day with a disease intervention specialist in your community. They track down people who may have been exposed to sexually transmitted diseases and can speak to the impact of the opioid epidemic.

  • Check with local hospitals and maternity clinics to learn if there are more babies that have been born with syphilis. What is being done to prevent more cases?

  • How are public health officials using big data to predict infectious disease outbreaks connected to opioid misuse?

Coverage to read for ideas:

With the opioid epidemic, communities see dramatic increases in infectious diseases: ContagionLive (October 2017)

The nightmare everyone is worried about: HIV cases tied to opioids spike in West Virginia county. Politico. (September 2019)

Alarming number of heart infections tied to the opioid epidemic (September 2019) ScienceDaily:

The intersection of opioids and HIV Politico (June 2019)

The US opioid epidemic is driving a spike in infectious diseases Nature (July 2019):

A three-quarter home in Pittsburgh was a key stop in my recovery from opioid addiction (July 25, 2019) Publicsource

Opioid epidemic stigma mirrors early rise of HIV: Medpage Today (June 2019)

Opioid epidemic is increasing rates of some infections. National Institutes of Health (April 2019)

Prescribed opioids raise risk of pneumonia in patients with and without HIV  Science Daily (January 2019)

A tip sheet for covering HIV today: A 2019 update: AHCJ (May 2019)

Covering STD’s, What Reporters Need to Know: AHCJ (December 2018)

Covering social determinants and infectious diseases: AHCJ (September 2018)

Addressing the opioid

Epidemic, what does the research say? : Journalist’s Resource (Harvard Kennedy School Shorenstein Cener on Media, Politics and Public Polic:

Government reports:

Addressing the infectious disease consequences of the US opioid crisis (March 2019) Centers for Disease Control and Prevention

Addressing infectious  disease consequences of the opioid epidemic: National Association of Governors (May 2019)

What is ‘ending the HIV epidemic, a plan for America?’: HIV.gov (December 2019)

National Survey on Drug Use and Health for 2018: Substance Abuse and Mental Health Services Administration. (2019)

Experts:

Georgiy Bobashev, PhD, fellow, Center for Data Science, RTI International
Contact: news@rti.org,  919-541-7340
Expertise: He uses computer models to simulate drug users and their social networks to predict locations of opioid-related HIV outbreaks.

Hermione Hurley, MD, infectious disease and behavioral health physician at Denver Health and Hospital Authority
Expertise: She is lead co-author of a paper on infectious diseases physician’s roles in stopping the opioid epidemic. Phone: 303-436-4949

Anthony Fauci, MD, director, National Institutes of Allergies and Infectious Diseases
Reach him at 301-402-1663, or niaidnews@niaid.nih.gov
Expertise: As a national public health leader on HIV and infectious disease issues, he can speak to this topic.

Judith Feinberg, MD, professor, West Virginia University Rockefeller Neuroscience Institute
Contact: Judith.Feinberg@hsc.wvu.edu
Expertise: An infectious disease physician who established Ohio’s third safe needle exchange program

David Harvey, B.S., executive director, The National Coalition of STD Directors
Email: dharvey@ncsddc.org
Expertise: He leads one of the country’s largest public health membership organizations that represent public health department STD directors and their community partners.

Jonathan Mermin, M.D., M.P.H.. director, CDC National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
Can be reached via press coordinator Rachel Wingard: miv1@cdc.gov, 404-639-2013 or 678-708-9171
Expertise: Mermin oversees the nation’s efforts to prevent the spread of HIV and STDs.

Carlos del Rio, M.D., professor and chair, Department of Global Health at the Rollins School of Public Health and professor at Emory University School of Medicine
Contact: 404-778-1405, cdelrio@emory.edu
Expertise: Chair of a working group at the National Academy of Medicine working on a strategy for integrating care for infections and opioid use.

Dan Wohlfeiler, M.J., M.P.H., director, Building Health Online Communities
Email: danwohlfeiler@bhocpartners.org
Expertise: Serves in the California’s Department of Public Health and has decades of expertise in working on STD and HIV prevention.

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