Physicians weigh ethics of expensive surgery for opioid addicts

Treating intravenous drug users for endocarditis — inflammation of the heart valve related to infection — is putting physicians in harrowing ethical territory, according to a report from NPR.

While cardiologists, surgeons and infectious disease experts can treat the endocarditis in these patients, they cannot cure the underlying problem of addiction. Many patients continue to use drugs after treatment, which can incite recurring infections.

Intravenous drug users who undergo heart valve replacement surgery have an approximately 1 percent mortality rate while being treated in the hospital, according to Jonathan Eddinger, MD, a cardiologist at Catholic Medical Center in Manchester, N.H., who spoke with NPR for the report. To learn more about the mortality of these patients post-discharge, Dr. Eddinger perused online obituaries to find out if heart valve replacement patients had died.

Dr. Eddinger discovered 25 percent of Catholic Medical Center's patients who were intravenous drug users and received treatment for endocarditis had died after leaving the hospital. This patient population also proved costly to treat as some returned for treatments multiple times.

Nancy Teixeira, MSN, RN, the director of Catholic Medical Center's cardiovascular surgical unit, told NPR endocarditis treatment doesn't always work in patients who inject drugs.

"We've had people come in, get their valves done, go back out and use, and they either die or they show up in extremis because they've used again and now they've reinfected their new valve and they're right back at square one," she said.

Catholic Medical Center is one of the first hospitals in the nation to write ethical guidelines for treating these patients, according to NPR. The guidelines call for referring these patients to primary care physicians and addiction counseling after treatment.

In 2011, Catholic Medical Center treated three intravenous drug abusers with endocarditis. In 2016, physicians at the hospital treated 51. While this is a growing trend at hospitals across the United States, no one is reportedly tracking the national numbers, according to NPR.

More articles on opioids: 
Youth opioid use on the decline, studies show 
4 issues the opioid epidemic creates for employers 
CDC: Likelihood of chronic opioid use spikes with prescriptions longer than a few days

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