CHICAGO – Almost on a daily basis, radiologists see evidence of the toll that the nation’s opioid epidemic is having – frequently on the lives of younger people, researchers reported here at the annual scientific sessions of the Radiological Society of North America.
During a 12-year period, emergency department radiologists at Massachusetts General Hospital in Boston imaged 1,031 patients that were identified through their scans as having complications from substance abuse, reported Efren Flores, MD, an instructor of radiology there.
Among the signs of abuse evident via imaging: pulmonary and cerebral emboli composed of pill fragments.
He said that about 30% of the patients included in the study period – 2004 to 2016 – had received prescriptions for opioids. “Opioid prescriptions may be a gateway to substance abuse in some patients,” Flores told MedPage Today.
Of the 310 persons who had a history of opioid prescriptions, the average number of scripts was 10, but one person had received 163 opioid prescriptions.
“We’ve seen a dramatic increase in the past year of patients coming into the emergency department with complications related to substance use disorders,” he said. “The patient population is underserved. By the time we see them, they have more advanced complications because they’re hesitant to ask for help due to social stigmas.”
Of all the patients, 66% were men; 78% were white; their mean age was 36 years. “Complications were most frequently related to skin and soft tissue infections caused by the use of nonsterile needles,” Flores said. “In some cases, we found septic emboli in the lung or brain. As these patients start having to access larger veins, they become more prone to these types of infections.”
He cited a case of a young women who was having difficulty breathing. The radiologist saw what looked to be multiple emboli in the lung. The doctor determined that the patient was crushing drugs and then injecting them in large veins, but the drugs were not crushed finely enough and were being trapped in the lungs.
During the study period, doctors performed 1,673 imaging exams — 779 x-rays, 544 CTs, 292 MRIs and 58 ultrasounds. Mean time from opioid prescription to first imaging exam was 51 months. Overall, 121 of the 1,031 patients, or 11.7%, died before the end of the study period. The mortality rate was 14% for patients with a positive imaging diagnosis of substance-abuse-related complications.
Stamatia Destounis, MD, a clinical professor of radiology at the University of Rochester in New York, told MedPage Today that patients with drug-abuse complications are seen also daily where she works.
“They present with advanced infections, with pulmonary embolus because they are injecting crushed pills, and they are not using safe injection practices,” she said. “They present with pneumonias, with septic emboli that go to the lungs and the brain and anywhere in the body. They may present with pain in their hips due to abscesses linked to these infections.
“The radiologist who is interpreting the imaging studies gets to see the severity of the disease process. When we see the evidence of drug abuse we have to go back to the treating physician and have them ask the patients about their addictions,” Destounis said.
Typically, Destounis said, “We often don’t see these patients until they are very ill because they are embarrassed to go see a doctor for fear that their addiction will be discovered.” She also said that many patients present late because they are homeless, have no money, have no insurance and don’t go to a hospital until their condition becomes desperate.
She said that usually the emergency room nurse or doctor who takes a medical history will find out that the patients is abusing drugs, but sometimes the radiologist sees an otherwise healthy person with drug-related disease and “it throws up a red flag and that radiologist can bring the information back to the admitting physician and say ‘you have to ask this question’.”
The prevalence of substance use disorder in patients presenting to emergency radiology provides radiologists a unique opportunity to “look beyond the reading room, and see other ways we can help,” Flores said. For instance, radiologists can encourage patients to use sterile needles, inform them about needle exchange programs and advise them to use alcohol at the injection site to avoid infections. Radiologists can also help steer patients into programs or connect them with recovery coaches, both in the hospital and the community, to help them with their illness.
Flores and Destounis disclosed no relevant relationships with industry.