An uptick of thrombotic microangiopathy (TMA) cases with a presentation similar to that of a rare blood disorder, thrombotic thrombocytopenic purpura, at Wake Forest Baptist Health in Winston-Salem, North Carolina, tipped off hematologist Peter Miller, MD, that something unusual was going on. An assistant professor at Wake Forest University, Miller had read a report from the U.S. Centers for Disease Control and Prevention (CDC) about similar cases linked to the illicit intravenous injection of a newly reformulated version of extended-release oxymorphone, Opana ER, so he and his colleagues began asking patients with suspected cases whether they had injected this oral medication.
“As soon as we did that, it was very evident we were on the verge of a crisis in our local area,” Miller said.
North Carolina is one of many states grappling with an ongoing epidemic of opioid abuse and addiction. In 2017 alone, the state’s emergency departments treated 5762 opioid overdoses—a 25.5% increase over the 4177 opioid overdose–related visits in 2016, according to the North Carolina Injury and Violence Prevention Branch. This mirrors a nationwide 30% increase in opioid overdose visits to emergency departments during that same period, according to the CDC.
For physicians like Miller and his colleagues, little data is available on the potential kidney risks associated with such opioid abuse, so they and other researchers have tried to fill the gaps. Some studies have found increased kidney risks associated with illicit opioid use, but how such use may harm the kidney isn’t clear.
“It’s still very much a black box,” said Tess Novick, MD, a nephrology clinical fellow at Johns Hopkins University in Baltimore.