Background: The opioid epidemic continues to exert a significant impact on our health care system. Patients with intravenous drug use (IVDU) often develop life threating infections leading to prolonged hospitalizations with poor outcomes. Traditionally, the focus of treatment during these hospitalizations is on the infectious complications with very little emphasis on the underlying substance use disorder. There however has been a growing interest in using these hospitalizations as an opportunity to start the rehabilitation process. Here we describe our institute’s current treatment practice towards opioid use disorders in a cohort of hospitalized patients with IVDU and infective endocarditis.
Methods: Adults with confirmed or suspected IVDU with infective endocarditis hospitalized at UPMC Presbyterian between January 1, 2015 and December 31, 2015 were included in our analysis.
Results: In total, 44 patients met our inclusion criteria and accounted for 50 hospitalizations. Most of the patients were male (N=30; 68.2%) and the mean age was 39 years (range 23 – 66). Median length of stay was 21 days (range 1 – 79). Thirty patients received a social work evaluation (68.2%) and 11 received a psychiatric evaluation (25%). Of our cohort, 4 patients left against medical advice (9.1%). There were 11 deaths (25%). Seven occurred during the hospitalization and 4 after discharge. Of the patients who survived the hospitalization, 9 (24.3%) were referred to rehabilitation. None of the patients were started on opioid maintenance therapy during the hospitalization. At the time of discharge, there were 19 (51.4%) patients prescribed opioids while none of them received a prescription for intranasal naloxone. The follow up rate in our infectious diseases clinic was 27% (N=10).
Conclusions: In this cohort, the majority of patients were evaluated by either social work or psychiatry but only a small percentage were referred to rehabilitation. Additionally, opioids were prescribed at discharge to more than half of our patients even though that practice is generally discouraged in this high risk population. Despite the known benefits of opioid maintenance therapy, none of our patients were started on methadone or buprenorphine while hospitalized. Intranasal naloxone to prevent death from accidental overdose was not given to any of the patients in our study cohort. Our data suggests the management of substance use disorders lacks priority during hospitalizations. A more comprehensive approach to the treatment of IVDU and its infectious complications may improve outcomes.