Missed Opportunity: Suboptimal Addiction Treatment Interventions Among Patients Hospitalized for Infective Endocarditis

Patients hospitalized with infective endocarditis (IE)—which is often associated with injection drug use (IDU)—have high morbidity and mortality and hospital readmission is common. Acute management of patients with IE often focuses on treatment of the infection and associated complications. However, interventions, including initiation of and linkage to addiction treatment, are often lacking. The purpose of this study was to determine the addiction interventions delivered to inpatients, with IDU-associated IE, hospitalized during the hospitalization and at discharge with IDU-associated IE over a 10-year period at a single academic tertiary care hospital.

• 102 patients were admitted with IDU-associated IE; 86% had a social work consultation, 24% had an addiction medicine consultation, and 24% had a psychiatry consultation.
• 55% of discharge summaries mentioned addiction in the assessment and plan; 8% were referred for opioid agonist treatment (OAT) and none were prescribed naloxone for overdose prevention.
• 26% of the total sample died and 49% were readmitted (14% with recurrent IE); 28% of those readmitted had ongoing IDU.

Comments:

Although this study reported on a retrospective medical record review at a single institution, it underscores the importance of addiction treatment as a component of hospital treatment and discharge planning. It is important to note that not all patients with IDU will be eligible for OAT or naloxone as some patients may inject non-opioid substances or may not meet criteria for an opioid use disorder. This study highlights hospitalization for addiction-related complications as an opportunity initiate and to link patients to addiction treatment services.

Jeanette M. Tetrault, MD

Reference:

Rosenthal ES, Karchmer AW, Theisen-Toupal J, et al. Suboptimal addiction interventions for patients hospitalized with injection drug use-associated infective endocarditis. Am J Med. 2015 [Epub ahead of print] doi: 10.1016/j.amjmed.2015.09.024.