Initiation of Medication for Opioid Use Disorder Associated With Improved Retention in Treatment for Endocarditis and Osteomyelitis

People who inject drugs (PWID) are at risk for severe infections, including endocarditis and osteomyelitis, both of which require long-term intravenous antibiotic therapy. Unfortunately, PWID often do not complete these treatments; stigma and inadequate treatment of symptoms may contribute to this. In this study, researchers used data from the private for-profit HCA Healthcare facilities in the US to investigate the association of receipt of medications for opioid use disorder (MOUD) and retention in treatment for injection drug use-related infections.

• A total of 1433 patients with OUD and concurrent endocarditis or osteomyelitis were admitted to an HCA Healthcare facility between 2014 and 2018; 26 were receiving MOUD prior to admission and were excluded from this analysis.
• Only 269 of these patients (19%) received MOUD and only 44 (3%) were prescribed MOUD on discharge.
• Patients who received MOUD received an average of 5.7 additional days of IV antibiotic therapy.
• Receipt of MOUD was not associated with patient-directed discharge or 30-day readmission.

Comments: This study adds to growing evidence that MOUD facilitates the treatment of other serious complications of OUD. Providing MOUD should be considered the standard of care for the treatment of OUD in the same way that IV antibiotics are the standard of care for endocarditis and osteomyelitis.

Darius A. Rastegar, MD

Reference: Jo Y, Nosal R, Vittori A, et al. Effect of initiation of medications for opioid use disorder on hospitalization outcomes for endocarditis and osteomyelitis in a large private hospital system in the United States, 2014–18. Addiction. 2021;116:2127–2134.