Residential Addiction Treatment for Injection Drug Users Requiring Intravenous Antibiotics

Jewell, Carolyn; Weaver, Michael F.; Sgroi, Cameron; Anderson, Karen; Sayeed, Zabe

doi:10.1097/adm.0b013e318294b1eb

Cited by 20 publications

(30 citation statements)

References 18 publications

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“…These barriers have led to pilot interventions exploring the administration of antibiotics within a residential addiction treatment program. 3 While such alternative models to provide both addiction treatment and post-acute medical care are promising, few exist. Consequently, most patients with opioid use disorder and infectious diseases are left with limited options for SNF placement.…”

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confidence: 99%

“…In addition, hospitals bear substantial costs, as patients often remain in the acute care setting for longer than expected, sometimes until the entire course of antibiotics is completed. 3 Not surprisingly, a model of delivering antibiotics within a residential addiction treatment program was shown to save 2.43 million dollars for the care of 205 patients. 3 Historically, patients with other stigmatized illnesses have similarly been excluded from post-acute care settings.…”

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confidence: 99%

“…3 Not surprisingly, a model of delivering antibiotics within a residential addiction treatment program was shown to save 2.43 million dollars for the care of 205 patients. 3 Historically, patients with other stigmatized illnesses have similarly been excluded from post-acute care settings. HIV/ AIDS is an unfortunate recent example of this type of exclusion.…”

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confidence: 99%

See 2 more Smart Citations

Barriers to Post-Acute Care for Patients on Opioid Agonist Therapy; An Example of Systematic Stigmatization of Addiction

Wakeman

Rich

2016

J GEN INTERN MED

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confidence: 99%

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confidence: 99%

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Barriers to Post-Acute Care for Patients on Opioid Agonist Therapy; An Example of Systematic Stigmatization of Addiction

Wakeman

Rich

2016

J GEN INTERN MED

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“…24 Other interventions such as long term residential addiction treatment and patient navigator programs have been shown to improve outcomes and reduce readmission rates for at risk patients, hence the importance of post-operative discharge to drug rehabilitation facilities or enrollment in rehabilitation programs. 25 In cases where such resources may not be deployed, adequate outpatient follow-up after initiation of pharmacotherapy could contribute to sustaining improvement in outcomes.…”

Section: Discussionmentioning

confidence: 99%

Inconsistent Addiction Treatment for Patients Undergoing Cardiac Surgery for Injection Drug Use-Associated Infective endocarditis

Tiako

Hong

Mahmood

et al. 2019

Preprint

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Introduction: Cases of injection drug use-related infective endocarditis (IDU-IE) requiring surgery are rising in the setting of the current U.S. opioid epidemic. We thus aimed to determine the nature of addiction interventions in the perioperative period. Methods: This is a retrospective review of surgical IDU-IE from 2011 to 2016 at a tertiary care center in New Haven, Connecticut. The data collected included substances consumed recreationally, consultations by social work (SW), psychiatry, pharmacotherapy for addiction, and evidence of enrollment in a drug rehabilitation program upon discharge. Among patients with active drug use (ADU), we compared the 24-month survival of those who received at least one form of addiction intervention to that of those who did not. Results: Forty-two patients (75%) had active drug use. Among them, 22 used heroin. Forty-one patients (73.2%) saw SW, 17 (30.4%) saw psychiatry; 14 (25%) saw neither SW nor psychiatry. Twenty-one patients (37.5%) received methadone, 6 (10.7%) received buprenorphine, 1 (0.02%) received naltrexone; 26 (46.4%) did not receive any pharmacotherapy. Fifteen patients (26.8%) attended a drug rehabilitation program, 13 (86.7%) of whom had seen SW and 8 (53%) psychiatry. Among patients with ADU, there was no statistically significant difference in survival between those who received at least one intervention and those who did not (p=0.1 by log rank). Conclusion: Addiction interventions are deployed inconsistently for patients with surgical IDU-IE. Untreated substance use disorder and recurrent endocarditis are the leading cause of death in this population. Studying best-practices for perioperative interventions in IDU-IE and establishing protocols are of the upmost importance.

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“…30 When available, medical respite programs and OPAT-friendly residential addiction programs have shown success and financial savings as well. 31,32 Still, many patients would prefer home OPAT, and there is evidence that home OPAT is no less successful than OPAT provided in an SNF. 33 Despite this mounting evidence, there remains systemic stigmatization of people with OUD and inequity as many SNFs, and home infusion companies will not provide either MOUD or services to patients with OUD.…”

Section: What Is the Best Location For Patients To Receive Antibioticmentioning

confidence: 99%

New Answers for Old Questions in the Treatment of Severe Infections from Injection Drug Use

Serota

Vettese

2019

Journal of Hospital Medicine

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A s a result of the epidemic of opioid use disorder (OUD), there has been a secondary surge in hospitalizations for infectious complications of injection drug use (IDU). 1,2 In the previous 10 years, there have been significant increases in IDU-associated human immunodeficiency virus (HIV) 3 and hepatitis C virus (HCV) 4 infection as well as increased hospitalizations from IDU-associated skin and soft tissue infections, osteomyelitis, septic arthritis, bacteremia, fungemia, and infective endocarditis in the United States. 2,[5][6][7] Patients admitted with IDU-associated infections have long lengths of stay, high rates of leaving against medical advice (AMA), readmission, and mortality. [8][9][10][11][12][13] In a British cohort (median age 36 years), five-year mortality after an episode of IDU-associated endocarditis was 42%. 14 Admissions for IDU-associated infections can be a troubling experience for both patients and providers alike. 15 While management decisions of IDU-associated infectious syndromes have sometimes been based on emotion, dogma, and an often-stigmatizing approach toward people suffering from addiction, 16 with a better understanding of addiction and effective treatments, as well as accumulating data in both addiction and infectious disease fields, it is an appropriate time to reevaluate the approach to treatment.The goal of this review is to examine recent evidence and attempt to answer questions that frequently arise in the management of hospitalized patients with IDU-associated infections. The questions addressed in this review primarily stem from the discussion of Schranz and colleagues in their description of increasing hospitalizations for IDU-associated endocarditis. 7 Additionally, questions were developed from discussions with practicing academic hospitalists. For each question, a review of the published literature was performed, with a focus on articles published between 2014 and 2019. Finally, a framework for how to approach patients with infectious complications of IDU is presented. As a comprehensive review of infectious complications of OUD would be difficult to cover in one review, this review will focus on eight questions that frequently arise in the care of inpatients.

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Residential Addiction Treatment for Injection Drug Users Requiring Intravenous Antibiotics

Abstract: The program saved $2.43 million over 6 years for the health care system by reducing hospital length of stay with safe and appropriate discharge planning for IDUs with infections requiring long-term IV antibiotics.

Cited by 20 publications

References 18 publications

Barriers to Post-Acute Care for Patients on Opioid Agonist Therapy; An Example of Systematic Stigmatization of Addiction

Barriers to Post-Acute Care for Patients on Opioid Agonist Therapy; An Example of Systematic Stigmatization of Addiction

Inconsistent Addiction Treatment for Patients Undergoing Cardiac Surgery for Injection Drug Use-Associated Infective endocarditis

New Answers for Old Questions in the Treatment of Severe Infections from Injection Drug Use

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