Suboptimal Addiction Interventions for Patients Hospitalized with Injection Drug Use-Associated Infective Endocarditis

Rosenthal, Elana; Karchmer, Adolf W.; Theisen‐Toupal, Jesse; Araujo‐Castillo, Roger V.; Rowley, Chris F.

doi:10.1016/j.amjmed.2015.09.024

Cited by 253 publications

(236 citation statements)

References 19 publications

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“…Most cases occurred within 1 year of the prior episode, a phenomenon noted in other studies as well [5, 8]. These facts highlight the urgent need to provide effective substance use disorder treatment after hospital discharge [8, 26]. …”

Section: Discussionmentioning

confidence: 72%

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Repeat Infective Endocarditis in Persons Who Inject Drugs: “Take Another Little Piece of my Heart”*

Huang

Barnes

Peacock

2018

Open Forum Infectious Diseases

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BackgroundInjection drug use (IDU) is a major risk factor for infective endocarditis (IE). Few data exist on repeat IE (rIE) in persons who inject drugs (PWID).MethodsPatients ≥18 years old seen at Wake Forest Baptist Medical Center from 2004 to 2017 who met Duke criteria for IE and who self-reported IDU in the 3 months before admission were identified. The subset of PWID who developed rIE, defined as another episode of IE at least 10 weeks after diagnosis of the first episode, was then reviewed.ResultsOf the 87 PWID who survived their first episode of IE, 22 (25.3%) experienced rIE and 77.3% had rIE within a year of the first episode. All patients who experienced rIE resumed IDU between episodes of IE. Of the patients with rIE, 54.5% had an infection caused by S. aureus and 22.7% required surgical intervention. Mortality at 1 year was 36.3%. Compared with their first IE episode, patients with rIE had fewer S. aureus infections (P = .01). Compared with PWID who experienced single-episode IE, intravenous prescription opioid use (P = .01), surgery (P < .01), tricuspid valve involvement (P = .02), and polymicrobial infection (P = .03) occurred more often during first episodes of IE in individuals who then developed rIE.ConclusionsrIE is common among IDU-related IE and confers a high 1-year mortality rate. The microbiology of rIE is varied, with S. aureus being less frequently isolated. More studies on modification of social and clinical risk factors are needed to prevent rIE.

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Section: Discussionmentioning

confidence: 72%

“…Conceptually, the most effective intervention to reduce morbidity and mortality as well as the economic costs of rIE would be to address the root cause of these infections, which is substance use disorder [16, 26, 36]. In response to this crisis, our institution is working to expand its addiction treatment capabilities.…”

Section: Discussionmentioning

confidence: 99%

Repeat Infective Endocarditis in Persons Who Inject Drugs: “Take Another Little Piece of my Heart”*

Huang

Barnes

Peacock

2018

Open Forum Infectious Diseases

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“…The cumulative expense of care for IDU-IE poses increasing financial burdens for healthcare facilities and insurance companies, because the majority of patients with hospitalizations from IDU are unemployed or underemployed and are reliant on publically funded medical insurance [24, 25]. Rosenthal et al [26] showed that readmission rates in IDU-IE are high (approximately 50%), implying increased costs and poorer outcomes. Rates of treatment for opioid addiction by opioid-replacement therapy after hospitalization are very low (<8%) [26].…”

Section: Discussionmentioning

confidence: 99%

Increasing Infectious Endocarditis Admissions Among Young People Who Inject Drugs

Wurcel

Anderson

Chui

et al. 2016

Open Forum Infectious Diseases

323

212

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People who inject drugs (PWID) are at risk for infective endocarditis (IE). Hospitalization rates related to misuse of prescription opioids and heroin have increased in recent years, but there are no recent investigations into rates of hospitalizations from injection drug use-related IE (IDU-IE). Using the Health Care and Utilization Project National Inpatient Sample (HCUP-NIS) dataset, we found that the proportion of IE hospitalizations from IDU-IE increased from 7% to 12.1% between 2000 and 2013. Over this time period, we detected a significant increase in the percentages of IDU-IE hospitalizations among 15- to 34-year-olds (27.1%–42.0%; P < .001) and among whites (40.2%–68.9%; P < .001). Female gender was less common when examining all the IDU-IE (40.9%), but it was more common in the 15- to 34-year-old age group (53%). Our findings suggest that the demographics of inpatients hospitalized with IDU-IE are shifting to reflect younger PWID who are more likely to be white and female than previously reported. Future studies to investigate risk behaviors associated with IDU-IE and targeted harm reduction strategies are needed to avoid further increases in morbidity and mortality in this rapidly growing population of young PWID.

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“…However, researchers that conducted that study also reported opioid prescribing did not change after patients received an OUD diagnosis (although researchers were not able to examine which clinicians provided the prescriptions before or after the OUD diagnosis) (Paulozzi et al, 2016). Programs to treat substance abuse disorders among inpatients have demonstrated success, although patients are often discharged without specific plans for treatment services and patient follow-up for post-discharge treatment is low (Naeger, Mutter, Ali, Mark, & Hughey, 2016; Rosenthal, Karchmer, Theisen-Toupal, Castillo, & Rowley, 2016; Trowbridge et al, 2017). …”

Section: Discussionmentioning

confidence: 99%

US hospital discharges documenting patient opioid use disorder without opioid overdose or treatment services, 2011–2015

Peterson

Mikosz

et al. 2018

Journal of Substance Abuse Treatment

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Background Understanding more about circumstances in which patients receive an opioid use disorder (OUD) diagnosis might illuminate opportunities for intervention and ultimately prevent opioid overdoses. This study aimed to describe patient and clinical characteristics of hospital discharges documenting OUD among patients not being treated for opioid overdose, detoxification, or rehabilitation. Methods We assessed patient, payer, and clinical characteristics of nationally-representative 2011–2015 National Inpatient Sample discharges documenting OUD, excluding opioid overdose, detoxification, and rehabilitation. Discharges were clinically classified by Diagnostic Related Group (DRG) for analysis. Results Annual discharges grew 38%, from 347,137 (2011) to 478,260 (2015), totaling 2 million discharges during the study period. The annual discharge rate increased among all racial/ethnic groups, but was highest among the non-Hispanic black population until 2015, when non-Hispanic whites had a slightly higher rate (164 versus 162 per 100,000 population). Female patients and Medicaid and Medicare as primary payer accounted for an increasing annual proportion of discharges. Just 14 DRGs accounted for nearly 50% of discharges over the study period. The most prevalent primary treatment received during OUD inpatient stays was for psychoses (DRG 885; 16% of discharges) and drug and alcohol abuse or dependence symptoms (including withdrawal) or (non-opioid) poisoning (DRG 894, 897, 917, 918; 12% of discharges). Conclusions Now nearly half a million yearly US hospital discharges for a range of primary treatment include patients’ diagnosis of OUD without opioid overdose, detoxification, or rehabilitation services. Inpatient stays present an important opportunity to link OUD patients to treatment to reduce opioid-related morbidity and mortality.

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Suboptimal Addiction Interventions for Patients Hospitalized with Injection Drug Use-Associated Infective Endocarditis

Cited by 253 publications

References 19 publications

Repeat Infective Endocarditis in Persons Who Inject Drugs: “Take Another Little Piece of my Heart”*

Repeat Infective Endocarditis in Persons Who Inject Drugs: “Take Another Little Piece of my Heart”*

Increasing Infectious Endocarditis Admissions Among Young People Who Inject Drugs

US hospital discharges documenting patient opioid use disorder without opioid overdose or treatment services, 2011–2015

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