W e are infectious disease providers who run an academic Outpatient Parenteral Antimicrobial Therapy program and ID-Addiction clinic. We read with great interest Dr Cortes-Penfield and colleagues recent work. 1 While glad to see advocacy on behalf of this underserved population, we have concerns about discharging persons who actively inject drugs (PWID) to private residences with central venous catheters (CVCs).First, we note that in the meta-analysis by Suzuki et al., 2 75% of the group received therapy in a nursing facility/ group home. They also defined "recent" or "active" drug use as those who injected in the last year; however, the person who injected the day of hospital admission is very different from one in long term remission (≥12-month abstinent). These concerns limit the work's impact on risk assessment of PWID discharging to unobserved settings. In the second cited work, all of the PWID had nursing services for every infusion. 3 This is not generalizable as only a small number of home health agencies will visit more than weekly. The increased work load documented here is also significant as US OPAT is frequently underresourced. 4 The best evidence for safe home OPAT in PWID is University of Alabama Birmingham's 9-point