Impact of Substance Use Disorders on Outcomes in OPAT Patients with Medical Insurance

Overview

This retrospective claims-based study analyzed 5,903 medically insured adults undergoing outpatient parenteral antimicrobial therapy (OPAT) from 2015 to 2020, comparing those with and without substance use disorder (SUD). While unadjusted data showed higher 90-day readmission and overdose rates in patients with SUD, adjusted analyses revealed SUD was not independently associated with increased readmission or central venous catheter (CVC) complications but was strongly linked to overdose risk.

Background

Substance use disorder (SUD) is a significant public health issue in the US, with rising injection drug use contributing to increased bacterial infections such as infective endocarditis and osteomyelitis. These infections often require prolonged intravenous antimicrobial therapy, commonly delivered via outpatient parenteral antimicrobial therapy (OPAT) with central venous catheters. Despite concerns about catheter misuse and overdose, evidence on OPAT outcomes in patients with SUD remains limited, leading to hesitancy in offering OPAT to this population.

Data Highlights

Key Findings

• 18% of the 5,903 patients receiving OPAT had a documented history of SUD.
• Patients with SUD were younger, less often male, and less frequently discharged home compared to those without SUD.
• Unadjusted analyses showed significantly higher 90-day readmission (40.1% vs 32.5%) and overdose rates (1.2% vs 0.1%) in the SUD group.
• Adjusted logistic regression indicated no significant association between SUD and 90-day readmission (OR 1.16, P=0.067) or CVC events (OR 1.10, P=0.552).
• SUD was independently associated with a markedly increased risk of overdose during OPAT (OR 6.03, P<.001).
• Other predictors of readmission included insurance type, mental health disorders, and infection type; CVC events were linked to infection type and discharge disposition.

Clinical Implications

These findings support offering OPAT to patients with SUD without automatic exclusion, as SUD alone does not increase readmission or catheter complication risks. However, heightened overdose risk in this population underscores the need for integrated harm reduction strategies and close monitoring during OPAT. Clinicians should consider comprehensive care plans addressing mental health and social determinants alongside infection management.

Conclusion

Substance use disorder is not an independent risk factor for readmission or central venous catheter complications in medically insured patients undergoing OPAT, but it significantly elevates overdose risk. This evidence advocates for harm reduction approaches rather than exclusion of patients with SUD from OPAT programs.

References

1. Authors, 2024 -- Effects of Substance Use Disorders on the Outcomes of Medically Insured Patients Undergoing Extended Outpatient Parenteral Antimicrobial Therapy