Clinical Scorecard: Reflections on Hospitalization: Insights from Patients Regarding Substance Use, Opioid Use Disorder Treatments, and Harm Reduction After Serious Injection-Related Infections

At a Glance

Key Highlights

• Hospitalizations for SIRIs often lead to reduced substance use and adoption of harm reduction practices among patients.
• Patient perspectives on medications for opioid use disorder (MOUD) vary, with persistent negative experiences and medication stigma despite access to hospital-based addiction services.
• SIRI hospitalizations and the postdischarge period are critical opportunities for patient reflection and engagement in longitudinal addiction and infectious disease care.

Guideline-Based Recommendations

Diagnosis

• Identify SIRIs using International Classification of Diseases, 10th Revision (ICD-10) codes related to injection drug use complications.
• Diagnose SIRIs such as endocarditis, bloodstream infection, septic arthritis, osteomyelitis, and epidural abscesses in patients with injection drug use history.

Management

• Administer 2 to 6 weeks of antibiotics, often intravenously, with some cases treated with oral antibiotics.
• Provide medications for opioid use disorder (MOUD) during hospitalization as standard of care to reduce re-hospitalizations and mortality.
• Utilize Addiction Consult Services comprising multidisciplinary teams to initiate MOUD and provide harm reduction counseling.
• Develop dedicated SIRI care teams to improve treatment completion and reduce reinfection rates.

Monitoring & Follow-up

• Monitor antibiotic treatment completion rates and adherence.
• Track re-hospitalization rates for injection-related infectious complications within one year post-discharge.
• Assess ongoing substance use patterns and harm reduction practice adoption post-hospitalization.

Risks

• Incomplete antibiotic therapy leading to increased morbidity and mortality.
• Ongoing substance use and reinfection contributing to poor outcomes.
• Underuse of MOUD despite availability, partly due to medication stigma and negative patient experiences.

Patient & Prescribing Data

Adults hospitalized with SIRIs, predominantly male, White, and housed individuals with opioid use disorder.

Despite access to hospital-based addiction medicine services, only about half receive MOUD in the year following hospitalization; patients express ambivalence and stigma towards MOUD, highlighting the need for longitudinal support including harm reduction and MOUD linkage and retention.

Clinical Best Practices

• Integrate infectious disease and addiction medicine consult services during hospitalization for SIRIs.
• Provide harm reduction counseling alongside MOUD initiation to support behavior change.
• Use hospitalization as a critical moment for patient reflection and engagement in substance use treatment.
• Implement longitudinal post-hospitalization support programs to improve antibiotic completion, MOUD retention, and harm reduction adoption.
• Address medication stigma and negative experiences to improve MOUD uptake and adherence.

References

• Boston Medical Center Addiction Consult Service
• International Classification of Diseases, 10th Revision (ICD-10)
• Medications for Opioid Use Disorder (MOUD) and Infectious Disease Care