Objective:

To investigate the impact of substance use disorder (SUD) on clinical outcomes, including readmission rates and overdose incidents, of patients undergoing outpatient parenteral antimicrobial therapy (OPAT).

Key Findings:

• 18% of the 5903 patients had SUD.
• Unadjusted readmission rates were higher in the SUD group (40.1% vs 32.5%, P < .001), indicating a potential concern for healthcare providers.
• Adjusted analyses showed SUD was not significantly associated with readmission (OR 1.16, P = .067) or CVC events (OR 1.10, P = .552), suggesting that other factors may play a more critical role.
• SUD was associated with higher odds of overdose (OR 6.03, P < .001), highlighting a significant risk that warrants attention.

Interpretation:

SUD does not independently increase the risk of readmission or CVC events in OPAT patients, but significantly raises the risk of overdose, suggesting a need for harm reduction strategies to ensure safe treatment.

Limitations:

• Retrospective design may limit causality conclusions.
• Potential confounding factors not fully accounted for, which may affect the reliability of the results.
• Data limited to claims database, which may not capture all clinical nuances, potentially impacting the generalizability of the findings.

Conclusion:

Patients with SUD should not be excluded from OPAT based on their SUD status alone; harm reduction approaches are recommended to mitigate overdose risks.