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Residential Addiction Treatment for Injection Drug Users Requiring Intravenous Antibiotics: A Cost-Reduction Strategy

Jewell, Carolyn PMHNP-BC, CARN-NP; Weaver, Michael MD, FASAM; Sgroi, Cameron MSW, LCSW; Anderson, Karen RN, Clinician IV; Sayeed, Zabe MD

doi: 10.1097/ADM.0b013e318294b1eb
Original Research

Objectives: Injection drug users (IDUs) are prone to developing infections and complications requiring prolonged intravenous (IV) antibiotic treatment. Our institution's unique multidisciplinary approach provides special consideration and successful management of IDUs in a residential addiction treatment facility with nurse-administered IV antibiotics. Our hypothesis is that hospital costs can be reduced by providing both IV antibiotics and addiction treatment in a community residential treatment setting outside the hospital.

Methods: A retrospective chart review was performed for inpatients requiring prolonged antibiotic treatment who were admitted to the university teaching hospital between January 2006 and December 2011 and were treated at the residential addiction treatment facility. Data were gathered to characterize this population of patients and estimate cost savings.

Results: A total of 205 patients were sent to the residential addiction treatment facility from 2006 to 2011. The majority were African American, men, and in their early forties. Heroin was the most popular injected substance, but most patients were polysubstance users, including alcohol and tobacco. The most common infections were osteomyelitis and septic arthritis. There was a 73% completion rate of antibiotic treatment in this program. The relapse rate for return to illicit drug use was at least 32%. This program has resulted in a significant cost savings of $2.43 million in a 6-year period.

Conclusions: The program saved $2.43 million over 6 years for the health care system by reducing hospital length of stay with safe and appropriate discharge planning for IDUs with infections requiring long-term IV antibiotics.

From the Departments of Psychiatry (CJ and ZS), Physical Medicine and Rehabilitation (CS), and Care Coordination (KA), Virginia Commonwealth University Health System, and Department of Internal Medicine (MW), Virginia Commonwealth University School of Medicine, Richmond, VA.

Send correspondence and reprint requests to Michael Weaver, MD, FASAM, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, PO Box 980109, Richmond, VA 23298. E-mail:

None of the authors have any conflict of interest related to this research project or the content of this article.

Received August 10, 2012

Accepted March 29, 2013

© 2013 American Society of Addiction Medicine