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Substance Use Disorder Assessment, Diagnosis, and Management for Patients Hospitalized With Severe Infections Due to Injection Drug Use

Jicha, Crystal, MD; Saxon, David, MD; Lofwall, Michelle R., MD, DFASAM; Fanucchi, Laura C., MD, MPH

doi: 10.1097/ADM.0000000000000454
Original Research

Objectives: Persons with injection drug use (IDU) have high healthcare utilization. Consequently, healthcare providers have opportunities to identify and treat underlying substance use disorders (SUD) that drive these hospitalizations. The study purpose was to characterize current SUD evaluation and treatment practices by primary and consulting services during hospitalization for severe infections related to IDU.

Methods: This study is a retrospective chart review of inpatient admissions to an academic medical center. The 2 inclusion criteria were documentation of IDU in clinical notes and the presence of an infection likely related to IDU. Demographic and clinical data were extracted from electronic medical records.

Results: A total of 108 inpatient admissions met inclusion criteria and were included in the study. The most common infections related to IDU were endocarditis (n = 65, 60.2%) and osteomyelitis (n = 27, 25.0%). The primary team explicitly documented substance use in the H&P and progress notes in 103 (95.4%) hospitalizations and in 84 (77.8%) at discharge. Opioid use disorder was coded by International Classification of Diseases, Ninth Revision in 62 (57.4%). The most frequent intervention was screening, brief intervention, and referral to treatment in 99 (91.7%) episodes. The vast majority of patients did not have specific plans or recommendations for SUD treatment upon discharge.

Conclusions: Though more than half of the patients in this study had opioid use disorder, pharmacotherapy for opioid use disorder was typically not provided, and screening, brief intervention, and referral to treatment (SBIRT) was the most common intervention. There are significant gaps in the clinical assessment, diagnosis, and management of SUD in persons hospitalized with life-threatening complications of IDU, leaving many opportunities to improve care for this complex patient population.

Montefiore Medical Center, Bronx, NY (CJ); Department of Internal Medicine, University of Michigan, Ann Arbor, MI (DS); Center on Drug and Alcohol Research (MRL); Division of Infectious Disease, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY (LCF).

Send correspondence to Laura C. Fanucchi, MD, MPH, University of Kentucky, Bluegrass Care Clinic, 740 S. Limestone, K512, Lexington, KY 40536. E-mail:

Received 15 June, 2018

Accepted 22 August, 2018

There were no funding sources for this study. None of the authors have any relevant conflicts of interests to disclose.

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© 2019 American Society of Addiction Medicine