Effect of initiation of medications for opioid use disorder on hospitalization outcomes for endocarditis and osteomyelitis in a large private hospital system in the United States, 2014-18

BACKGROUND AND AIMS: Opioid use disorder (OUD) has led to not only increases in overdose deaths, but also increases in endocarditis and osteomyelitis secondary to injection drug use (IDU). We studied the association between initiation of medications for opioid use disorder (MOUD) and treatment outcomes for people with infectious sequelae of IDU and OUD.

DESIGN AND SETTING: This is a retrospective cohort study reviewing encounters at 143 HCA Healthcare hospitals across 21 states of the United States from 2014 to 2018.

PARTICIPANTS: Adults aged 18-65 with the ICD diagnosis code for OUD and endocarditis or osteomyelitis (n = 1407).

MEASUREMENTS: Main exposure was the initiation of MOUD, defined as either methadone or buprenorphine at any dosage started during hospitalization. Primary outcomes were defined as patient-directed discharge (PDD), 30-day re-admission and days of intravenous antibiotic treatment. Covariates included biological sex, age, ethnicity, other co-occurring substance use disorders, and insurance status.

FINDINGS: MOUD was initiated among 269 (19.1%) patients during hospitalization. Initiation of MOUD was not associated with decreased odds of PDD. Initiation of MOUD did not impact 30-day re-admission. Patients who received MOUD, on average, had 5.7 additional days of gold-standard intravenous antibiotic treatment compared with those who did not [β = 5.678, 95% confidence interval (CI) = 3.563, 7.794), P < 0.05].

CONCLUSION: For people with opioid use disorder hospitalized with endocarditis or osteomyelitis, initiation of methadone or buprenorphine appears to be associated with improved receipt of gold-standard therapy, as quantified by increased days on intravenous antibiotic treatment.