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Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis

Brothers, Thomas D., Mosseler, Kimiko, Kirkland, Susan, Melanson, Patti, Barrett, Lisa, Webster, Duncan·2022·PLOS ONE
DOI 10.1371/journal.pone.0263156PMC PMC8791472
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Abstract

Background: Addiction treatment and harm reduction services reduce risks of death and re-infection among patients with injection drug use-associated infective endocarditis (IDU-IE), but these are not offered at many hospitals. Among hospitalized patients with IDU-IE at the two tertiary-care hospitals in the Canadian Maritimes, we aimed to identify (1) the availability of opioid agonist treatment (OAT) and sterile drug injecting equipment, and (2) indicators of potential unmet addiction care needs. Methods: Retrospective review of IDU-IE hospitalizations at Queen Elizabeth II Health Sciences Centre (Halifax, Nova Scotia) and the Saint John Regional Hospital (Saint John, New Brunswick), October 2015 -March 2017. In Halifax, there are no addiction medicine providers on staff; in Saint John, infectious diseases physicians also practice addiction medicine. Inclusion criteria were: (1) probable or definite IE as defined by the modified Duke criteria; and (2) injection drug use within the prior 3 months. Results: We identified 38 hospitalizations (21 in Halifax and 17 in Saint John), for 30 unique patients. Among patients with IDU-IE and untreated opioid use disorder, OAT was offered to 36% (5/14) of patients in Halifax and 100% (6/6) of patients in Saint John. Once it was offered, most patients at both sites initiated OAT and planned to continue it after discharge. In Halifax, no patients were offered sterile injecting equipment, and during five hospitalizations staff confiscated patients’ own equipment. In Saint John, four patients were offered (and one was provided) injecting equipment in hospital, and during two hospitalizations staff confiscated patients’ own equipment. Concerns regarding undertreated pain or opioid withdrawal were documented during 66% (25/38) of hospitalizations, and in-hospital illicit or non-medical drug use during 32% (12/38). Two patients at each site (11%; 4/38) had self-directed discharges against medical advice. Conclusions: Patients with IDU-IE in the Canadian Maritimes have unequal access to evidence-based addiction care depending on where they are hospitalized, which differs from the community-based standard of care. Indicators of potential unmet addiction care needs in hospital were common.

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Fig 1 Policy enabling inpatient needle and syringe distribution at Saint John Regional Hospital during the study period.
Fig 1 Policy enabling inpatient needle and syringe distribution at Saint John Regional Hospital during the study period.CC BY · PubMed Central
Fig 2 Access to and uptake of opioid agonist treatment during hospitalizations for injection drug use-associated infective endocarditis in Halifax, Nova Scotia (n = 14 hospitalizations), and Saint John, New Brunswick (n = six hospitalizations), October 2015-March 2017. Vertical bars represent proportion of patients with IDU-IE and untreated opioid use disorder at each site; numbers within bars represent the number of patients in each category at each site. IDU-IE: Injection drug use-associated infective endocarditis. OAT: Opioid agonist treatment.
Fig 2 Access to and uptake of opioid agonist treatment during hospitalizations for injection drug use-associated infective endocarditis in Halifax, Nova Scotia (n = 14 hospitalizations), and Saint John, New Brunswick (n = six hospitalizations), October 2015-March 2017. Vertical bars represent proportion of patients with IDU-IE and untreated opioid use disorder at each site; numbers within bars represent the number of patients in each category at each site. IDU-IE: Injection drug use-associated infective endocarditis. OAT: Opioid agonist treatment.CC BY · PubMed Central

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Metadata

Authors
Brothers, T. D., Mosseler, K., Kirkland, S., Melanson, P., Barrett, L., & Webster, D.
ORCID
Brothers, Thomas D.
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2022-01-26
Volume
17
Issue
1
Pages
e0263156
ISSN
1932-6203
DOI
10.1371/journal.pone.0263156
PMC
PMC8791472
Cited by
17
References
1
Language
en
Licence
creativecommons.org/licenses/by/4.0/ (vor)
Funders
  • Canadian Institutes of Health Research (CIHR-FRN# 171259)
  • Dalhousie University Internal Medicine Research Foundation (Internal Fellowship)
  • National Institute on Drug Abuse (R25DA033211)
  • Faculty of Medicine, Dalhousie University (Ross Stewart Smith Memorial Fellowship in Medical Research)
  • Canadian Society of Internal Medicine (Hui Lee Health Promotion Scholarship)
  • Dalhousie Medical Research Foundation (Katelyn Robarts Studentship)

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