In-hospital illicit drug use, substance use disorders, and acceptance of residential treatment in a prospective pilot needs assessment of hospitalized adults with severe infections from injecting drugs
In-hospital illicit drug use, substance use disorders, and acceptance of residential treatment in a prospective pilot needs assessment of hospitalized adults with severe infections from injecting drugs
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DOI：
10.1016/j.jsat.2018.06.011
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发表时间：
2018-09-01
影响因子：
3.9
通讯作者：
Walsh, Sharon L.
中科院分区：
文献类型：
--
作者：
Fanucchi, Laura C.;Lofwall, Michelle R.;Walsh, Sharon L.
目的：对注射毒品合并静脉(IV)抗生素复杂感染的住院成人进行潜在物质使用障碍(SUD)需求评估、SUD治疗动机和住院治疗意愿的试点评估，并评估住院期间非法药物使用的存在。患者和方法：从2016年3月8日至2016年8月25日，前瞻性纳入有注射吸毒史和当前感染需要静脉注射抗生素治疗的未接受SUD治疗的讲英语的成人患者。结果：42名研究对象中，8名(19.0%)接受住院治疗，16名(38.0%)在出院后完成至少一次随访研究，3名(7.1%)在5个月的研究期间死亡。大多数(33人；78%)因心内膜炎住院，37人(88.0%)有阿片类药物使用障碍(DSM-5)。与出院后30天相比，住院前30天自行报告的静脉注射阿片类药物使用的平均天数显著减少(16.5至1.5天，P=.001)，尽管没有接受SUD治疗。17名参与者(40.5%)被发现非法使用医院药物，其中阿片类药物最常见。结论：住院是启动阿片类药物使用障碍循证治疗的关键机会。本研究中观察到的医院内持续的非法药物使用和高短期死亡率有助于扩大获得阿片类药物使用障碍的有效药物治疗的机会，并将其纳入卫生保健环境。
Objective: To conduct a pilot needs assessment of underlying substance use disorders (SUD), motivation for SUD treatment, and willingness to enter residential SUD treatment in hospitalized adults who inject drugs with complex infections requiring intravenous (IV) antibiotics, and to assess the presence of in-hospital illicit substance use.Patients and methods: From March 8, 2016 through August 25, 2016 hospitalized, English-speaking, adult patients not currently in SUD treatment with a history of injection drug use and a current infection requiring treatment with IV antibiotics, were prospectively enrolled. Participants were followed weekly during the hospitalization and for 60 days after discharge via interview and medical record review.Results: Of the 42 participants, 8 (19.0%) accepted discharge to residential SUD treatment, 16 (38.0%) completed at least one follow-up research visit after hospital discharge, and 3 (7.1%) died during the 5-month study period. The majority (33; 78%) were hospitalized with endocarditis, and 37 (88.0%) had an opioid use disorder (DSM-5). Mean days of self-reported IV opioid use in the 30 days before hospitalization compared to 30 days after discharge decreased significantly (16.5 to 1.5, P = .001) despite not receiving SUD treatment. Illicit in hospital drug use was identified in 17 (40.5%) participants, with opioids most commonly detected.Conclusion: Hospitalization is a 'reachable moment' and critical opportunity to initiate evidence-based treatment for opioid use disorder. The ongoing in-hospital illicit drug use and high short-term mortality observed in this study contribute to the mandate to expand access to effective pharmacotherapy for opioid use disorder and integrate it into health care settings.