Combining Opioid Addiction Treatment Services With CARe for Infectious Endocarditis
Status:
Recruiting
Trial end date:
0000-00-00
Target enrollment:
Participant gender:
Summary
Hospitalizations for severe infections associated with opioid use disorder (OUD), such as
infective endocarditis (IE), have doubled in the US over the past decade and are frequently
prolonged and resource-intensive. Once medically stabilized, persons with IE but without
drug use typically enroll in outpatient parenteral antibiotic therapy (OPAT), while persons
with IE and OUD are kept in the hospital for the duration of therapy (often 6 weeks or more)
largely due to concerns of ongoing drug use. Unfortunately, hospitalization for IE with OUD
infrequently includes evidence-based medication-assisted treatment (MAT) with buprenorphine
or methadone to address the OUD, despite the strong evidence that MAT decreases illicit drug
use and mortality. Enrolling hospitalized persons with IE due to OUD into comprehensive MAT
(i.e., buprenorphine + counseling) while inpatient, and providing an intensive transitional
outpatient care program supporting MAT, may support provision of outpatient IV antibiotic
therapy and be cost effective. The primary aim of this pilot randomized clinical trial is to
evaluate the equivalence of current practice plus buprenorphine (keeping patients with IE
due to opioid use disorder in the hospital for the full duration of antibiotic treatment)
compared to OPAT plus buprenorphine (discharge with outpatient treatment once medically
stable).