“Every Time I Go in There, It Gives Me Time to Reflect”: A Qualitative Study of Patient Perspectives on Substance Use, Medications for Opioid Use Disorder, and Harm Reduction Following Hospitalization for Serious Injection-Related Infection

TL;DR

Hospitalizations for serious injection-related infections can lead to reflection on substance use and harm reduction, but challenges remain with medications for opioid use disorder.

Contribution

This study provides new qualitative insights into patient perspectives on substance use and addiction care following hospitalization for SIRIs.

Findings

Hospitalization for SIRIs often leads to reduced substance use and adoption of harm reduction practices.

Patients expressed mixed views on medications for opioid use disorder, with lingering stigma and negative experiences.

Hospitalization is seen as a chance for reflection on health and substance use behaviors.

Abstract

Serious injection-related infections (SIRIs) have high morbidity and mortality, in part from incomplete antibiotic treatment, ongoing substance use and reinfection. Understanding how hospitalizations for SIRIs affect patient perspectives on substance use, harm reduction, and medications for opioid use disorder (MOUD) in the era of hospital-based addiction services will inform efforts to improve care.

We conducted qualitative interviews at Boston Medical Center with individuals hospitalized with SIRIs between 2020 and 2024. To ensure diverse experiences, we recruited qualifying participants based on record of SIRI International Classification of Diseases, 10th Revision, codes, presence on the outpatient parenteral antibiotic program list, during hospitalizations, and from a drop-in harm reduction program. Interviews were transcribed, coded inductively, and analyzed for key themes.

Participants with SIRIs (n = 30) had the following characteristics: Most had endocarditis (n = 10) or osteomyelitis (n = 9) and had completed the recommended antibiotics (n = 24); the mean age was 39; most were male (n = 19), White (n = 21), and housed (n = 18). Three key themes emerged after SIRI hospitalization: (1) reduced substance use and adoption of harm reduction practices were common; (2) perspectives on MOUD varied, but negative experiences and medication stigma persisted; and (3) SIRI hospitalizations were viewed as an opportunity for reflection on substance use and health.

SIRI hospitalizations and the postdischarge period are opportunities to engage patients in addiction and infectious disease care. Participants expressed ambivalence about MOUD despite access to robust hospital-based addiction medicine services. Longitudinal support that explicitly includes harm reduction and MOUD, both linkage and retention, is needed to improve care for people with SIRIs.

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