Stimulants were involved in 46.2% of drug use-associated infective endocarditis hospitalizations in 2022, up from 37.3% in 2016, according to a study published Oct. 27 in Clinical Infectious Diseases.
Researchers from the University of Colorado School of Medicine in Aurora, Washington University School of Medicine in St. Louis, University of California San Francisco and Boston University Chobanian and Avedisian School of Medicine analyzed National Inpatient Sample data. The data represented an estimated 118,190 hospitalizations nationwide from 2016 to 2022.
Here are five things to know:
1. Drug use-associated endocarditis hospitalizations rose each year from 13,350 in 2016 to a peak of 18,735 in 2020, then fell to 15,345 in 2022. Opioid-only cases fell sharply starting in 2020, and their share of hospitalizations dropped from 49.4% in 2016 to 39.9% in 2022. Co-use of opioids and stimulants climbed from 22.6% to 28.6% over the same period.
2. The shift varied sharply by region. By 2022, stimulants alone were the most common drug type behind these hospitalizations in the Pacific, Mountain and West South Central census divisions. Opioids remained dominant in five Eastern and Central divisions, including New England and the Middle Atlantic. The adjusted probability that a case involved any stimulant was 59% in the Pacific division, compared with 34% in New England.
3. Medicaid was the primary payer for 61.3% of these hospitalizations. Median length of stay was 10 days, 27.1% of stays ended in self-directed discharge and 7.6% ended in death. Nearly 80% occurred at urban teaching hospitals.
4. Hospital addiction care for these patients has largely centered on opioid use disorder. The researchers noted that contingency management is the first-line treatment for stimulant use disorder, but anti-kickback laws and limited insurance coverage restrict its use. No FDA-approved medications exist for the condition. The researchers concluded that “targeted strategies addressing stimulant use are urgently needed.”
5. The National Institute on Drug Abuse and Boston University Chobanian and Avedisian School of Medicine’s department of medicine funded the study. The researchers wrote that hospitals may need to tailor addiction services to the drug use patterns in their region.
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