Treating Substance Use Disorder Problems in the Endocarditis Patient

People who inject drugs (PWID) are vulnerable to a whole host of infections, including aspiration pneumonia, cellulitis, septic arthritis, and endocarditis. Tricuspid valve endocarditis in PWID can present a particular challenge even to an experienced and sophisticated treatment team. The combination of acute infection, untreated psychiatric problems, and active substance use disorder (SUD) has led to frustration with and stigmatization of these very ill individuals. Additionally, the US health care system’s tendency to separate teaching hospitals from both postacute care facilities and SUD treatment centers often leads to inconsistencies in the capabilities of the latter two types of programs to provide evidence-based treatment of all of these problems simultaneously. Only through collaboration between these groups of caregivers, establishing a reasonably unified service line, can the PWID with serious infection get the comprehensive care that is needed. Without this approach, the likely result is caregiver and patient frustration, along with the expenditure of hundreds of thousands of dollars in health care costs with little in terms of patient benefit to show for this effort.