“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

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 2020-2024. To ensure diverse experiences, we recruited qualifying participants based on record of a SIRI ICD-10 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), completed recommended antibiotics (n=24); mean age 39; male (n=19); white race (n=21); and were 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 post-discharge 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 which explicitly includes harm reduction and MOUD, both linkage and retention, are needed to improve care for people with SIRIs.