Opioid Addiction Complicates Surgical Decisions


With the significant increase in the use of opioids, both prescribed and not prescribed, hospitals are experiencing new challenges determining appropriate treatment paths, including surgery, for patients abusing opioids. National Public Radio recently explored one specific challenge involving the treatment of opioid abusers diagnosed with endocarditis, an expensive condition to treat. 

A typical treatment path might be heart valve replacement and high-dose antibiotics. What is unique in the case of opioid users is the potential need for addiction services. Without treatment for the underlying addiction, patients might return to opioid abuse once discharged and return to the hospital having become infected once again and in need of repeat treatment.

A cardiologist at Catholic Medical Center in Manchester, NH, Jonathan Eddinger, became increasingly frustrated wondering what happened to these patients once they left his care. He used the web to search for patients from the previous five years who met both criteria; diagnosis with endocarditis and addiction.

The results? From his small sample of the population, one in four patients had died. Many of those who hadn't died returned for multiple treatments, incurring an average of a half million dollars in additional care. As a result, Dan Daly, a Saint Anselm College medical ethicist, is assisting Catholic Medical Center in creating guidelines that establish post-hospitalization treatment for these patients. Addiction counseling and setting up a primary care doctor are the focus, rather than determining whether the patient is worthy of endocarditis treatment.

Has your OR established or considered similar procedures to assist this aspect of treatment? What addiction treatment options are presented to your IV-user endocarditis patients and how can you improve them?