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Treating Drug-Related Infections With Antibiotics And Trust


People who inject drugs risk getting bacterial infections in their bones and in their hearts. These infections are treated with antibiotics at home, and they're administered through IV tubes. So this presents a problem - sending patients who shoot up drugs home with open IV lines. For a long time, it's been considered too risky, but some doctors in Boston say they've started to treat these patients with trust. Martha Bebinger at WBUR has the story.

MARTHA BEBINGER, BYLINE: Arthur Jackson says he hasn't used heroin in two years. But when a serious infection spread from a cut on his toe into the bone, that drug history came back to haunt this 69-year-old. Jackson's treatment is six to eight weeks of a steady IV antibiotic drip. Jackson argues to complete the treatment at home with his cat, near his mother and recovery group meetings, not tethered to a hospital bed.

ARTHUR JACKSON: I guess the best way to put it is, I have a life, and I need to get back to it.

BEBINGER: But doctors worry that open IV line will tempt Jackson to use heroin again, a concern Jackson understands.

JACKSON: First thing I thought was, oh, I could inject heroin in here easily. But I dismissed that thought because I'm not going back.

BEBINGER: Back to living from one heroin fix to the next. Jackson persuades doctors to let him go home - with three conditions; he must be on a medication to help stave off cravings for heroin, see an addiction specialist weekly and remain in stable housing. It's a pilot project at Brigham and Women's Hospital. Dr. Christin Price says it hasn't been easy to persuade some colleagues to participate and release current or former drug users with an open port into a major vein.

CHRISTIN PRICE: A lot of people did sort of look aghast. It was just their policy that anybody with a history of injection drug use just would not go home.

BEBINGER: How to treat drug users with a serious infection is a daily conundrum at hospitals across the U.S. One study found a twelvefold increase in a heart infection called endocarditis within one decade. Price says virtually every patient she sees with a substance use disorder has an infection. She finds that holding them for extended treatment often doesn't work.

PRICE: They kind of get stir crazy. You can imagine it's almost like being sort of held captive for six weeks, especially when you're feeling fine now because the infection is clearing. A huge problem is that some of them then leave.

BEBINGER: Not finishing their course of antibiotics, risking a repeat infection and a return hospital stay. Price's pilot seems to fix those problems for carefully selected patients. Among 21 active drug users, all but one completed the treatment at home. That patient was readmitted. There have been three relapses, but no one used the antibiotic line to inject illegal drugs.

PRICE: I think we've shown through this pilot that it is safe and feasible for certain patients.

BEBINGER: And saves money - Price estimates $866,000 in savings, based on the number of days these patients stayed out of the hospital. Dr. Sarah Hull is a cardiologist and bioethicist at the Yale School of Medicine.

SARAH HULL: The key here is, rather than relying on emotional arguments or knee-jerk reactions, I think it's really critical that we use an evidence-based approach to making sure that we're treating these patients appropriately.

BEBINGER: Only a handful of hospitals are trying this counterintuitive approach. The evidence is promising but not robust. What nurses and doctors do know is that infection rates among drug users are rising and that too many patients are not getting or completing needed treatment.

For NPR News, I'm Martha Bebinger in Boston.