Serious Infections: The Downstream Complication of the Opioid Epidemic

Hospitalizations related to opioid abuse and dependence both with and without associated serious infections significantly increased from 2002 to 2012, according to a new study in Health Affairs. There was a quadrupling of inpatient charges, reaching almost $15 billion, for opioid abuse- and dependence-related hospitalizations, and more than $700 million for those related to associated infection in 2012. Medicaid was the most common primary payer for both types of hospitalizations, the study found.

Study authors Matthew V. Ronan, MD, and Shoshana Herzig, MD, noted that although serious infection is a recognized complication of intravenous (IV) drug abuse and a major cause of morbidity and mortality among IV drug users, trends in rates of serious infection and the associated costs related to opioid use and dependence have not been studied previously. Ronan is a hospitalist at West Roxbury Medical Center, Veterans Health Administration in Boston and Herzig is a hospitalist at Beth Israel Deaconess Medical Center and assistant professor of medicine at Harvard Medical School in Boston.

Hospitalizations related to opioid abuse/dependence with and without associated serious infections significantly increased from 2002 to 2012 from 301,707 to 520,275 and from 3421 to 6535, respectively. Infections associated with opioid use include endocarditis and pyogenic spinal infections.

The study used discharge data from 2002 and 2012 from the National Inpatient Sample, developed for the Healthcare Cost and Utilization Project by the Agency for Healthcare Research and Quality, the largest publicly available, all-payer, national inpatient database in the United States. The authors performed 2 sensitivity analyses in which they recalculated total hospitalization estimates after restricting the patient cohort to young patients without other strong risk factors for these types of infections.

The data showed that total charges for hospitalizations related to opioid abuse/dependence and associated infections have increased out of proportion to the rate of increase in number of hospitalizations for these conditions over the same time period, even when inflation is accounted for. Ronan and Herzig wrote that future research is needed to investigate the factors behind the exponentially rising charges. In addition, the study suggests that the financial burden largely falls on government-funded agencies, patients, and hospitals because only 20% of discharges related to opioid abuse/dependence and 14% of discharges with associated infections were covered by private insurance.

“Our results characterize the financial burden on the healthcare system related to opioid abuse/dependence and one of the more serious downstream complications of this epidemic: serious infection,” the authors wrote. “The findings have important implications for the hospitals and government agencies that disproportionately shoulder these costs, and for clinicians, researchers, and policymakers interested in estimating the potential impact of targeted public health interventions on a national level.”