Addiction consults and MOUD initiation in injection-related endogenous endophthalmitis

Hospitalized patients with injection-drug-use–associated endogenous endophthalmitis were described in a Mass General Brigham report, including whether an inpatient addiction consult service was involved and how medications for opioid use disorder (MOUD) were initiated during admission.

The account focuses on consult involvement during hospitalization and the MOUD-related actions documented in the chart. It also highlights a reported association between a specific substance exposure and severe vision loss.

The research describes injection-related endogenous endophthalmitis cases and reports consult involvement, treatment initiation patterns, and ophthalmic outcomes during the same episode of care. It references a retrospective review over six years. The narrative then contrasts MOUD-related actions by consult status.

Investigators reported different MOUD initiation patterns depending on whether an inpatient addiction consult occurred. Among admitted patients who were seen by the addiction consult service and were eligible for treatment, all were offered MOUD and 13 of 24 (54.2%) accepted and initiated a new MOUD during hospitalization. No MOUDs were initiated for inpatients or outpatients who did not see the addiction consult service. These consult-linked patterns are presented alongside reporting on visual outcomes in the same clinical context.

Ophthalmic outcome reporting includes an association between substance exposure and severe vision loss. Specifically, the report describes fentanyl use as being associated with approximately five-fold higher odds of off-chart visual acuity (≤ counting fingers) at most recent follow-up (odds ratio 5.25; 95% CI 1.3–20.9; P = 0.012) among the patients discussed.

Overall, the research reports that MOUD initiation occurred only when an addiction consult service was involved and that reported fentanyl use was associated with significantly higher odds of off-chart visual acuity at follow-up. The account therefore centers on consult-linked MOUD initiation patterns and one substance-specific association with visual outcomes in this inpatient population.

Key Takeaways:

• MOUD was initiated only when an inpatient addiction consult service was involved.
• Patients described as not receiving an addiction consult reportedly did not start MOUD.
• Fentanyl use was reported to be associated with more than five-fold higher odds of severe vision loss.