Evolving Epidemiology and the Expanding Imperative in Drug Use–Associated Endocarditis

Nearly a decade after the opioid epidemic was declared a public health emergency, the rise of synthetic opioids such as fentanyl has led to unprecedented increases not only in overdose deaths but also in injection-related infections, including drug use–associated infective endocarditis (DUA-IE) [1, 2]. Drug use–associated infective endocarditis tends to affect younger individuals with fewer comorbid conditions, with lower in-hospital and short-term mortality compared with non–DUA-IE [3]. However, given the complex psychosocial and environmental factors, long-term outcomes remain poor, with high recurrence and readmission rates [3]. Given the severity and complexity of management of DUA-IE, substantial attention has focused on the inadequacy of addiction-related care during hospitalization, prompting the infectious diseases community to better integrate addiction care and harm reduction into routine practice [4, 5]. These efforts have contributed to meaningful progress, including integrated infectious diseases and addiction training programs, expanded access to medications for opioid use disorder (MOUD) through legislative and regulatory changes, and growing recognition of the importance of harm-reduction services. However, these advances occurred alongside major health system disruptions during the coronavirus disease 2019 (COVID-19) pandemic, which led to worsened addiction-related outcomes, at least in its initial phases [6].