Do you routinely offer OPAT to patients with a history of substance use?

This is a complex question and I would reframe it. At our institution, we aim to provide individualized care to every patient, including those who inject drugs. The concerns about misuse of vascular access devices in the OPAT setting, while understandable, are largely not based in actual evidence, and we know that patients who remain hospitalized actually frequently use drugs (some studies suggest at least 40% of patients do so). Since staying hospitalized for 6 weeks is often very unrealistic f...

This is a nuanced question. I think it depends mainly on 2 factors: (1) what type of substance use, and (2) how long ago was the use/when did they stopped using. If the use is IV drug use, then I do not offer OPAT unless they have not used for a long time (like over 20 years), and even then, I have to make sure that there are no other possible reasons that they would relapse given "easy access" to a vein. If they smoke or snort substances, then I usually feel comfortable sending them out on OPAT...