U.S. drug-related infective endocarditis hospitalizations fell 18% after 2020 peak while stimulant share rose to 47%

Researchers used ICD codes in the National Inpatient Sample to capture 118,000 hospitalizations for injection drug use-associated infective endocarditis across 2016–2022. They stratified by opioid-only, stimulant-only, and polysubstance use and applied survey weights to produce national estimates. Overall cases peaked during the COVID period then fell, driven by an 18% drop in opioid-linked admissions.

The decline coincides with expanded opioid agonist therapy access and syringe service programs, plus a documented shift from injection to smoking of opioids. In contrast, stimulant-associated cases continued rising, especially west of the Mississippi, where the probability of stimulant involvement reached 59%. No FDA-approved pharmacotherapies exist for stimulant use disorder, limiting hospital-to-treatment pathways.

Regional patterns suggest the national stimulant share could exceed 50% within two years if western trends generalize. Next studies should link discharge data to post-hospital treatment uptake and mortality to test whether current harm-reduction infrastructure can be adapted for stimulants.