Ethical Considerations in the Use of Indwelling Lines in Persons Who Use Injection Drugs

Clinicians and hospital systems often struggle with the question of whether to place indwelling catheters for long-term antibiotics in persons who inject drugs (PWID). Historically, the reluctance has been grounded in the concern that patients will use their lines for non-prescribed injection drug administration and that this could facilitate their substance use disorder and lead to infectious or thrombotic complications. In recent years, new studies have emerged that provide real-world data on the safety and efficacy outcomes of different approaches to long-term antibiotics in PWID. We synthesize and apply this empirical data to develop an ethical framework for decision-making around use of indwelling catheters in PWID. We use a case-based approach to outline the relevant principles, including beneficence and nonmaleficence, and discuss how clinicians may be able to reconcile their seemingly conflicting duties when navigating treatment of PWID. We also explore the question of forcible line removal in such patients through the lens of patient autonomy.