A 32-Year-Old Man with Opioid Use Disorder Comes to the Emergency

A 32-year-old man with opioid use disorder comes to the emergency department with a temperature of 39.4 C (103 F) and is diagnosed with tricuspid valve endocarditis due to Staphylococcus aureus.  A 6-week course of intravenous (IV) antibiotics is initiated.  On hospital day 3, the patient develops diaphoresis, tachycardia, and diarrhea consistent with opioid withdrawal and requests to leave the hospital.  He says, "I know IV antibiotics are the best treatment and that I could die without them, but I gotta get out of here.  Can you at least give me some antibiotic pills to take?"  Which of the following is the most appropriate response to this patient's question?

A) "I am unable to provide a prescription for inferior care to a patient leaving against medical advice."
B) "I can try and treat your opioid withdrawal to make it easier for you to stay in the hospital.  But if you insist on leaving, I can prescribe an oral antibiotic."
C) "You are free to leave if you understand the risks, but you will need to sign a waiver of liability."
D) "You should know that your insurance may not cover this hospitalization if you leave against medical advice.  Are you sure you want to leave?"
E) "Your addiction is clouding your capacity to make rational decisions.  If you try to leave, we may have to restrain you to give you the care you need."

Correct Answer:

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