Driven by the ongoing surge of injection substance use, rates of hospitalization for infective endocarditis are increasing. In the United States, the 15,000 patients hospitalized annually for endocarditis secondary to opioid use disorder (OUD) have distinctly poor outcomes, with one in 10 dying in the hospital and one in 20 having a patient-directed discharge (against medical advice; Rudasill et al., 2019). These patients amass more than $700 million in annual inpatient charges (Ronan & Herzig, 2016) and require lengthy hospitalizations, typically for completion of six weeks of intravenous (IV) antibiotic therapy (Schranz et al., 2019). Despite the availability of effective medications for OUD (MOUD) such as buprenorphine and methadone, these are not initiated or continued during or following hospitalization for most patients (Rosenthal et al., 2016). Additionally, many patients do not complete their IV antibiotic course, which is essential to prevent morbidity and mortality related to endocarditis (Adams et al., 2022).