OBJECTIVE Recent population-level increases in intravenous drug abuse (IVDA) may contribute to incidence of spinal infection. The aim of this study was to evaluate national trends of spinal infections and evaluate effect of IVDA on outcomes in operative management of spinal infection. METHODS Using the National (Nationwide) Inpatient Sample database for 2002-2014, all patients undergoing spinal decompression or fusion for treatment of spinal infection were evaluated. Inpatient outcomes included length of stay, total cost, complications, discharge to facility, reoperations, and inpatient mortality. Bivariate and multivariate logistic regression analyses were performed to compare patients with IVDA and patients without IVDA. RESULTS A total of 60,964 patients undergoing surgical management of spinal infection were identified. Number of surgically managed spine infections increased from 2002 to 2014 (P < 0.0001). Proportion of surgically managed spine infections associated with IVDA increased from 3.3% in 2002 to 14.0% in 2014 (P < 0.0001). IVDA was associated with increased hospital length of stay (odds ratio = 1.38; 95% confidence interval, 1.32-1.45; P < 0.0001) and greater total charges (odds ratio = 1.23; 95% confidence interval, 1.17-1.29; P < 0.0001). No other significant differences between groups were noted. CONCLUSIONS From 2002 to 2014 in the United States, the incidence of operatively treated spine infections increased 227.9%, and the proportion of cases associated with IVDA significantly increased. Patients with IVDA had a longer mean length of stay and increased inpatient cost of care but were not at increased risk for complication, reoperation, or mortality. These findings are important for surgeons, internists, hospitals, and insurers to ensure proper resource allocation in treating these at-risk patients.