Integrating Treatments for Opioid Use Disorder and Infectious Diseases
NASEM asserts that integration of collective skills may make the difference between life and death in patients with OUD.
All healthcare providers have a role in combating the opioid use disorder (OUD) epidemic and its infectious disease (ID) consequences, according to an article published in Annals of Internal Medicine.
Due to the OUD epidemic, the rates of new outbreaks of hepatitis C virus (HCV) and HIV infection have risen and hospitalizations for bacteremia, endocarditis, skin and soft tissue infections, and osteomyelitis have increased. Optimal treatment for these conditions is impeded by untreated OUD, resulting in long hospital stays, frequent readmissions due to lack of adherence to antibiotic regimens or reinfection, morbidity, and a financial toll on the healthcare system. There is, therefore, an urgent need to implement and scale up effective OUD treatment in healthcare settings in order to address the intersection of the OUD epidemic and its ID consequences.
To address these intersecting epidemics, the US Department of Health and Human Services (DHHS) requested that the National Academies of Sciences, Engineering, and Medicine convene a workshop, and Integrating Infectious Disease Considerations with Response to the Opioid Epidemic, took place March 12-13, 2018, in Washington DC. Based on the workshop discussions, 5 action steps were agreed upon by the participants.
Action Step 1: Implement screening for OUD in all relevant healthcare settings. All individuals who are evaluated in medical settings for overdose, endocarditis, bacteremia, skin abscesses, vertebral osteomyelitis, HIV infection, and HCV infection should be screened for OUD.
Action Step 2: For patients with positive screening results, immediately prescribe effective medication for OUD and/or opioid withdrawal symptoms. Opiod withdrawal and pain syndromes should be addressed with opioid agonist therapies to optimize ID treatment and relieve pain in hospitals, as this enables patient retention long enough to complete antibiotic treatment, instead of patients leaving against medical advice due to opioid cravings or withdrawal symptoms.
Actions Step 3: Develop hospital-based protocols that facilitate OUD treatment initiation and linkage to community-based treatment upon discharge. Hospital pharmacies should stock US Food and Drug Administration (FDA)-approved medications for OUD (methadone, buprenorphine, and extended-release naltrexone). Hospitals should partner with community-based programs and skilled-nursing facilities to provide seamless transitions of care for individuals with OUD and serious infections.
Action Step 4: Hospitals, medical schools, physician assistant schools, nursing schools, and residency programs should increase training to identify and treat OUD. All medical staff and other hospital personnel should receive training on Drug Addiction Treatment Act waivers (an authorization for clinicians to prescribe buprenorphine for treatment of OUD) and how to safely prescribe methadone and extended-release naltrexone for patients before hospital discharge.
Action Step 5: Increase access to addiction care and funding to states to provide effective medications to treat OUD. The majority of patients hospitalized for OUD are treated through Medicaid; therefore, expanding access to Medicaid and other insurance while requiring that insurers cover FDA-approved treatments for OUD without cumbersome prior-authorization barriers would improve OUD access.
Overall, the study investigators concluded that, “Integrating our collective skills may make the difference between life and death for patients with OUD.”
Springer SA, Korthuis PT, del Rio C. Integrating treatment at the intersection of opioid use disorder and infectious disease epidemics in medical settings: a call for action after a national academies of sciences, engineering, and medicine workshop [published online July 13, 2018]. Ann Intern Med. doi:10.7326/M18-1203