Screening people with certain infectious diseases for opioid use disorder (OUD) should be implemented, a panel of experts convened by the proposed.
Clinicians "who treat infectious complications of OUD are well-suited to screen for OUD and begin treatment with effective FDA-approved medications," wrote Sandra Springer, MD, of Yale University School of Public Health in New Haven, Conn., and co-authors in .
The recommendation is part of a call-to-action stemming from a requested by the Department of Health and Human Services (DHHS) in March.
As a result of the opioid epidemic, outbreaks of virus and infection have emerged and blood stream infections, endocarditis, osteomyelitis, and skin and soft tissue have increased.
"We are unable to fully treat these infections without treating the opioid use disorder. The opioid epidemic and infectious disease epidemic are entwined," Springer told 51˶.
"Patients are dying not just from opiate use disorder, but from infections that can't be fully treated. Either they're leaving the hospital against medical advice because they're withdrawing and require opiate treatment, or when they get discharged from the hospital to complete their antibiotics, they're unable to do so because of their addiction."
Workshop participants, including infectious disease physicians, hospitalists, primary care providers, nurses, health policy experts, epidemiologists, law enforcement personnel, and CDC and DHHS staff, agreed on five action steps:
- Screen all people who are evaluated for overdose, endocarditis, bacteremia, skin abscesses, vertebral osteomyelitis, HIV infection, and HCV infection in medical settings for OUD
- Immediately prescribe FDA-approved medication like methadone, buprenorphine, and extended-release naltrexone for patients with positive screening results
- Develop protocols to start addiction medication treatment in the hospital and connect patients with community-based treatment at discharge
- Improve education to identify and treat opioid use disorder in medical, physician assistant, and nursing schools and residency training
- Increase access to addiction care and funding to states to provide OUD treatment medications
The (RODS) takes less than 5 minutes to administer, and OUD screening should be a standard part of an inpatient infectious disease consult, the authors noted.
They added that most hospitals do not provide inpatient OUD medications during inpatient stays. There is also no standard of practice, and barriers to prescribing addiction treatment exist. Expanding access to Medicaid or implementing measures like the , which gave underinsured persons with HIV a safety net, may be needed.
"We need to view the opioid epidemic just as we would view any other infectious disease epidemic, like the HIV epidemic when it was first recognized," Springer said. "There's also a stigma associated with the opioid epidemic; many of us think it might be worse than what it was with HIV."
"Many compounding factors have led to the opioid epidemic and all these associated infections. We have the tools and we have the ability not only to treat opioid use disorder, but to help treat infectious disease."
Primary Source
Annals of Internal Medicine
Springer S, et al "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" Ann Intern Med 2018; DOI 10.7326/m18-1203.