Five Action Steps to Integrate Treatment of Opioid Use Disorder & Infectious Disease Epidemics

As the ongoing opioid epidemic continues to plague the United States, health care providers are reminded that opioid use disorder (OUD), especially if left untreated, not only leads to an increase in hospital stays and readmissions, significant mortality, and substantial financial tolls, but also to a rise in infectious diseases, such as HIV and hepatitis C.

There is an urgent need to implement and scale-up effective treatment for OUD in health care settings to better address the related infectious disease (ID) consequences of the OUD epidemic. As such, the authors of a recent “Ideas and Opinions” article published in the Annals of Internal Medicine, identified 5 key calls to action for clinicians who are responsible for treating these complications. The actions are listed below.

1. The implementation of OUD screening in all relevant health care settings. Specifically, patients under evaluation for overdose, endocarditis, bacteremia, skin abscesses, vertebral osteomyelitis, and HIV and hepatitis C (HCV) infection should all be screened for OUD via the use of the Rapid Opioid Dependence Screen; the test should take under 5 minutes to perform. The idea is to have the screening be a part of the standard part of an ID consult assessment.
2. Providers should immediately prescribe effective OUD medication for patients with positive screening results during hospitalization. The medications currently approved by the US Food and Drug Administration (FDA) for OUD treatment that have been deemed effective in preventing relapse include methadone, buprenorphine, and extended-release naltrexone. Naloxone rescue kits may also be prescribed. Referral of these patients to needle- and syringe-exchange programs is also acceptable.
3. Protocols within hospital settings that can be used to facilitate the initiation of OUD treatment and help link patients to community-based treatment upon discharge need to be developed. Passive referral to community-based addiction treatment programs is not working; therefore, this call-to-action requires hospital pharmacy committees to stock FDA-approved OUD treatment. Coupled with this, protocols for the integration and implementation of addiction treatment need to be developed. Furthermore, hospitals should collaborate with community-based programs in order to provide seamless transitions in care for OUD patients.
4. Training of staff from hospitals, medical schools, physician assistant schools, nursing schools, and residency programs to better identify and treat patients with OUD needs to be increased. This means that all prescribers and personnel undergo training on Drug Addiction Treatment Act waivers. Hospitals need to make sure that buprenorphine prescribers are available for OUD hospitalized patients and that buprenorphine waiver training is available. Furthermore, training should also be offered to ensure that clinicians can safely prescribe methadone and extended-release naltrexone to patients before they are discharged from the health facility.
5. Increased access to addiction care and funding to states so that they can better provide effective treatment to OUD patients is imperative. The majority of OUD hospitalized patients receive their treatment through Medicaid and so, in order to improve access to treatment, increased access to Medicaid and other types of insurance is needed.

“All health care providers have a role in combating the OUD epidemic and its ID consequences,” the authors wrote. “Those who treat infectious complications of OUD are well-suited to screen for OUD and begin treatment with effective FDA-approved medications.”

Collaboration across specialties and the integration of collective skillsets could mean the difference between life and death for patients with OUD, they add.

The calls for action were based on discussions held at a workshop convened by the US Department of Health and Human Services (DHHS) which was held March 12-13, 2018 in Washington, DC. Workshop participants spanned several specialties, including infectious disease physicians, hospitalists, primary care providers, nurses, health policy experts, epidemiologists, law enforcement personnel, as well as staff from DHHS and the Centers for Disease Control and Prevention.