Along with the high rates of opioid-related overdose deaths, the opioid use disorder (OUD) epidemic has led to substantial increases in new cases of hepatitis C virus (HCV) and HIV infection, as well as hospitalizations for other OUD-related infections.1 Between 2002 and 2012, for example, rates of hospitalization for endocarditis, osteomyelitis, epidural abscess, and septic arthritis increased 1.5-, 2.2-, 2.6-, and 2.7-fold, respectively.2
“Optimal treatment of these conditions is often impeded by untreated OUD resulting in long hospital stays, frequent readmissions due to lack of adherence to antibiotic regimens or reinfection, substantial morbidity, and a heavy financial toll on the health care system,” according to a paper published in the Annals of Internal Medicine.1
However, clinicians and facilities that treat infectious diseases often lack the skills or resources needed to engage patients in OUD treatment. “There is thus an urgent need to implement and scale up effective OUD treatment in health care settings to address the intersecting epidemics of OUD and its infectious disease (ID) consequences.”
In a 2018 workshop initiated by the US Department of Health and Human Services, professionals from a wide range of relevant backgrounds (including medicine, research, law, and government) convened to explore these issues and potential solutions. They identified the following 5-point strategy:
- Better addiction prevention, treatment, and recovery services
- Better data
- Better pain management
- Better targeting of overdose reversing drugs
- Better research
To glean additional insights and recommendations regarding this topic, Infectious Disease Advisor interviewed Jessica Meisner, MD, MS, a postdoctoral fellow in the division of infectious diseases at the Hospital of the University of Pennsylvania-Penn Presbyterian in Philadelphia, whose main area of focus is the intersection of the opioid epidemic and infectious disease.
Infectious Disease Advisor: From your perspective, what are some areas in which ID doctors’ knowledge falls short regarding the intersection of ID and the opioid epidemic?
Jessica Meisner, MD: The first need is for ID physicians to recognize that this is an ID problem, and thus we are at the frontline of the opioid epidemic. Patients with substance use disorders, most notably with opiate-abuse, tend to engage in a limited manner with the health system. When these individuals do seek care at a hospital or clinic, it is often when they have an infection. Recognizing that as a window of opportunity is key.
I think most ID physicians already know that 10% of new HIV cases and approximately 50% of new HCV cases are a result of injection drug use.3 There is less knowledge about OUD and its treatment. A lot of people may not realize how high rates of relapse are without medication-assisted treatment. It is often shocking for clinicians to realize that individuals are 9.6-fold more likely to overdose within the first 28 days after a hospital discharge, and yet we often don’t give patients naloxone when we discharge them.4 Also, clinicians need to be comfortable obtaining a detailed drug history and speaking freely about harm reduction strategies with patients.
The ID community has started to take action, though. It was great to see that at IDWeek 2018, held October 3-7 in San Francisco, California, buprenorphine training was offered during the pre-sessions. There were multiple oral presentations on topics related to the opioid epidemic and even more posters on topics such as endocarditis in this population. I’ve met a lot of ID providers who are really passionate about addressing this problem, so I’m hopeful that things will change.