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Should ID specialists treat opioid use disorder using medication-assisted therapy?
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To address the underlying opioid addiction that so often leads to injection-related infections, experts have suggested that directly treating the addiction should be a priority for ID specialists. We asked Peter Chin-Hong, MD, a professor of medicine at the University of California, San Francisco School of Medicine and Infectious Disease News Editorial Board member, if he agrees that ID specialists should treat opioid use disorder with medicine.
What is at issue today should not be a subject of debate at the moment. ID specialists and trainees should be at the forefront of treating opioid use disorder (OUD) with evidence-based pharmacotherapy.
Almost 100 Americans are dying every day from complications related to opioid addiction, and infectious diseases are common sequelae. Rather than sitting on the sidelines, we need to be actively involved in the conversation about treating OUD.
This was jarringly apparent to me as I recently consulted several inpatients in their 20s who had MRSA endocarditis. None had been offered opioid addiction treatment. As I witnessed the protean manifestations of subarachnoid hemorrhage, mycotic aneurysm, septic pulmonary emboli, heart failure, splenic and renal infarcts, I hoped that there was still time to treat the underlying injection drug use that fueled these infections.
Having ID providers become more facile with prescribing buprenorphine could have benefits that go beyond the idea of preventing infections. Treating opioid addiction may result in better adherence to long-term antimicrobials that we commonly prescribe for infections. But it goes beyond that.
We can forge a better alliance with our patients and less of what my mentor at Brown University, Josiah D. “Jody” Rich MD, MPH, calls an “us vs. them” mentality. Having ID clinicians prescribe OUD medications “makes us view patients as people with a disease that responds to treatment,” Rich says, and not as social pariahs.
How do we do that? It is not hard. DATA 2000 allows physicians to acquire a waiver to administer OUD medication. The Provider’s Clinical Support System for Medication-Assisted Treatment, at https://pcssnow.org, provides free training and CME. Many institutions, like mine, provide on-site training several times a year as well.
The onus is on us, as ID specialists, to lead. However, there are workforce issues. Fewer than 5% of physicians in the U.S. have been trained to prescribe buprenorphine. Rich thinks we should start training ID fellows, who he says are “like gods in training programs. They are looked up to by all the house staff.”
We urgently need to train the new generation if we are to make a dent in this crisis.
Disclosure: Chin-Hong reports no relevant financial disclosures.
Editors note: To read the March cover story on the opioid crisis, click here.