Program provides ‘proof of concept’ that ID clinicians can treat opioid use disorder
Click Here to Manage Email Alerts
A program implemented in Kentucky — one of the states hit hardest by the opioid epidemic — provided “proof of concept” that infectious disease providers can help treat patients with opioid use disorder, researchers reported at IDWeek.
Sarah R. Blevins, PharmD, an HIV clinical pharmacist at University of Kentucky HealthCare, and colleagues implemented a multidisciplinary intervention in the University of Kentucky division of infectious diseases (UKID) to improve access to medication-assisted treatment (MAT) for patients with opioid use disorder.
The results came as some in the field have argued for a new ID subspecialty covering addiction.
“In infectious diseases, we talk about source control, and for a lot of patients, they present over and over to the ED or clinic because the ultimate problem is the addiction,” Blevins told Healio. “Infectious diseases and addiction medicine are starting to overlap.”
According to Blevins and colleagues, UKID treated 400 patients with endocarditis in 2018, including 73% who had injection drug use-associated infections.
Out of 87 eligible patients, 54 enrolled in their study, which was open to any patients with an injection drug use-associated infection who was not pregnant or incarcerated. Under the program, “Patients may start MAT and mental health counseling with UKID or be referred elsewhere and are eligible for transportation assistance and medical case management.”
Among participants, 88% received naloxone, 47% received relapse prevention services, 25% had peer support, 18% went to self-help groups and 20% were given transportation aid. Approximately 48% of the patients were male, 91% were white and 35% were receiving medication-assisted treatment.
“A huge challenge for providing medication for opioid use disorder in an infectious disease clinic is time,” Blevins said. “Often times these patients need to be seen weekly or every other week. Trying to work that in in an already very busy schedule for the provider is difficult.”
Blevins emphasized that a multidisciplinary approach is “essential” to meet the needs of patients in this setting.
“I think what is really important about a multidisciplinary team is that we utilize each person to their maximum potential so that we can preserve that time with the provider, so that all the work does not fall on the prescriber,” Tiffany Stivers, MSN, APRN, an advanced practice provider at the University of Kentucky, said during a presentation of the study’s results at IDWeek. “It depends so much on the social worker and nurse to ensure when I go to see the patient, I have the full picture.”
Blevins said that venturing from ID to addiction medicine can be “very daunting” for some physicians, and that further improvements to the program are warranted.
“Ultimately, and this might be a few years down the road, we would like to see if our program can help reduce or have an impact on hospital readmission,” Blevins said. “We are constantly looking for ways to gather more funding and provide services for those patients who have polysubstance abuse and not just opioids.”
Perspective
Back to Top
The UKID has demonstrated that providing MAT and wrap-up services to patients with OUD in the ID clinics will ensure that more targeted interventions will reach those at a high risk for opioid overdose.
Multiple factors such as poverty, lack of education and unemployment and artificial barriers (such as legal ones) do end up getting in the way of health care access for patients with OUD. This multidisciplinary approach described by UKID, of engaging patients for MAT in the ID clinic itself, has shown promise. These patients would otherwise have been out of much-needed MAT and other interventions.
The multidisciplinary approach of UKID essentially leverages the outreach of ID clinics to include MAT and wrap-around services. This allows clinicians to observe the impact of high-risk prescriptions for OUD, the effect of various therapies and learn for themselves the norms of treatment. Additionally, continued engagement with patients with OUD with infectious diseases is bound to yield data that will be invaluable for clinicians.
The aim of this UKID study was to bring more patients with OUD in the ambit of MAT, and the approach seems to have worked. Longitudinal review of patients in ID clinics can be used to fill gaps in our understanding of infectious diseases like HIV/HCV, besides profitably collecting information related to high-risk prescriptions, reduction in use of injection drugs, pain management and a myriad of other topics.
As we all know, the opioid crisis was declared a nationwide public health emergency in 2017. (In fact, it has just been reported that Walmart has filed a pre-emptive lawsuit against the federal government in the opioid case. Also, Purdue Pharma has agreed to plead guilty to three federal criminal charges for its role in the nation's opioid crisis and will pay more than $8 billion and close down the company.
So any research/study on the subject is welcome. Extending OUD therapies/services in ID clinics will not only mitigate OUD-related maladies but also yield data on feasibility of implementation in clinic settings.
Collapse
Blevins SR, et al. Abstract 83. Presented at: IDWeek; Oct. 21-25, 2020 (virtual meeting).
Read more about
Click Here to Manage Email Alerts