Within opioid abuse epidemic, infectious disease epidemic emerges

NEW YORK (Reuters Health) - There is a new epidemic of hepatitis C, HIV, and other infections within the opioid abuse epidemic, according to participants in a National Academies of Sciences, Engineering, and Medicine workshop.

There is an urgent need for actions to address this combined threat, they write in Annals of Internal Medicine,

"Opioid use disorder is like any other medical disorder, and through simple screening and starting medication treatment with the FDA-approved medications to prevent relapse to opioid use and decrease opioid craving, people can reduce acquiring infections," Dr. Sandra A. Springer from Yale School of Medicine, New Haven, Connecticut told Reuters Health by email. "For those who do have associated infections at the time of screening, then starting treatment for their opioid use disorder can help them recover from their infectious diseases as well. Two for the price of one."

Dr. Springer and colleagues from the National Academies of Sciences, Engineering, and Medicine convened a workshop, "Integrating Infectious Disease Considerations with Response to the Opioid Epidemic," to address these intersecting epidemics.

The participants agreed on five action steps:

-Action Step 1: all individuals who are evaluated in medical settings for overdose, heart valve infections, blood poisoning, HIV, hepatitis C, and other serious infections should be screened for opioid use disorder using a quick test like the Rapid Opioid Dependence Screen.

-Action Step 2: people found to have opioid use disorder should immediately receive prescriptions for an FDA-approved medication that treats the disorder and/or withdrawal symptoms and prevents relapse.

-Action Step 3: hospitals should develop processes that ensure treatment for opioid use disorder is started and that patients get linked to community-based treatment after discharge.

-Action Step 4: hospitals, medical schools, physician assistant (PA) schools, nursing schools, and residency programs should increase training to identify and treat opioid use disorder.

-Action Step 5: access to addiction care needs to be increased, as does funding to states to provide effective medications for treating opioid use disorder.

Successful implementation of these action steps will require improved cooperation across healthcare providers, the group writes in a paper online July 13th Annals of Internal Medicine.

"This is the biggest epidemic we have seen in this country linked with new infectious disease epidemics, and we have the medications and the ability to fight this epidemic," Dr. Springer said. "We now need funding for states to provide the medications and all clinicians (nurses, specialist physicians, physician assistants, and primary care physicians) to make it routine practice to screen and start treatment."

"The Ryan White CARE Act that was instituted to help with coverage of HIV medications in all states could be used as a model to direct resources to all states to provide opioid use disorder treatment," she said.

Dr. Yu-Hsiang Hsieh from Johns Hopkins University School of Medicine, Baltimore, Maryland, who has studied the role of urban emergency departments in addressing these intersecting epidemics, told Reuters Health by email, "As an infectious disease and public health researcher in the emergency department (ED) setting, I have noted in the past two years patients filling rooms in hospitals and EDs across Maryland due to opioid overdoses, in addition to those who have died before arriving at the ED."

"A call for targeted federal funding similar to the Ryan White CARE Act would greatly assist state and local governments, as well as public and private sectors, in dedicating resources for needed manpower and infrastructure to combat these intersecting epidemics," he said.

Videos and slides from the workshop are available from the National Academies of Sciences, Engineering, and Medicine at http://bit.ly/2NgjJZ9.

SOURCE: http://bit.ly/2NeK3mC Annals of Internal Medicine, online July 13, 2018.