1
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Szpak V, Prostko S, Weiss RD, Suzuki J. Developing a remotely delivered intensive outpatient program adapted for hospitalized patients with opioid use disorder: A qualitative study. Addict Behav Rep 2024; 19:100546. [PMID: 38680207 PMCID: PMC11046241 DOI: 10.1016/j.abrep.2024.100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/01/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Individuals with opioid use disorder (OUD) who inject drugs have an elevated risk of experiencing serious injection-related infections. While such infections can be treated, treatment for the underlying OUD is often limited. One potential strategy for more intensive addiction treatment is to offer a remotely delivered intensive outpatient program (IOP), adapted from an existing remote IOP ("Smart IOP"). We aimed to conduct a qualitative study to gather feedback on Smart IOP and identify adaptations needed for hospitalized patients. Methods Individuals with OUD and a history of serious injection-related infections completed a semi-structured interview and were shown samples of the videos and program content. The interviews were transcribed verbatim and coded to conduct a thematic analysis. Results Seventeen individuals participated. The mean age was 40.8 years and 70.6 % were men. Participants reported that IOP during the hospitalization would have been helpful to their recovery. The themes that emerged were the importance of medications for OUD, having a relapse prevention plan, engaging with a recovery coach, and ensuring treatment linkage post-discharge. Other themes included the recognition of the severity of one's illness and the emotional experiences related to the hospitalization. Conclusions Participants expressed the value of an IOP during hospitalization and provided insights into the support needed while hospitalized. The tailored IOP is now being developed and will undergo a pilot feasibility trial.
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Affiliation(s)
- Veronica Szpak
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
| | - Sara Prostko
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
| | - Roger D. Weiss
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, United States
| | - Joji Suzuki
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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2
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White DAE, Solnick RE. Communicable Disease Screening and Human Immunodeficiency Virus Prevention in the Emergency Department. Emerg Med Clin North Am 2024; 42:369-389. [PMID: 38641395 DOI: 10.1016/j.emc.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Emergency departments (ED) provide care to populations with high rates of communicable diseases, like HIV, hepatitis C virus, and syphilis. For many patients, the ED is their sole entry point into the healthcare system and they do not routinely access screening and prevention services elsewhere. As such, the ED can serve an important public health role through communicable disease identification, treatment, and prevention. In this article, we examine national recommendations, peer-reviewed literature, and expert consensus to provide cutting edge strategies for implementing communicable infectious disease screening and prevention programs into routine ED care.
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Affiliation(s)
- Douglas A E White
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Rachel E Solnick
- Icahn School of Medicine at Mount Sinai Hospital, 555 West 57th Street 5-25, New York, NY 10019, USA
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3
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Yıldız Ü, Kuruoğlu E, Günvar T, Çöme O, Mevsim V. The Relationship Between Obesity and Internet Addiction in University Students: A Cross-Sectional Study. Am J Health Promot 2024; 38:513-521. [PMID: 38205606 PMCID: PMC10981175 DOI: 10.1177/08901171241227036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
PURPOSE The purpose of this study was to investigate the relationship between obesity and internet addiction in first-year university students (aged 18-25 years). DESIGN The study was designed using a cross-sectional analytic model. SETTING Data collection took place at Dokuz Eylul University, involving a diverse group of first-year students from different faculties. SUBJECTS The study population comprised 12,365 students, with 2890 individuals selected using cluster sampling. MEASURES Internet addiction was evaluated using the Online Cognition Scale (OCS). Data on obesity-related variables and demographic details were collected through a questionnaire. Descriptive statistics, chi-square analysis, t test, and ANOVA were applied for statistical evaluation. RESULTS The study included 2105 participants, with 43.8% males and 56.2% females. A significant positive correlation was found between body mass index (BMI) and OCS scores (P = .000), indicating a higher prevalence of internet addiction among individuals with higher BMI. Males had higher mean OCS scores (91.19 ± 35.14) than females (80.21 ± 30.51) (P = .00). Overweight and obese individuals exhibited higher scores on OCS sub-dimensions (P < .005). Notably, individuals with a BMI over 25 were categorized as overweight, and those with a BMI over 30 were classified as obese. CONCLUSIONS The findings demonstrate a noteworthy relationship between internet addiction and obesity among university students. The study emphasizes the necessity of increased attention to this issue in Turkey for the implementation of effective interventions and preventive measures.
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Affiliation(s)
- Ülkü Yıldız
- Faculty of Medicine, Department of Family Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Emel Kuruoğlu
- Faculty of Science, Department of Computer Science, Dokuz Eylul University, Izmir, Turkey
| | - Tolga Günvar
- Faculty of Medicine, Department of Family Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Oğulcan Çöme
- Faculty of Medicine, Department of Family Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Vildan Mevsim
- Faculty of Medicine, Department of Family Medicine, Dokuz Eylul University, Izmir, Turkey
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Anderson ES, Frazee BW. The Intersection of Substance Use Disorders and Infectious Diseases in the Emergency Department. Emerg Med Clin North Am 2024; 42:391-413. [PMID: 38641396 DOI: 10.1016/j.emc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Substance use disorders (SUDs) intersect clinically with many infectious diseases, leading to significant morbidity and mortality if either condition is inadequately treated. In this article, we will describe commonly seen SUDs in the emergency department (ED) as well as their associated infectious diseases, discuss social drivers of patient outcomes, and introduce novel ED-based interventions for co-occurring conditions. Clinicians should come away from this article with prescriptions for both antimicrobial medications and pharmacotherapy for SUDs, as well as an appreciation for social barriers, to care for these patients.
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Affiliation(s)
- Erik S Anderson
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA; Division of Addiction Medicine, Highland Hospital, Alameda Health System, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Bradley W Frazee
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA
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5
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Thakarar K, Appa A, Abdul Mutakabbir JC, Goff A, Brown J, Tuell C, Fairfield K, Wurcel A. Frame Shift: Focusing on Harm Reduction and Shared Decision Making for People Who Use Drugs Hospitalized With Infections. Clin Infect Dis 2024; 78:e12-e26. [PMID: 38018174 DOI: 10.1093/cid/ciad664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Indexed: 11/30/2023] Open
Affiliation(s)
- Kinna Thakarar
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Center for Interdisciplinary Population & Health Research, MaineHealth Institute for Research, Portland, Maine, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
| | - Ayesha Appa
- Division of HIV, Infectious Diseases, and Global Medicine at San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA
| | - Jacinda C Abdul Mutakabbir
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California-San Diego, La Jolla, California, USA
- Division of the Black Diaspora and African American Studies, University of California-San Diego, La Jolla, California, USA
| | - Amelia Goff
- Section of Addiction Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Jessica Brown
- Department of Care Management, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Kathleen Fairfield
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Center for Interdisciplinary Population & Health Research, MaineHealth Institute for Research, Portland, Maine, USA
- Department of Medicine, Maine Medical Center, Portland, Maine, USA
| | - Alysse Wurcel
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medicine, Boston, Massachusetts, USA
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6
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El-Dalati S, Thornton A, Reda H, Alnabelsi T, Gurley J, Stoner BJ, Gill D, Kennedy K, Dornbos DL, Fraser J, Cremeans K, Mansoor AER, Laugherty G, Norris K, Tremblay A, Annichiarico N, Van Sickels N, Ogburn E, London-Bounds T, Sekela M. Beyond a team: The comprehensive interdisciplinary endocarditis program in the United States. Int J Cardiol 2024; 397:131638. [PMID: 38061608 DOI: 10.1016/j.ijcard.2023.131638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/26/2023] [Accepted: 12/03/2023] [Indexed: 01/13/2024]
Abstract
Although multidisciplinary teams have been shown to decrease in-hospital mortality for patient with infectious endocarditis, most studies have focused on the inpatient role of these teams, and are primarily based at European tertiary care centers. There is limited literature available on the optimal longitudinal care of this patient population. Here we outline our experience developing an interdisciplinary endocarditis program at the University of Kentucky, which cares for patients from their index hospitalization into the outpatient setting, while also coordinating transfers from regional hospitals and offering education to regional providers.
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Affiliation(s)
- Sami El-Dalati
- University of Kentucky Medical Center, Division of Infectious Diseases, Department of Internal Medicine, 740 S. Limestone Street, Lexington, KY 40536, United States of America.
| | - Alice Thornton
- University of Kentucky Medical Center, Division of Infectious Diseases, Department of Internal Medicine, 740 S. Limestone Street, Lexington, KY 40536, United States of America
| | - Hassan Reda
- University of Kentucky Medical Center, Division of Cardiovascular & Thoracic Surgery, 800 Rose Street, Lexington, KY 40536, United States of America
| | - Talal Alnabelsi
- University of Kentucky Medical Center, Gill Heart and Vascular Institute, 800 Rose Street, Lexington, KY 40536, United States of America
| | - John Gurley
- University of Kentucky Medical Center, Gill Heart and Vascular Institute, 800 Rose Street, Lexington, KY 40536, United States of America
| | - Bobbi Jo Stoner
- University of Kentucky College of Pharmacy, United States of America
| | - Deborah Gill
- University of Kentucky Medical Center, Division of Infectious Diseases, Department of Internal Medicine, 740 S. Limestone Street, Lexington, KY 40536, United States of America
| | - Kara Kennedy
- University of Kentucky Medical Center, Department of Neurology, 740 S. Limestone, Lexington, KY 40536, United States of America
| | - David L Dornbos
- University of Kentucky Medical Center, Department of Neurosurgery, 780 Rose Street, Lexington, KY 40536, United States of America
| | - Justin Fraser
- University of Kentucky Medical Center, Department of Neurosurgery, 780 Rose Street, Lexington, KY 40536, United States of America
| | - Kelli Cremeans
- University of Kentucky Medical Center, Division of Infectious Diseases, Department of Internal Medicine, 740 S. Limestone Street, Lexington, KY 40536, United States of America
| | - Armaghan-E-Rehman Mansoor
- University of Kentucky Medical Center, Division of Infectious Diseases, Department of Internal Medicine, 740 S. Limestone Street, Lexington, KY 40536, United States of America
| | - Grant Laugherty
- University of Kentucky Medical Center, Division of Infectious Diseases, Department of Internal Medicine, 740 S. Limestone Street, Lexington, KY 40536, United States of America
| | - Kathyrn Norris
- University of Kentucky Medical Center, Division of Infectious Diseases, Department of Internal Medicine, 740 S. Limestone Street, Lexington, KY 40536, United States of America
| | - Alyssa Tremblay
- University of Kentucky Medical Center, Division of Infectious Diseases, Department of Internal Medicine, 740 S. Limestone Street, Lexington, KY 40536, United States of America
| | - Nicholas Annichiarico
- University of Kentucky Medical Center, Department of Physical Medicine and Rehabilitation, Cardinal Hill Hospital, 2050 Versailles Road, Lexington, KY 40504, United States of America
| | - Nicholas Van Sickels
- University of Kentucky Medical Center, Division of Infectious Diseases, Department of Internal Medicine, 740 S. Limestone Street, Lexington, KY 40536, United States of America
| | - Erinn Ogburn
- University of Kentucky Medical Center, Division of Cardiovascular & Thoracic Surgery, 800 Rose Street, Lexington, KY 40536, United States of America
| | - Tessa London-Bounds
- University of Kentucky Medical Center, Division of Cardiovascular & Thoracic Surgery, 800 Rose Street, Lexington, KY 40536, United States of America
| | - Michael Sekela
- University of Kentucky Medical Center, Division of Cardiovascular & Thoracic Surgery, 800 Rose Street, Lexington, KY 40536, United States of America
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7
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Marks LR, Durkin MJ, Ayres K, Ellis M. Drug preparation, injection-related infections, and harm reduction practices among a national sample of individuals entering treatment for opioid use disorder. Harm Reduct J 2024; 21:16. [PMID: 38243269 PMCID: PMC10799462 DOI: 10.1186/s12954-024-00939-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The rise in injection drug use in the USA has led to an increase in injection site infections. We performed a national survey of people who use drugs to evaluate common drug use preparation, harm reduction practices, and experiences with injection site infections. METHODS A survey was disseminated to members of the Survey of Key Informants' Patients Program from 2021 to 2022 and distributed to patients 18 years or older newly entering one of 68 substance use disorder treatment programs across the USA with a primary diagnosis of an opioid use disorder. Participants were surveyed about practices when preparing and using drugs, along with self-reported infections and drug use complications. RESULTS 1289 participants responded to the survey. Sexually transmitted infections were common, with 37.6% reporting ever having had any sexually transmitted infection. Injection-associated infections had affected 63.4% of participants who had ever used injection drugs. Many respondents reported not seeking professional medical assistance for infection management, including 29% draining abscesses without seeking medical care and 22.8% obtaining antibiotics through non-healthcare sources. Non-sterile injection practices included sharing needles with others who were febrile or ill (18%), using needles previously used to drain wounds/abscesses (9.9%) for subsequent injection drug use, and licking needles (21.2%). CONCLUSION Patients entering treatment for opioid use disorder reported a high burden of infectious diseases. A number of easily-modifiable high risk behaviors for developing injection-related infections were identified. Efforts are needed to disseminate targeted harm reduction education to PWID on how to reduce their risks for injection-related infections.
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Affiliation(s)
- Laura R Marks
- Division of Infectious Disease, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO, USA.
| | - Michael J Durkin
- Division of Infectious Disease, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO, USA
| | - Kelly Ayres
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew Ellis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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8
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Hill K, Kuo I, Shenoi SV, Desruisseaux MS, Springer SA. Integrated Care Models: HIV and Substance Use. Curr HIV/AIDS Rep 2023; 20:286-295. [PMID: 37698755 PMCID: PMC11034717 DOI: 10.1007/s11904-023-00667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE OF REVIEW Behaviors and practices associated with substance use contribute to lack of HIV virologic suppression and onward transmission. In the USA, many recent HIV outbreaks have been connected with substance use. Evidence-based strategies for integrating care of those at risk for and living with HIV and who use substances continue to evolve. This review, based on scientific and medical literature through March 2023, provides an overview and evaluation of initiatives for integrated care aimed to serve patients at risk for and with HIV and a substance use disorder. RECENT FINDINGS Integrated care services can improve health outcomes for patients at risk for and with HIV and a substance use disorder; for instance, treatment for an opioid use disorder can help improve HIV viral suppression. Brick-and-mortar facilities can provide successful care integration with appropriate clinic leadership to support multidisciplinary care teams, up-to-date provider training, and sufficient pharmacy stock for substance use treatment. Delivering healthcare services to communities (e.g., mobile healthcare clinics and pharmacies, telehealth) may prove to be an effective way to provide integrated services for those with or at risk of HIV and substance use disorders. Incorporating technology (e.g., mobile phone applications) may facilitate integrated care. Other venues, including harm reduction programs and carceral settings, should be targets for integrated services. Venues providing healthcare should invest in integrated care and support legislation that increases access to services related to HIV and substance use.
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Affiliation(s)
- Katherine Hill
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Irene Kuo
- Department of Epidemiology, Milken Institute School of Public Health at The George Washington University, Washington, DC, USA
| | - Sheela V Shenoi
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA
- Yale Institute of Global Health, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
- The Veterans Administration Connecticut Healthcare System, West Haven, CT, USA
| | - Mahalia S Desruisseaux
- Yale Institute of Global Health, New Haven, CT, USA
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Sandra A Springer
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
- The Veterans Administration Connecticut Healthcare System, West Haven, CT, USA.
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9
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Wurcel AG, Zubiago J, Reyes J, Smyth E, Balsara KR, Avila D, Barocas JA, Beckwith CG, Bui J, Chastain CA, Eaton EF, Kimmel S, Paras ML, Schranz AJ, Vyas DA, Rapoport A. Surgeons' Perspectives on Valve Surgery in People With Drug Use-Associated Infective Endocarditis. Ann Thorac Surg 2023; 116:492-498. [PMID: 35108502 PMCID: PMC9339044 DOI: 10.1016/j.athoracsur.2021.12.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 11/01/2021] [Accepted: 12/09/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Hospitalizations for drug-use associated infective endocarditis (DUA-IE) have led to increasing surgical consultation for valve replacement. Cardiothoracic surgeons' perspectives about the process of decision making around operation for people with DUA-IE are largely unknown. METHODS This multisite semiqualitative study sought to gather the perspectives of cardiothoracic surgeons on initial and repeat valve surgery for people with DUA-IE through purposeful sampling of surgeons at 7 hospitals: University of Alabama, Tufts Medical Center, Boston Medical Center, Massachusetts General Hospital, University of North Carolina-Chapel Hill, Vanderbilt University Medical Center, and Rhode Island Hospital-Brown University. RESULTS Nineteen cardiothoracic surgeons (53% acceptance) were interviewed. Perceptions of the drivers of addiction varied as well as approaches to repeat valve operations. There were mixed views on multidisciplinary meetings, although many surgeons expressed an interest in more efficient meetings and more intensive postoperative and posthospitalization multidisciplinary care. CONCLUSIONS Cardiothoracic surgeons are emotionally and professionally impacted by making decisions about whether to perform valve operation for people with DUA-IE. The use of efficient, agenda-based multidisciplinary care teams is an actionable solution to improve cross-disciplinary partnerships and outcomes for people with DUA-IE.
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Affiliation(s)
| | | | | | - Emma Smyth
- Tufts Medical Center, Boston, Massachusetts
| | - Keki R Balsara
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Danielle Avila
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Joshua A Barocas
- Divisions of Internal Medicine and Infectious Diseases, University of Colorado, Denver, Colorado
| | - Curt G Beckwith
- Division of Infectious Diseases, Alpert Medical School of Brown University/The Miriam Hospital, Providence, Rhode Island
| | - Jenny Bui
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | | | - Ellen F Eaton
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Simeon Kimmel
- Section of General Internal Medicine/Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Molly L Paras
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Asher J Schranz
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Darshali A Vyas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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10
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Nolan NS, Fracasso Francis SM, Marks LR, Beekmann SE, Polgreen PM, Liang SY, Durkin MJ. Harm Reduction: A Missing Piece to the Holistic Care of Patients Who Inject Drugs. Open Forum Infect Dis 2023; 10:ofad402. [PMID: 37593531 PMCID: PMC10428197 DOI: 10.1093/ofid/ofad402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023] Open
Abstract
Background The rise in injection drug use (IDU) has led to an increase in drug-related infections. Harm reduction is an important strategy for preventing infections among people who inject drugs (PWID). We attempted to evaluate the harm reduction counseling that infectious diseases physicians provide to PWID presenting with infections. Methods An electronic survey was distributed to physician members of the Emerging Infections Network to inquire about practices used when caring for patients with IDU-related infections. Results In total, 534 ID physicians responded to the survey. Of those, 375 (70%) reported routinely caring for PWID. Most respondents report screening for human immunodeficiency virus (HIV) and viral hepatitis (98%) and discussing the risk of these infections (87%); 63% prescribe immunization against viral hepatitis, and 45% discuss HIV preexposure prophylaxis (PrEP). However, 55% of respondents (n = 205) reported not counseling patients on safer injection strategies. Common reasons for not counseling included limited time and a desire to emphasize antibiotic therapy/medical issues (62%), lack of training (55%), and believing that it would be better addressed by other services (47%). Among respondents who reported counseling PWID, most recommended abstinence from IDU (72%), handwashing and skin cleansing before injection (62%), and safe disposal of needles/drug equipment used before admission (54%). Conclusions Almost all ID physicians report screening PWID for HIV and viral hepatitis and discussing the risks of these infections. Despite frequently encountering PWID, fewer than half of ID physicians provide safer injection advice. Opportunities exist to standardize harm reduction education, emphasizing safer injection practices in conjunction with other strategies to prevent infections (eg, HIV PrEP or hepatitis A virus/hepatitis B virus vaccination).
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Affiliation(s)
- Nathanial S Nolan
- Division of Infectious Disease, VA St Louis Health Care, St Louis, Missouri, USA
- Division of Infectious Disease, Washington University School of Medicine, St Louis, Missouri, USA
| | | | - Laura R Marks
- Division of Infectious Disease, Washington University School of Medicine, St Louis, Missouri, USA
| | - Susan E Beekmann
- Division of Infectious Disease, Carver College of Medicine, Iowa City, Iowa, USA
| | - Philip M Polgreen
- Division of Infectious Disease, Carver College of Medicine, Iowa City, Iowa, USA
| | - Stephen Y Liang
- Division of Infectious Disease, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Emergency Medicine, Washington University School of Medicine, St Louis Missouri, USA
| | - Michael J Durkin
- Division of Infectious Disease, Washington University School of Medicine, St Louis, Missouri, USA
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11
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Evans KN, Vettese T, Wortley PM, Gandhi AP, Bradley H. Missed opportunities for prevention: prevalence and incidence of human immunodeficiency virus and hepatitis C virus diagnoses among a cohort of individuals discharged from an urban hospital with injection drug-related diagnoses, 2012-2019. Ann Epidemiol 2023; 80:69-75.e2. [PMID: 36791871 DOI: 10.1016/j.annepidem.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE Risk for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections has increased due to the ongoing opioid epidemic and unsafe injection practices. We estimated the prevalence and incidence of HIV and HCV diagnoses among people who inject drugs from hospital-based clinical encounters. METHODS We linked clinical encounters at an Atlanta hospital during 2012-2018 with state HIV and HCV surveillance records to examine the prevalence of infections at discharge and incidence of infections post clinical encounter. RESULTS At discharge, 32.9% and 28.6% of patients with injection drug use-related clinical encounters had an HIV or HCV diagnosis, respectively. HIV and HCV diagnoses at the time of discharge were mostly among 40-64 years old patients, males, and Black/African Americans. Post clinical encounter, 3.8% of patients were later diagnosed with HIV, and 16.5% were later diagnosed with HCV, translating to incidence rates of 9.3 per 1000 person-years and 41.5 per 1000 person-years, respectively. The majority of HIV and HCV diagnoses post clinical encounter occurred among Black/African Americans and males. Of patients with HIV and HCV diagnoses post clinical encounter, 27.3% and 11.9% had been tested during their clinical encounter, respectively. CONCLUSIONS Targeted interventions for HIV/HCV prevention, screening, diagnosis, and linkage to treatment are needed to reduce the incidence of new infections among people who inject drugs.
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Affiliation(s)
- Kimberly N Evans
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta.
| | - Theresa Vettese
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Pascale M Wortley
- Department of Population Health Sciences, Georgia Department of Public Health, Atlanta, GA, USA
| | - Ami P Gandhi
- Department of Population Health Sciences, Georgia Department of Public Health, Atlanta, GA, USA
| | - Heather Bradley
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta
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12
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Mosnier E, Loubiere S, Monfardini E, Alibert A, Landier J, Ninoves L, Bosetti T, Auquier P, Mosnier M, Wakap SN, Warszawski J, Tinland A. Cumulative incidence of SARS-CoV-2 infection within the homeless population: insights from a city-wide longitudinal study. BMJ Open 2023; 13:e065734. [PMID: 36822808 PMCID: PMC9950589 DOI: 10.1136/bmjopen-2022-065734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVES The aim of this study was to determine the risk factors associated with SARS-CoV-2 infection in a cohort of homeless people using survival analysis. Seroprevalence in the homeless community was also compared with that of the general population. DESIGN Cohort study. SETTING Data were collected across two testing sessions, 3 months apart, during which each participant was tested for anti-SARS-CoV-2 antibodies and completed a face-to-face survey. PARTICIPANTS All homeless adults sleeping rough, in slums or squats, in emergency shelters or transitional accommodation in Marseille were eligible. PRIMARY OUTCOME MEASURES Occurrence of a seroconversion event defined as a biologically confirmed SARS-CoV-2 infection. Local data from a national seroprevalence survey were used for comparison between homeless people and the general population. RESULTS A total of 1249 people were included. SARS-CoV-2 seroprevalence increased from 6.0% (4.7-7.3) during the first session to 18.9% (16.0-21.7) during the second one, compared with 3.0% (1.9-4.2) and 6.5% (4.5-8.7) in the general population. Factors significantly associated with an increased risk of COVID-19 infection were: having stayed in emergency shelters (1.93 (1.18-3.15)), being an isolated parent (1.64 (1.07-2.52)) and having contact with more than 5-15 people per day (1.84 (1.27-2.67)). By contrast, smoking (0.46 (0.32-0.65)), having financial resources (0.70 (0.51-0.97)) and psychiatric or addictive comorbidities (0.52 (0.32-0.85)) were associated with a lower risk. CONCLUSION We confirm that homeless people have higher infection rates than the general population, with increased risk in emergency shelters. There is growing evidence that, in addition to usual preventive measures, public policies should pay attention to adapt the type of accommodation and overall approach of precariousness. TRIAL REGISTRATION NUMBER NCT04408131.
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Affiliation(s)
- Emilie Mosnier
- Department of Psychiatry, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Sandrine Loubiere
- Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille University, School of medicine - La Timone Medical Campus, UR3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Elisabetta Monfardini
- Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Agathe Alibert
- Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Research Group on Epidemiology of Zoonoses and Public Health (GREZOSP), Faculty of Veterinary Medicine, Université de Montréal, 3200 rue Sicotte, Saint-Hyacinthe, QC, Canada
| | - Jordi Landier
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Laeticia Ninoves
- Unité des Virus Émergents (UVE: Aix-Marseille Univ-IRD 190-Inserm 1207), Marseille, France
| | - Thomas Bosetti
- Médecins du Monde - Doctors of the World, Marseille, France
| | - Pascal Auquier
- Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille University, School of medicine - La Timone Medical Campus, UR3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Marine Mosnier
- Médecins du Monde - Doctors of the World, Marseille, France
| | | | | | - Aurelie Tinland
- Department of Psychiatry, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Aix-Marseille University, School of medicine - La Timone Medical Campus, UR3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
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Harvey L, Kimmel SD, Edelman EJ. Meeting the Moment: More ID Physicians Must Be Prepared to Provide Buprenorphine. Clin Infect Dis 2023; 76:1205-1208. [PMID: 36695340 DOI: 10.1093/cid/ciad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/12/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Affiliation(s)
- Leah Harvey
- Sections of General Internal Medicine and Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA
| | - Simeon D Kimmel
- Sections of General Internal Medicine and Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA
| | - E Jennifer Edelman
- Department of Internal Medicine and Program in Addiction Medicine, Yale School of Medicine and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
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14
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Serota DP, Rosenbloom L, Hervera B, Seo G, Feaster DJ, Metsch LR, Suarez E, Chueng TA, Hernandez S, Rodriguez AE, Tookes HE, Doblecki-Lewis S, Bartholomew TS. Integrated Infectious Disease and Substance Use Disorder Care for the Treatment of Injection Drug Use-Associated Infections: A Prospective Cohort Study With Historical Control. Open Forum Infect Dis 2023; 10:ofac688. [PMID: 36632415 PMCID: PMC9830545 DOI: 10.1093/ofid/ofac688] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background To address the infectious disease (ID) and substance use disorder (SUD) syndemic, we developed an integrated ID/SUD clinical team rooted in harm reduction at a county hospital in Miami, Florida. The Severe Injection-Related Infection (SIRI) team treats people who inject drugs (PWID) and provides medical care, SUD treatment, and patient navigation during hospitalization and after hospital discharge. We assessed the impact of the SIRI team on ID and SUD treatment and healthcare utilization outcomes. Methods We prospectively collected data on patients seen by the SIRI team. A diagnostic code algorithm confirmed by chart review was used to identify a historical control group of patients with SIRI hospitalizations in the year preceding implementation of the SIRI team. The primary outcome was death or readmission within 90 days post-hospital discharge. Secondary outcomes included initiation of medications for opioid use disorder (MOUD) and antibiotic course completion. Results There were 129 patients included in the study: 59 in the SIRI team intervention and 70 in the pre-SIRI team control group. SIRI team patients had a 45% risk reduction (aRR, 0.55 [95% confidence interval CI, .32-.95]; 24% vs 44%) of being readmitted in 90 days or dying compared to pre-SIRI historical controls. SIRI team patients were more likely to initiate MOUD in the hospital (93% vs 33%, P < .01), complete antibiotic treatment (90% vs 60%, P < .01), and less likely to have patient-directed discharge (17% vs 37%, P = .02). Conclusions An integrated ID/SUD team was associated with improvements in healthcare utilization, MOUD initiation, and antibiotic completion for PWID with infections.
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Affiliation(s)
- David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Liza Rosenbloom
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Belén Hervera
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Grace Seo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel J Feaster
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Edward Suarez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Salma Hernandez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Susanne Doblecki-Lewis
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
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15
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Implementation of an integrated infectious disease and substance use disorder team for injection drug use-associated infections: a qualitative study. Addict Sci Clin Pract 2023; 18:8. [PMID: 36747268 PMCID: PMC9902242 DOI: 10.1186/s13722-023-00363-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/25/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hospitalizations for severe injection drug use-related infections (SIRIs) are characterized by high costs, frequent patient-directed discharge, and high readmission rates. Beyond the health system impacts, these admissions can be traumatizing to people who inject drugs (PWID), who often receive inadequate treatment for their substance use disorders (SUD). The Jackson SIRI team was developed as an integrated infectious disease/SUD treatment intervention for patients hospitalized at a public safety-net hospital in Miami, Florida in 2020. We conducted a qualitative study to identify patient- and clinician-level perceived implementation barriers and facilitators to the SIRI team intervention. METHODS Participants were patients with history of SIRIs (n = 7) and healthcare clinicians (n = 8) at one implementing hospital (Jackson Memorial Hospital). Semi-structured qualitative interviews were performed with a guide created using the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed, double coded, and categorized by study team members using CFIR constructs. RESULTS Implementation barriers to the SIRI team intervention identified by participants included: (1) complexity of the SIRI team intervention; (2) lack of resources for PWID experiencing homelessness, financial insecurity, and uninsured status; (3) clinician-level stigma and lack of knowledge around addiction and medications for opioid use disorder (OUD); and (4) concerns about underinvestment in the intervention. Implementation facilitators of the intervention included: (1) a non-judgmental, harm reduction-oriented approach; (2) the team's advocacy for PWID as a means of institutional culture change; (3) provision of close post-hospital follow-up that is often inaccessible for PWID; (4) strong communication with patients and their hospital physicians; and (5) addressing diverse needs such as housing, insurance, and psychological wellbeing. CONCLUSION Integration of infectious disease and SUD treatment is a promising approach to managing patients with SIRIs. Implementation success depends on institutional buy-in, holistic care beyond the medical domain, and an ethos rooted in harm reduction across multilevel (inner and outer) implementation contexts.
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Bartholomew TS, Tookes HE, Spencer EC, Feaster DJ. Application of machine learning algorithms for localized syringe services program policy implementation - Florida, 2017. Ann Med 2022; 54:2137-2150. [PMID: 35900201 PMCID: PMC9341345 DOI: 10.1080/07853890.2022.2105391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) are at an amplified vulnerability for experiencing a multitude of harms related to their substance use, including viral (e.g. HIV, Hepatitis C) and bacterial infections (e.g. endocarditis). Implementation of evidence-based interventions, such as syringe services programs (SSPs), remains imperative, particularly in locations at an increased risk of HIV outbreaks. This study aims to identify communities in Florida that are high-priority locations for SSP implementation by examining state-level data related to the substance use and overdose crises. METHODS State-level surveillance data were aggregated at the ZIP Code Tabulation Area (ZCTA) (n = 983) for 2017. We used confirmed cases of acute HCV infection as a proxy of injection drug use. Least Absolute Selection and Shrinkage Operator (LASSO) regression was used to develop a machine learning model to identify significant indicators of acute HCV infection and high-priority areas for SSP implementation due to their increased vulnerability to an HIV outbreak. RESULTS The final model retained three variables of importance: (1) the number of drug-associated skin and soft tissue infection hospitalizations, (2) the number of chronic HCV infections in people aged 18-39, and 3) the number of drug-associated endocarditis hospitalizations. High-priority SSP implementation locations were identified in both urban and rural communities outside of current Ending the HIV Epidemic counties. CONCLUSION SSPs are long researched, safe, and effective evidence-based programs that offer a variety of services that reduce disease transmission and assist with combating the overdose crisis. Opportunities to increase services in needed regions across the state now exist in Florida as supported by the expansion of the Infectious Disease Elimination Act of 2019. This study provides details where potential areas of concern may be and highlights regions where future evidence-based harm reduction programs, such as SSPs, would be useful to reduce opioid overdoses and disease transmission among PWID.Key messagesThe rate of acute HCV in Florida in 2017 was 1.9 per 100,000, nearly twice the national average.Serious injection related infections among PWID are significant indicators of acute HCV infection.High-priority SSP implementation locations in Florida were identified in both urban and rural communities, including those outside of current Ending the HIV Epidemic counties.
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Affiliation(s)
- Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hansel E Tookes
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Emma C Spencer
- Florida Department of Health, Division of Disease Control and Health Protection, HIV/AIDS Section, Bureau of Communicable Diseases, Tallahassee, FL, USA
| | - Daniel J Feaster
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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17
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Fujita AW, Loughry N, Moore DE, Carter AE, Hussen SA, Cooper H, Colasanti JA, Sheth AN. Prevalence, Distribution, and Characteristics Associated with Possession of Buprenorphine Waivers Among Infectious Diseases Physicians in the United States. Clin Infect Dis 2022; 76:1197-1204. [PMID: 36419250 DOI: 10.1093/cid/ciac909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/10/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Persons with opioid use disorder (OUD) may present with infectious complications from injection drug use, thus ID physicians are uniquely positioned to treat OUD. Buprenorphine is safe and effective for OUD but remains underutilized. The prevalence and geographic distribution of ID physicians who are waivered to prescribe buprenorphine are unknown. METHODS This cross-sectional study merged data from several publicly available datasets from November 1, 2021 to January 15, 2022. Our primary outcome was proportion of ID physicians possessing buprenorphine waivers in the United States. We identified individual and county-level characteristics associated with buprenorphine waiver possession. We then used geospatial analysis to determine geographic distribution of waivered ID physicians. RESULTS We identified 6372 ID physicians in the US, among whom 170 (2.7%) possessed waivers. Most ID physicians (97.3%) practiced in metropolitan counties. In our multivariable analysis, ID physicians had lower odds of having a waiver for every 10-year increase since graduating medical school (OR 0.79, 95% CI 0.68-0.91). ID physicians practicing in counties with higher proportion of uninsured residents had lower odds of having a waiver (OR 0.75, 95% CI 0.62-0.90). Among counties with at least one ID physician (n = 729), only 11.2% had at least one waivered ID physician. CONCLUSIONS We found an extremely low prevalence and skewed geographic distribution of ID physicians with buprenorphine waivers. Our findings suggest an urgent need to increase the workforce of ID physicians waivered to prescribe buprenorphine and a call for increased integration of OUD education into ID training and continuing medical education.
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Affiliation(s)
- Ayako Wendy Fujita
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA
| | - Nora Loughry
- Division of General Internal Medicine, Emory University Department of Medicine, Atlanta, GA, USA
| | - DeLante E Moore
- Department of Biostatistics, Rollins School of Public Health, Emory University Department of Medicine, Atlanta, GA, USA
| | - Andrea E Carter
- Division of General Internal Medicine, University of Pittsburgh Department of Medicine, Pittsburgh, PA, USA
| | - Sophia A Hussen
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Hannah Cooper
- Department of Behavioral, Social, and Health Education Services, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Emory University Department of Medicine, Atlanta, GA, USA
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Caceres J, Malik A, Ren T, Naeem A, Clemence J, Makkinejad A, Wu X, Yang B. Poor long-term outcomes of intravenous drug users with infectious endocarditis. JTCVS OPEN 2022; 11:92-104. [PMID: 36172440 PMCID: PMC9510881 DOI: 10.1016/j.xjon.2022.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/08/2022] [Accepted: 05/24/2022] [Indexed: 11/05/2022]
Abstract
Objectives The optimal management of active endocarditis in intravenous (IV) drug users is still lacking. Methods From the years 1997 to 2017, 536 patients with active infectious endocarditis were surgically treated, including 83 (15%) with IV drug use (IVDU) and 453 (85%) without IV drug use (non-IVDU). Initial data were obtained from the Society of Thoracic Surgeons database and supplemented with chart review and national death index data. Results The IVDU group was significantly younger (43 vs 56 years old) than the non-IVDU group and had greater rates of psychiatric disorders, drug use, and tricuspid valve endocarditis (28% vs 8.6%). Hypertension, dyslipidemia, and diabetes mellitus were significantly more common in the non-IVDU group. Perioperative complications and operative mortality (7.2% vs 7.9%) were similar. IVDU was not a significant risk factor for operative mortality. Kaplan–Meier survival was significantly lower in the IVDU group (5-year survival, 46% vs 67%). Significant risk factors for long-time mortality included IV drug use (hazard ratio [HR], 1.92), age ≥65 years (HR, 1.78), congestive heart failure (HR, 1.87), and enterococcus endocarditis (HR, 1.54). The 5-year rate of reoperation was similar between IVDU and non-IVDU groups (2.4% vs 2.7%). Conclusions IVDU is a significant risk factor for long-term mortality. A multidisciplinary approach was preferred for IVDU patients to treat both endocarditis and substance use disorder and improve long-term survival.
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19
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Jawa R, Walley AY, Wilson DJ, Green TC, McKenzie M, Hoskinson R, Bratberg J, Ramsey S, Rich JD, Friedmann PD. Prescribe to Save Lives: Improving Buprenorphine Prescribing Among HIV Clinicians. J Acquir Immune Defic Syndr 2022; 90:546-552. [PMID: 35587832 PMCID: PMC9283214 DOI: 10.1097/qai.0000000000003001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV clinicians are uniquely positioned to treat their patients with opioid use disorder using buprenorphine to prevent overdose death. The Prescribe to Save Lives (PtSL) study aimed to increase HIV clinicians' buprenorphine prescribing via an overdose prevention intervention. METHODS The quasi-experimental stepped-wedge study enrolled 22 Ryan White-funded HIV clinics and delivered a peer-to-peer training to clinicians with follow-up academic detailing that included overdose prevention education and introduced buprenorphine prescribing. Site-aggregated electronic medical record (EMR) data measured with the change in X-waivered clinicians and patients prescribed buprenorphine. Clinicians completed surveys preintervention and at 6- and 12-month postintervention that assessed buprenorphine training, prescribing, and attitudes. Analyses applied generalized estimating equation models, adjusting for time and clustering of repeated measures among individuals and sites. RESULTS Nineteen sites provided EMR prescribing data, and 122 clinicians returned surveys. Of the total patients with HIV across all sites, EMR data showed 0.38% were prescribed buprenorphine pre-intervention and 0.52% were prescribed buprenorphine postintervention. The intervention increased completion of a buprenorphine training course (adjusted odds ratio 2.54, 95% confidence interval: 1.38 to 4.68, P = 0.003) and obtaining an X-waiver (adjusted odds ratio 2.11, 95% confidence interval: 1.12 to 3.95, P = 0.02). There were nonsignificant increases at the clinic level, as well. CONCLUSIONS Although the PtSL intervention resulted in increases in buprenorphine training and prescriber certification, there was no meaningful increase in buprenorphine prescribing. Engaging and teaching HIV clinicians about overdose and naloxone rescue may facilitate training in buprenorphine prescribing but will not result in more treatment with buprenorphine without additional interventions.
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Affiliation(s)
- Raagini Jawa
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118
- Boston University School of Medicine, Boston, MA, USA
| | - Alexander Y. Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118
- Boston University School of Medicine, Boston, MA, USA
| | - Donna J. Wilson
- University of Massachusetts Medical School- Baystate and Baystate Health, 3601 Main Street, 3 Floor, Springfield, MA
| | - Traci C. Green
- Opioid Policy Research Collaborative, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Michelle McKenzie
- The Center for Health + Justice Transformation, The Miriam and Rhode Island Hospitals, 164 Summit Avenue, Providence, RI 02906
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Randall Hoskinson
- University of Massachusetts Medical School- Baystate and Baystate Health, 3601 Main Street, 3 Floor, Springfield, MA
| | - Jeffrey Bratberg
- University of Rhode Island College of Pharmacy, 7 Greenhouse Rd, Kingston, RI 02881
| | - Susan Ramsey
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Josiah D. Rich
- The Center for Health + Justice Transformation, The Miriam and Rhode Island Hospitals, 164 Summit Avenue, Providence, RI 02906
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Peter D. Friedmann
- University of Massachusetts Medical School- Baystate and Baystate Health, 3601 Main Street, 3 Floor, Springfield, MA
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Englander H, Jones A, Krawczyk N, Patten A, Roberts T, Korthuis PT, McNeely J. A Taxonomy of Hospital-Based Addiction Care Models: a Scoping Review and Key Informant Interviews. J Gen Intern Med 2022; 37:2821-2833. [PMID: 35534663 PMCID: PMC9411356 DOI: 10.1007/s11606-022-07618-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/12/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is pressing need to improve hospital-based addiction care. Various models for integrating substance use disorder care into hospital settings exist, but there is no framework for describing, selecting, or comparing models. We sought to fill that gap by constructing a taxonomy of hospital-based addiction care models based on scoping literature review and key informant interviews. METHODS Methods included a scoping review of the literature on US hospital-based addiction care models and interventions for adults, published between January 2000 and July 2021. We conducted semi-structured interviews with 15 key informants experienced in leading, implementing, evaluating, andpracticing hospital-based addiction care to explore model characteristics, including their perceived strengths, limitations, and implementation considerations. We synthesized findings from the literature review and interviews to construct a taxonomy of model types. RESULTS Searches identified 2,849 unique abstracts. Of these, we reviewed 280 full text articles, of which 76 were included in the final review. We added 8 references from reference lists and informant interviews, and 4 gray literature sources. We identified six distinct hospital-based addiction care models. Those classified as addiction consult models include (1) interprofessional addiction consult services, (2) psychiatry consult liaison services, and (3) individual consultant models. Those classified as practice-based models, wherein general hospital staff integrate addiction care into usual practice, include (4) hospital-based opioid treatment and (5) hospital-based alcohol treatment. The final type was (6) community-based in-reach, wherein community providers deliver care. Models vary in their target patient population, staffing, and core clinical and systems change activities. Limitations include that some models have overlapping characteristics and variable ways of delivering core components. DISCUSSION A taxonomy provides hospital clinicians and administrators, researchers, and policy-makers with a framework to describe, compare, and select models for implementing hospital-based addiction care and measure outcomes.
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Affiliation(s)
- Honora Englander
- Section of Addiction Medicine in Division of General Internal Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
- Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Amy Jones
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Noa Krawczyk
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Alisa Patten
- Section of Addiction Medicine in Division of General Internal Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Timothy Roberts
- NYU Health Sciences Library, New York University Grossman School of Medicine, New York, NY, USA
| | - P Todd Korthuis
- Section of Addiction Medicine in Division of General Internal Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer McNeely
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Weaver VK, Kennedy MC. Response to “Six Moments of Infection Prevention in Injection Drug Use: An Educational Toolkit for Clinicians” by Harvey et al. Open Forum Infect Dis 2022; 9:ofac145. [PMID: 35663287 PMCID: PMC9154324 DOI: 10.1093/ofid/ofac145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Victoria K Weaver
- British Columbia Centre on Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver
| | - Mary Clare Kennedy
- British Columbia Centre on Substance Use, Vancouver, Canada
- School of Social Work, University of British Columbia Okanagan, Canada
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22
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Jawa R, Rozansky H, Clemens D, Fagan M, Walley AY. Rethinking Home-based Outpatient Parenteral Antibiotic Therapy for Persons Who Inject Drugs: An Opportunity for Change in the Time of COVID-19. J Addict Med 2022; 16:e70-e72. [PMID: 33870955 PMCID: PMC8501142 DOI: 10.1097/adm.0000000000000856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/18/2021] [Indexed: 11/25/2022]
Abstract
Outpatient parenteral antibiotic therapy (OPAT) refers to the monitored provision of intravenous antibiotics for complicated infections outside of a hospital setting, typically in a rehabilitation facility, an infusion center, or the home. Home-based OPAT allows for safe completion of prolonged courses of therapy while decreasing costs to the healthcare system, minimizing the risk of hospital-related infectious exposures for patients, and permitting patients to recover in a familiar environment. Amidst the COVID-19 pandemic, during which nursing facilities have been at the center of many outbreaks of the SARS-CoV-2 virus, completion of antimicrobial therapy in the home is an even more appealing option. Persons who inject drugs (PWID) frequently present with infectious complications of their injection drug use which require long courses of parenteral therapy. However, these individuals are frequently excluded from home-based OPAT on the basis of their addiction history. This commentary describes perceived challenges to establishing home-based OPAT for PWID, discusses ways in which this is discriminatory and unsupported by available data, highlights ways in which the COVID-19 pandemic has accentuated inequities in care, and proposes a multidisciplinary approach championed by Addiction specialists to increasing implementation of OPAT for appropriate patients with substance use disorders.
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Affiliation(s)
- Raagini Jawa
- Section of Infectious Disease, Department of Medicine, Boston Medical Center, Boston, MA (RJ, DC, MF), Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA (RJ, HR, AYW)
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El-Dalati S, Cronin D, Riddell J, Shea M, Weinberg RL, Stoneman E, Patel T, Ressler K, Deeb GM. A step-by-step guide to implementing a multidisciplinary endocarditis team. Ther Adv Infect Dis 2021; 8:20499361211065596. [PMID: 34950478 PMCID: PMC8689603 DOI: 10.1177/20499361211065596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
Abstract
Over the last several years multiple studies, primarily from European centers have demonstrated the clinical and outcomes benefits of multidisciplinary endocarditis teams. Despite this literature, adoption of this approach to patient care has been slower in the United States. While there is literature outlining the optimal composition of an endocarditis team, there is little information to guide providers as they attempt to transform practice from a fragmented, disjointed process to an efficient, collaborative care model. In this review, the authors will outline the steps they took to create and implement a successful multidisciplinary endocarditis team at the University of Michigan. In conjunction with existing data, this piece can be used as a resource for clinicians seeking to improve the care of patients with endocarditis at their institutions.
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Affiliation(s)
- Sami El-Dalati
- Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, 740 South Limestone Street, Lexington, KY 40536, USA
| | - Daniel Cronin
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
| | - James Riddell
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
| | - Michael Shea
- Division of Cardiology, Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
| | - Richard L Weinberg
- Division of Cardiology, Department of Internal Medicine, Northwestern University, Chicago, IL, USA
| | - Emily Stoneman
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
| | - Twisha Patel
- College of Pharmacy, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
| | - Kirra Ressler
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
| | - George Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
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24
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Serota DP, Tookes HE, Hervera B, Gayle BM, Roeck CR, Suarez E, Forrest DW, Kolber MA, Bartholomew TS, Rodriguez AE, Doblecki-Lewis S. Harm reduction for the treatment of patients with severe injection-related infections: description of the Jackson SIRI Team. Ann Med 2021; 53:1960-1968. [PMID: 34726095 PMCID: PMC8567885 DOI: 10.1080/07853890.2021.1993326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Hospitalizations for severe injection-related infections (SIRI), such as endocarditis, osteomyelitis, and skin and soft tissue infections (SSTI) are increasingly common. People who inject drugs (PWID) experiencing SIRIs often receive inadequate substance use disorder (SUD) treatment and lack of access to harm reduction services. This translates into lengthy hospitalizations with high rates of patient-directed discharge, readmissions, and post-hospitalization mortality. The purpose of this study was to describe the development of an integrated "SIRI Team" and its initial barriers and facilitators to success. MATERIALS AND METHODS The Jackson SIRI Team was developed to improve both hospital and patient-level outcomes for individuals hospitalized with SIRIs at Jackson Memorial Hospital, a 1550-bed public hospital in Miami, Florida, United States. The SIRI Team provides integrated infectious disease and SUD treatment across the healthcare system starting from the inpatient setting and continuing for 90-days post-hospital discharge. The team uses a harm reduction approach, provides care coordination, focuses on access to medications for opioid use disorder (MOUD), and utilizes a variety of infection and addiction treatment modalities to suit each individual patient. RESULTS Over the initial 8-months of the SIRI Team, 21 patients were treated with 20 surviving until discharge. Infections included osteomyelitis, endocarditis, bacteraemia/fungemia, SSTIs, and septic arthritis. All patients had OUD and 95% used stimulants. All patients were discharged on MOUD and 95% completed their prescribed antibiotic course. At 90-days post-discharge, 25% had been readmitted and 70% reported taking MOUD. CONCLUSIONS A model of integrated infectious disease and SUD care for the treatment of SIRIs has the potential to improve infection and addiction outcomes. Providing attentive, patient-centered care, using a harm reduction approach can facilitate engagement of this marginalized population with the healthcare system.KEY MESSAGESIntegrated infectious disease and addiction treatment is a novel approach to treating severe injection-related infections.Harm reduction should be applied to treating patients with severe injection-related infections with a goal of facilitating antibiotic completion, remission from substance use disorder, and reducing hospital readmissions.
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Affiliation(s)
- David P. Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hansel E. Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Belén Hervera
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Babley M. Gayle
- Jackson Memorial Hospital, Jackson Health System, Miami, FL, USA
| | - Cara R. Roeck
- Jackson Memorial Hospital, Jackson Health System, Miami, FL, USA
| | - Edward Suarez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W. Forrest
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael A. Kolber
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S. Bartholomew
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan E. Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Susanne Doblecki-Lewis
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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25
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Jiang X, Parker RL, Vouri SM, Lo-Ciganic W, Diaby V, Henry L, Park H. Cascade of Hepatitis C Virus Care Among Patients With Substance Use Disorders. Am J Prev Med 2021; 61:576-584. [PMID: 34210584 PMCID: PMC8455419 DOI: 10.1016/j.amepre.2021.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Hepatitis C virus testing is recommended for people at high risk for infection, including those with substance use disorders. Little is known about the cascade of hepatitis C virus care (including testing, diagnosis, and treatments) among patients with substance use disorders in real-world clinical practice. This study aims to characterize the hepatitis C virus cascade of care and identify the factors associated with hepatitis C virus testing and diagnosis among Florida Medicaid beneficiaries with substance use disorders. METHODS A retrospective cohort analysis of Florida Medicaid data (2013-2018) was conducted in 2020 for patients aged 18-64 years with newly diagnosed substance use disorders (year 2012 was used to ascertain 1-year previous enrollment). A generalized estimating equation identified the factors associated with hepatitis C virus testing; a multivariable logistic model identified the factors associated with hepatitis C virus diagnosis. RESULTS Of the 156,770 patients with substance use disorders, 18% were tested for hepatitis C virus at least once. Among the tested patients, 8% had hepatitis C virus diagnoses. Among the 2,177 patients having a hepatitis C virus diagnosis, 11% initiated hepatitis C virus treatments, and 96% of them completed the hepatitis C virus treatments. Factors associated with being less likely to receive hepatitis C virus testing included being male (AOR=0.73, 95% CI=0.71, 0.75) and White (AOR=0.85, 95% CI=0.83, 0.87), whereas individuals who were male (AOR=1.49, 95% CI=1.35, 1.66) and White (AOR=2.71, 95% CI=2.38, 3.08) were more likely to be diagnosed with hepatitis C virus. The odds of receiving hepatitis C virus testing significantly increased annually (AOR=1.06, 95% CI=1.05, 1.07). CONCLUSIONS Future studies are warranted to investigate the barriers to access hepatitis C virus testing and treatment among Florida Medicaid beneficiaries with substance use disorders, especially for White male individuals.
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Affiliation(s)
- Xinyi Jiang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Robert L Parker
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida
| | - Scott Martin Vouri
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida
| | - Weihsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida
| | - Linda Henry
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Haesuk Park
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida; Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida.
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26
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Yeow RY, El-Dalati S, Jouney EA, Firn JI, Deeb GM, Konerman MC. The Root of the Problem. Circ Cardiovasc Qual Outcomes 2021; 14:e007750. [PMID: 34517727 DOI: 10.1161/circoutcomes.120.007750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Raymond Y Yeow
- Division of Cardiovascular Medicine (R.Y.Y., M.C.K.), Michigan Medicine, Ann Arbor
| | - Sami El-Dalati
- Division of Infectious Diseases, University of Pittsburgh Medical Center, PA (S.E.-D.)
| | - Edward A Jouney
- Department of Psychiatry (E.A.J.), Michigan Medicine, Ann Arbor
| | - Janice I Firn
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor (J.I.F.).,Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor (J.I.F.)
| | - G Michael Deeb
- Department of Cardiac Surgery (G.M.D.), Michigan Medicine, Ann Arbor
| | - Matthew C Konerman
- Division of Cardiovascular Medicine (R.Y.Y., M.C.K.), Michigan Medicine, Ann Arbor
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27
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Baddour LM, Thornhill MH, Dayer MJ. Injection Drug Use: A Minor Criterion With Major Implications for Patients With Infective Endocarditis. J Am Coll Cardiol 2021; 77:556-558. [PMID: 33538253 DOI: 10.1016/j.jacc.2020.11.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Larry M Baddour
- Division of Infectious Diseases, Departments of Medicine and Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
| | - Martin H Thornhill
- Unit of Oral and Maxillofacial Medicine Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - Mark J Dayer
- Department of Cardiology, Somerset Foundation National Health Service Trust, Taunton, United Kingdom
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McNamara KF, Biondi BE, Hernández-Ramírez RU, Taweh N, Grimshaw AA, Springer SA. A Systematic Review and Meta-Analysis of Studies Evaluating the Effect of Medication Treatment for Opioid Use Disorder on Infectious Disease Outcomes. Open Forum Infect Dis 2021; 8:ofab289. [PMID: 34430670 PMCID: PMC8378589 DOI: 10.1093/ofid/ofab289] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/30/2021] [Indexed: 11/12/2022] Open
Abstract
The opioid epidemic has fueled infectious disease epidemics. We determined the impact of medications for opioid use disorder (MOUD) on treatment outcomes of opioid use disorder (OUD)-associated infectious diseases: antiretroviral therapy (ART) adherence, human immunodeficiency virus (HIV) viral suppression, hepatitis C virus (HCV) sustained virologic response, HCV reinfection, new hepatitis B virus infections, and infectious endocarditis-related outcomes. Manuscripts reporting on these infectious disease outcomes in adults with OUD receiving MOUD compared with those with OUD "not" receiving MOUD were included. Initial search yielded 8169 papers; 9 were included in the final review. The meta-analysis revealed that MOUD was associated with greater ART adherence (odds ratio [OR] = 1.55; 95% confidence interval [CI] = 1.12-2.15) and HIV viral suppression (OR = 2.19; 95% CI = 1.88-2.56). One study suggested a positive association between MOUD and HCV sustained virologic response. There is significant support for integrating MOUD with HIV treatment to improve viral suppression among persons with HIV (PWH) and OUD. Treatment of OUD among PWH should be a priority to combat the opioid and HIV epidemics.
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Affiliation(s)
- Katelyn F McNamara
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Breanne E Biondi
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Raúl U Hernández-Ramírez
- Center for Methods in Implementation and Prevention Science, Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
| | - Noor Taweh
- Yale AIDS Program, Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA.,University of Connecticut, Storrs, Connecticut, USA
| | - Alyssa A Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, USA
| | - Sandra A Springer
- Yale AIDS Program, Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
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29
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Brothers TD, Lewer D, Bonn M, Webster D, Harris M. Social and structural determinants of injecting-related bacterial and fungal infections among people who inject drugs: protocol for a mixed studies systematic review. BMJ Open 2021; 11:e049924. [PMID: 34373309 PMCID: PMC8354281 DOI: 10.1136/bmjopen-2021-049924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/26/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Injecting-related bacterial and fungal infections are a common complication among people who inject drugs (PWID), associated with significant morbidity and mortality. Invasive infections, including infective endocarditis, appear to be increasing in incidence. To date, preventive efforts have focused on modifying individual-level risk behaviours (eg, hand-washing and skin-cleaning) without much success in reducing the population-level impact of these infections. Learning from successes in HIV prevention, there may be great value in looking beyond individual-level risk behaviours to the social determinants of health. Specifically, the risk environment conceptual framework identifies how social, physical, economic and political environmental factors facilitate and constrain individual behaviour, and therefore influence health outcomes. Understanding the social and structural determinants of injecting-related bacterial and fungal infections could help to identify new targets for prevention efforts in the face of increasing incidence of severe disease. METHODS AND ANALYSIS This is a protocol for a systematic review. We will review studies of PWID and investigate associations between risk factors (both individual-level and social/structural-level) and the incidence of hospitalisation or death due to injecting-related bacterial infections (skin and soft-tissue infections, bacteraemia, infective endocarditis, osteomyelitis, septic arthritis, epidural abscess and others). We will include quantitative, qualitative and mixed methods studies. Using directed content analysis, we will code risk factors for these infection-related outcomes according to their contributions to the risk environment in type (social, physical, economic or political) and level (microenvironmental or macroenvironmental). We will also code and present risk factors at each stage in the process of drug acquisition, preparation, injection, superficial infection care, severe infection care or hospitalisation, and outcomes after infection or hospital discharge. ETHICS AND DISSEMINATION As an analysis of the published literature, no ethics approval is required. The findings will inform a research agenda to develop and implement social/structural interventions aimed at reducing the burden of disease. PROSPERO REGISTRATION NUMBER CRD42021231411.
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Affiliation(s)
- Thomas D Brothers
- UCL Collaborative Centre for Inclusion Health, Institue of Epidemiology and Health Care, University College London, London, UK
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Dan Lewer
- UCL Collaborative Centre for Inclusion Health, Institue of Epidemiology and Health Care, University College London, London, UK
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, Nova Scotia, Canada
| | - Duncan Webster
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Infectious Diseases, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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30
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Sikka MK, Gore S, Vega T, Strnad L, Gregg J, Englander H. "OPTIONS-DC", a feasible discharge planning conference to expand infection treatment options for people with substance use disorder. BMC Infect Dis 2021; 21:772. [PMID: 34372776 PMCID: PMC8351414 DOI: 10.1186/s12879-021-06514-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Serious bacterial infections associated with substance use often result in long hospitalizations, premature discharges, and high costs. Out-of-hospital treatment options in people with substance use disorder (SUD) are often limited. Methods We describe a novel multidisciplinary and interprofessional care conference, “OPTIONS-DC,” to identify treatment options agreeable to both patients and providers using the frameworks of harm reduction and patient-centered care. We retrospectively reviewed charts of patients who had an OPTIONS-DC between February 2018 and July 2019 and used content analysis to understand the conferences’ effects on antibiotic treatment options. Results Fifty patients had an OPTIONS-DC during the study window. Forty-two (84%) had some intravenous (IV) substance use and 44 (88%) had an active substance use disorder. Participants’ primary substances included opioids (65%) or methamphetamines (28%). On average, conferences lasted 28 min. OPTIONS-DC providers recommended out-of-hospital antibiotic treatment options for 34 (68%) of patients. OPTIONS-DC recommended first line therapy of IV antibiotics for 35 (70%) patients, long-acting injectable antibiotics for 14 (28%), and oral therapy for 1 (2%). 35 (70%) patients that had an OPTIONS-DC completed an antibiotic course and 6 (12%) left the hospital prematurely. OPTIONS-DC expanded treatment options by exposing and contextualizing SUD, psychosocial risk and protective factors; incorporating patient preferences; and allowing providers to tailor antibiotic and SUD recommendations. Conclusions OPTIONS-DC is a feasible intervention that allows providers to integrate principles of harm reduction and offer patient-centered choices among patients needing prolonged antibiotic treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06514-9.
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Affiliation(s)
- Monica K Sikka
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L457, Portland, OR, 97239-3098, USA.
| | - Sara Gore
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L457, Portland, OR, 97239-3098, USA
| | - Taylor Vega
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Luke Strnad
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L457, Portland, OR, 97239-3098, USA.,Epidemiology Programs, School of Public Health, Oregon Health and Science University and Portland State University, Portland, OR, USA
| | - Jessica Gregg
- Section of Addiction Medicine, Division of General Internal Medicine, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, BTE 119, Portland, OR, 97239-3098, USA.,Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Honora Englander
- Section of Addiction Medicine, Division of General Internal Medicine, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, BTE 119, Portland, OR, 97239-3098, USA. .,Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
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31
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Serota DP, Chueng TA, Schechter MC. Applying the Infectious Diseases Literature to People who Inject Drugs. Infect Dis Clin North Am 2021; 34:539-558. [PMID: 32782101 DOI: 10.1016/j.idc.2020.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
People who inject drugs (PWID) presenting with injection drug use-associated infections are an understudied population excluded from most prospective infectious disease (ID) clinical trials. Careful application of the existing ID literature to PWID must consider their unique medical, psychological, and social challenges. Identification and treatment of the underlying substance use disorder are key underpinnings to any successful ID intervention.
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Affiliation(s)
- David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 Northwest 14 Street, Suite 851, Miami, FL 33136, USA.
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 Northwest 14 Street, Suite 851, Miami, FL 33136, USA; Jackson Memorial Hospital, Jackson Health System, Miami, FL, USA. https://twitter.com/teresachueng
| | - Marcos C Schechter
- Division of Infectious Diseases, Department of Medicine, Emory University, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303, USA. https://twitter.com/limbsandlungs
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32
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McCarthy NL, Baggs J, See I, Reddy SC, Jernigan JA, Gokhale RH, Fiore AE. Bacterial Infections Associated With Substance Use Disorders, Large Cohort of United States Hospitals, 2012-2017. Clin Infect Dis 2021; 71:e37-e44. [PMID: 31907515 DOI: 10.1093/cid/ciaa008] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/06/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Rises in the incidence of bacterial infections, such as infective endocarditis (IE), have been reported in conjunction with the opioid crisis. However, recent trends for IE and other serious infections among persons with substance use disorders (SUDs) are unknown. METHODS Using the Premier Healthcare Database, we identified hospitalizations from 2012 through 2017 among adults with primary discharge diagnoses of bacterial infections and secondary SUD diagnoses, using International Classification of Diseases, Clinical Modification Ninth and Tenth Revision codes. We calculated annual rates of infections with SUD diagnoses and evaluated temporal trends. Blood and cardiac tissue specimens were identified from IE hospitalizations to describe the microbiology distribution and temporal trends among hospitalizations with and without SUDs. RESULTS Among 72 481 weighted IE admissions recorded, SUD diagnoses increased from 19.9% in 2012 to 39.4% in 2017 (P < .0001). Hospitalizations with SUDs increased from 1.1 to 2.1 per 100 000 persons for IE, 1.4 to 2.4 per 100 000 persons for osteomyelitis, 0.5 to 0.9 per 100 000 persons for central nervous system abscesses, and 24.4 to 32.9 per 100 000 persons for skin and soft tissue infections. For adults aged 18-44 years, IE-SUD hospitalizations more than doubled, from 1.6 in 2012 to 3.6 in 2017 per 100 000 persons. Among all IE-SUD hospitalizations, 50.3% had a Staphylococcus aureus infection, compared with 19.4% of IE hospitalizations without SUDs. CONCLUSIONS Rates of hospitalization for serious infections among persons with SUDs are increasing, driven primarily by younger age groups. The differences in the microbiology of IE hospitalizations suggest that SUDs are changing the epidemiology of these infections.
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Affiliation(s)
- Natalie L McCarthy
- Division of Healthcare Quality Promotion, Epidemiology Research and Innovations Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Baggs
- Division of Healthcare Quality Promotion, Epidemiology Research and Innovations Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Isaac See
- Division of Healthcare Quality Promotion, Epidemiology Research and Innovations Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sujan C Reddy
- Division of Healthcare Quality Promotion, Epidemiology Research and Innovations Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John A Jernigan
- Division of Healthcare Quality Promotion, Epidemiology Research and Innovations Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Runa H Gokhale
- Division of Healthcare Quality Promotion, Epidemiology Research and Innovations Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anthony E Fiore
- Division of Healthcare Quality Promotion, Epidemiology Research and Innovations Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Springer SA, Del Rio C. Co-located Opioid Use Disorder and Hepatitis C Virus Treatment Is Not Only Right, But It Is Also the Smart Thing To Do as It Improves Outcomes! Clin Infect Dis 2021; 71:1723-1725. [PMID: 32011653 DOI: 10.1093/cid/ciaa111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 01/26/2023] Open
Affiliation(s)
- Sandra A Springer
- Department of Internal Medicine, Division of Infectious Disease, Yale AIDS Program, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carlos Del Rio
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
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Seval N, Frank CA, Litwin AH, Roth P, Schade MA, Pavlicova M, Levin FR, Brady KT, Nunes EV, Springer SA. Design and methods of a multi-site randomized controlled trial of an integrated care model of long-acting injectable buprenorphine with infectious disease treatment among persons hospitalized with infections and opioid use disorder. Contemp Clin Trials 2021; 105:106394. [PMID: 33838307 DOI: 10.1016/j.cct.2021.106394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospitalization with co-occurring opioid use disorder (OUD) and infections presents a critical time to intervene to improve outcomes for these intertwined epidemics that are typically managed separately. A surge in life-threatening infectious diseases associated with injection drug use, including bacterial and fungal infections, HIV, and HCV accounts for substantial healthcare utilization, morbidity, and mortality. Infectious Disease (ID) specialists manage severe infections that require hospitalization and are a logical resource to engage patients in medication treatment for OUD (MOUD). An injectable long-acting monthly formulation of buprenorphine (LAB) has a potential advantage for initiating MOUD within hospital settings and bridging to treatment after discharge. METHODS A randomized multi-site trial tests a new model of care (ID/LAB) in which OUD and infections are managed by ID specialists and hospitalists using LAB coupled with referrals to community resources for long-term MOUD. A sample of 200 adults admitted to three U.S. hospitals for OUD and infections are randomly assigned 1:1 to ID/LAB or treatment as usual (TAU). The primary outcome measure is the proportion of patients enrolled in effective MOUD at 12 weeks after randomization. Secondary outcomes include relapse to opioid use, adherence to infectious disease treatment, infection morbidity and mortality, and drug overdose. RESULTS We describe the design, procedures, statistical analysis, and early implementation issues of this randomized trial. CONCLUSIONS Study findings will provide insight into the feasibility and effectiveness of integrated treatment of OUD and serious infections and have the potential to reduce morbidity and mortality in this vulnerable population.
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Affiliation(s)
- Nikhil Seval
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Disease, Yale AIDS Program, New Haven, CT, USA
| | - Cynthia A Frank
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Disease, Yale AIDS Program, New Haven, CT, USA
| | - Alain H Litwin
- University of South Carolina School of Medicine Greenville, Prisma Health: Upstate Affiliate, Department of Infectious Disease, Greenville, SC, USA; Department of Medicine, University of South Carolina School of Medicine- Greenville, Greenville, SC, USA
| | - Prerana Roth
- University of South Carolina School of Medicine Greenville, Prisma Health: Upstate Affiliate, Department of Infectious Disease, Greenville, SC, USA
| | - Meredith A Schade
- Penn State Milton S. Hershey Medical Center, Department of Medicine, Division of Infectious Diseases, Hershey, PA, USA
| | - Martina Pavlicova
- Columbia University Mailman School of Public Health, Department of Biostatistics, New York, NY, USA
| | - Frances R Levin
- College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute/Division on Substance Use Disorders, New York, NY, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Edward V Nunes
- College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute/Division on Substance Use Disorders, New York, NY, USA
| | - Sandra A Springer
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Disease, Yale AIDS Program, New Haven, CT, USA.
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Park H, Song HJ, Jiang X, Henry L, Cook RL, Nelson DR. Direct-Acting Antiviral Treatment Use Remains Low Among Florida Medicaid Beneficiaries With Chronic Hepatitis C. Hepatol Commun 2021; 5:203-216. [PMID: 33553969 PMCID: PMC7850300 DOI: 10.1002/hep4.1634] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/25/2020] [Accepted: 10/18/2020] [Indexed: 02/04/2023] Open
Abstract
Medicaid prior authorization (PA) policies for treatment of hepatitis C virus (HCV) with direct-acting antiviral (DAA) therapy are changing. We aimed to evaluate effects of changes in PA requirements on treatment uptake and to determine the factors associated with DAA treatment among Florida Medicaid beneficiaries with HCV. This is a retrospective cohort analysis of Florida's Medicaid administrative claims and electronic medical records (2013-2018). A total of 14,063 newly diagnosed patients with HCV were grouped based on human immunodeficiency virus (HIV) co-infection and/or a substance use disorder (SUD) (7,735 HCV mono-infected with a SUD, 5,180 HCV mono-infected without a SUD, 564 HCV/HIV co-infected with a SUD, and 584 HCV/HIV co-infected without a SUD). Although the treatment rate increased three-fold after June 1, 2016, when a fibrosis-stage restriction was eliminated, only 8% received DAAs. Compared to HCV mono-infected without a SUD, HCV mono-infected with a SUD and HCV/HIV co-infected with a SUD were 47% (adjusted hazard ratio, 0.53; 95% confidence interval, 0.47-0.60) and 59% (adjusted hazard ratio, 0.41; 95% confidence interval, 0.28-0.61) less likely to initiate DAAs. Those with HCV/HIV/SUD did not experience a DAA initiation increase after a fibrosis-stage restriction was eliminated. Compared with Whites, Blacks were less likely to receive DAAs but were more likely to complete treatment. Use of medication-assisted therapy was low, despite those on medication-assisted therapy being 60% more likely to initiate DAA therapy and no more likely to discontinue therapy. Conclusion: Despite changes in Florida's Medicaid PA requirements for DAA treatment, only 8% received treatment. Disparities in treatment access were found among patients with HIV and a SUD, and who were Black.
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Affiliation(s)
- Haesuk Park
- Pharmaceutical Outcomes and PolicyCollege of PharmacyUniversity of FloridaGainesvilleFLUSA
| | - Hyun Jin Song
- Pharmaceutical Outcomes and PolicyCollege of PharmacyUniversity of FloridaGainesvilleFLUSA
| | - Xinyi Jiang
- Pharmaceutical Outcomes and PolicyCollege of PharmacyUniversity of FloridaGainesvilleFLUSA
| | - Linda Henry
- Pharmaceutical Outcomes and PolicyCollege of PharmacyUniversity of FloridaGainesvilleFLUSA
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of MedicineUniversity of FloridaGainesvilleFLUSA
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Althobaiti YS, Alzahrani MA, Alsharif NA, Alrobaie NS, Alsaab HO, Uddin MN. The Possible Relationship between the Abuse of Tobacco, Opioid, or Alcohol with COVID-19. Healthcare (Basel) 2020; 9:healthcare9010002. [PMID: 33375144 PMCID: PMC7822153 DOI: 10.3390/healthcare9010002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction: Substance use disorder has been frequently reported to increase the risk of infectious diseases, which might be owing to the sharing of contaminated inhalation, smoking, vaping, or injection equipment. Aim: This review analyzes the recent literature with the aim to put in light the possible relationship between the abuse of different substances (Tobacco, opioid, and Alcohol) with coronavirus disease (COVID-19). Tobacco: Multiple studies confirmed that cigarette smoking affects the respiratory system by increasing the expression of angiotensin-converting enzyme-2 (ACE2) receptors, which have a significant association with COVID-19 infection rate and disease severity. Opioid: Studies conducted regarding the association of opioid use disorder (OUD) and COVID-19 infection severity are limited; however, opioids can lead to both respiratory depression and kidney injuries, causing poor prognosis for those with COVID-19 infections. Alcohol: People with alcohol use disorders are at risk of developing acute lung injury and severe COVID-19 infection. Alcohol consumption during the COVID-19 pandemic has two possible scenarios: either increased or decreased based on situations. Conclusion: SUD has been frequently reported to have a positive relationship with COVID-19 severity Further studies are needed to understand the effects of opioids and alcohol abuse on COVID-19.
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Affiliation(s)
- Yusuf S. Althobaiti
- Addiction and Neuroscience Research Unit, Health Science Campus, Taif University, Taif 21974, Saudi Arabia; (M.A.A.); (N.A.A.); (N.S.A.)
- Department of Pharmacology and Toxicology, Health Science Campus, College of Pharmacy, Taif University, Taif 21974, Saudi Arabia
- General Directorate of Narcotics Control, General Administration for Precursors and Laboratories, Ministry of Interior, Riyadh 11134, Saudi Arabia
- Correspondence: ; Tel.: +966-545-736-200
| | - Maram A. Alzahrani
- Addiction and Neuroscience Research Unit, Health Science Campus, Taif University, Taif 21974, Saudi Arabia; (M.A.A.); (N.A.A.); (N.S.A.)
| | - Norah A. Alsharif
- Addiction and Neuroscience Research Unit, Health Science Campus, Taif University, Taif 21974, Saudi Arabia; (M.A.A.); (N.A.A.); (N.S.A.)
| | - Nawal S. Alrobaie
- Addiction and Neuroscience Research Unit, Health Science Campus, Taif University, Taif 21974, Saudi Arabia; (M.A.A.); (N.A.A.); (N.S.A.)
| | - Hashem O. Alsaab
- Department of Pharmaceutics and Pharmaceutical Technology, Taif University, Taif 21944, Saudi Arabia;
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Marks LR, Liang SY, Muthulingam D, Schwarz ES, Liss DB, Munigala S, Warren DK, Durkin MJ. Evaluation of Partial Oral Antibiotic Treatment for Persons Who Inject Drugs and Are Hospitalized With Invasive Infections. Clin Infect Dis 2020; 71:e650-e656. [PMID: 32239136 PMCID: PMC7745005 DOI: 10.1093/cid/ciaa365] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Persons who inject drugs (PWID) are at risk of invasive infections; however, hospitalizations to treat these infections are frequently complicated by against medical advice (AMA) discharges. This study compared outcomes among PWID who (1) completed a full course of inpatient intravenous (IV) antibiotics, (2) received a partial course of IV antibiotics but were not prescribed any antibiotics on AMA discharge, and (3) received a partial course of IV antibiotics and were prescribed oral antibiotics on AMA discharge. METHODS A retrospective, cohort study of PWID aged ≥18 years admitted to a tertiary referral center between 01/2016 and 07/2019, who received an infectious diseases consultation for an invasive bacterial or fungal infection. RESULTS 293 PWID were included in the study. 90-day all-cause readmission rates were highest among PWID who did not receive oral antibiotic therapy on AMA discharge (n = 46, 68.7%), compared with inpatient IV (n = 43, 31.5%) and partial oral (n = 27, 32.5%) antibiotics. In a multivariate analysis, 90-day readmission risk was higher among PWID who did not receive oral antibiotic therapy on AMA discharge (adjusted hazard ratio [aHR], 2.32; 95% confidence interval [CI], 1.41-3.82) and not different among PWID prescribed oral antibiotic therapy on AMA discharge (aHR, .99; 95% CI, .62-1.62). Surgical source control (aHR, .57; 95% CI, .37-.87) and addiction medicine consultation (aHR, .57; 95% CI, .38-.86) were both associated with reduced readmissions. CONCLUSIONS Our single-center study suggests access to oral antibiotic therapy for PWID who cannot complete prolonged inpatient IV antibiotic courses is beneficial.
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Affiliation(s)
- Laura R Marks
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Stephen Y Liang
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
- Division of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Dharushana Muthulingam
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Evan S Schwarz
- Division of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
- Section of Medical Toxicology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - David B Liss
- Division of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
- Section of Medical Toxicology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Satish Munigala
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - David K Warren
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Michael J Durkin
- Division of Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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Farnsworth CW, Lloyd M, Jean S. Opioid Use Disorder and Associated Infectious Disease: The Role of the Laboratory in Addressing Health Disparities. J Appl Lab Med 2020; 6:180-193. [PMID: 33438735 DOI: 10.1093/jalm/jfaa150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/07/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Opioid use disorder, defined as a pattern of problematic opioid use leading to clinically significant impairment, has resulted in considerable morbidity and mortality throughout the world. This is due, at least in part, to the marginalized status of patients with opioid use disorder, limiting their access to appropriate laboratory testing, diagnosis, and treatment. Infections have long been associated with illicit drug use and contribute considerably to morbidity and mortality. However, barriers to testing and negative stigmas associated with opioid use disorder present unique challenges to infectious disease testing in this patient population. CONTENT This review addresses the associations between opioid use disorder and infectious organisms, highlighting the health disparities encountered by patients with opioid use disorder, and the important role of laboratory testing for diagnosing and managing these patients. SUMMARY Infections are among the most frequent and adverse complications among patients with opioid use disorder. As a result of health disparities and systemic biases, patients that misuse opioids are less likely to receive laboratory testing and treatment. However, laboratories play a crucial in identifying patients that use drugs illicitly and infections associated with illicit drug use.
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Affiliation(s)
- Christopher W Farnsworth
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University, St. Louis, MO
| | - Matthew Lloyd
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University, St. Louis, MO
| | - Sophonie Jean
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH
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Capizzi J, Leahy J, Wheelock H, Garcia J, Strnad L, Sikka M, Englander H, Thomas A, Korthuis PT, Menza TW. Population-based trends in hospitalizations due to injection drug use-related serious bacterial infections, Oregon, 2008 to 2018. PLoS One 2020; 15:e0242165. [PMID: 33166363 PMCID: PMC7652306 DOI: 10.1371/journal.pone.0242165] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/27/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Injection drug use has far-reaching social, economic, and health consequences. Serious bacterial infections, including skin/soft tissue infections, osteomyelitis, bacteremia, and endocarditis, are particularly morbid and mortal consequences of injection drug use. METHODS We conducted a population-based retrospective cohort analysis of hospitalizations among patients with a diagnosis code for substance use and a serious bacterial infection during the same hospital admission using Oregon Hospital Discharge Data. We examined trends in hospitalizations and costs of hospitalizations attributable to injection drug use-related serious bacterial infections from January 1, 2008 through December 31, 2018. RESULTS From 2008 to 2018, Oregon hospital discharge data included 4,084,743 hospitalizations among 2,090,359 patients. During the study period, hospitalizations for injection drug use-related serious bacterial infection increased from 980 to 6,265 per year, or from 0.26% to 1.68% of all hospitalizations (P<0.001). The number of unique patients with an injection drug use-related serious bacterial infection increased from 839 to 5,055, or from 2.52% to 8.46% of all patients (P<0.001). While hospitalizations for all injection drug use-related serious bacterial infections increased over the study period, bacteremia/sepsis hospitalizations rose most rapidly with an 18-fold increase. Opioid use diagnoses accounted for the largest percentage of hospitalizations for injection drug use-related serious bacterial infections, but hospitalizations for amphetamine-type stimulant-related serious bacterial infections rose most rapidly with a 15-fold increase. People living with HIV and HCV experienced increases in hospitalizations for injection drug use-related serious bacterial infection during the study period. Overall, the total cost of hospitalizations for injection drug use-related serious bacterial infections increased from $16,305,129 in 2008 to $150,879,237 in 2018 (P<0.001). CONCLUSIONS In Oregon, hospitalizations for injection drug use-related serious bacterial infections increased dramatically and exacted a substantial cost on the health care system from 2008 to 2018. This increase in hospitalizations represents an opportunity to initiate substance use disorder treatment and harm reduction services to improve outcomes for people who inject drugs.
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Affiliation(s)
- Jeffrey Capizzi
- Public Health Division, Oregon Health Authority, Portland, Oregon, United States of America
| | - Judith Leahy
- Public Health Division, Oregon Health Authority, Portland, Oregon, United States of America
| | - Haven Wheelock
- OutsideIn, A Federally Qualified Health Center (FQHC), Portland, Oregon, United States of America
| | - Jonathan Garcia
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, United States of America
| | - Luke Strnad
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Monica Sikka
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Honora Englander
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Ann Thomas
- Public Health Division, Oregon Health Authority, Portland, Oregon, United States of America
| | - P. Todd Korthuis
- Public Health Division, Oregon Health Authority, Portland, Oregon, United States of America
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Timothy William Menza
- Public Health Division, Oregon Health Authority, Portland, Oregon, United States of America
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
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Peckham AM, Young EH. Opportunities to Offer Harm Reduction to People who Inject Drugs During Infectious Disease Encounters: Narrative Review. Open Forum Infect Dis 2020; 7:ofaa503. [PMID: 33241069 PMCID: PMC7676504 DOI: 10.1093/ofid/ofaa503] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022] Open
Abstract
Increased rates of overdose (OD) and blood-borne infections have been associated with injection drug use (IDU). This increasing overlap between IDU-related infectious diseases (ID) is a byproduct of the opioid OD crisis, especially with the transition to synthetic opioids with faster onset and shorter duration leading to potentially more frequent injections. ID specialists are uniquely positioned to positively impact the opioid OD crisis by capitalizing on opportunistic moments of engagement during clinical encounters with people who inject drugs (PWID). Harm reduction services should therefore be expanded and offered to PWID in ID settings to reduce rates of OD, infection, and hospitalization. Major target areas include (1) teaching and distribution of materials related to safer injection practice such as sterile injection supplies, fentanyl test strips, and naloxone; (2) increased screening and access to pre-exposure prophylaxis and postexposure prophylaxis; and (3) initiation of medications for opioid use disorder. Incorporating these strategies in various treatment settings can expand treatment access, improve patient outcomes, and reduce stigma associated with IDU.
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Affiliation(s)
- Alyssa M Peckham
- School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
- Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erika H Young
- School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
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Schranz A, Barocas JA. Infective Endocarditis in Persons Who Use Drugs: Epidemiology, Current Management, and Emerging Treatments. Infect Dis Clin North Am 2020; 34:479-493. [PMID: 32782097 PMCID: PMC7945002 DOI: 10.1016/j.idc.2020.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Infective endocarditis associated with injection drug use (IDU-IE) is markedly increasing in the United States and Canada. Long-term outcomes are dismal and stem from insufficient substance use disorder treatment. In this review, we summarize the principles of antimicrobial and surgical management for infective endocarditis associated with injection drug use. We discuss approaches to opioid use disorder care and harm reduction in the inpatient setting and review opportunities to address preventable infections among persons injecting drugs. We highlight barriers to implementing optimal treatment and consider novel approaches that may reshape infective endocarditis associated with injection drug use treatment in coming years.
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Affiliation(s)
- Asher Schranz
- Division of Infectious Diseases, University of North Carolina-Chapel Hill, 130 Mason Farm Road (Bioinformatics), CB #7030, Chapel Hill, NC 27599-7030, USA. https://twitter.com/asherjs
| | - Joshua A Barocas
- Section of Infectious Diseases, Boston Medical Center, Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA.
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Seval N, Eaton E, Springer SA. Beyond Antibiotics: A Practical Guide for the Infectious Disease Physician to Treat Opioid Use Disorder in the Setting of Associated Infectious Diseases. Open Forum Infect Dis 2020; 7:ofz539. [PMID: 31993454 PMCID: PMC6979000 DOI: 10.1093/ofid/ofz539] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/20/2019] [Indexed: 01/15/2023] Open
Abstract
Infections are a common cause of hospitalization for patients with opioid use disorder (OUD), and hospital admissions are rising in the context of the worsening US opioid crisis. Infectious disease (ID) physicians are frequently the first point of medical contact for these patients. In this article, we discuss the integration of evidence-based management of OUD and patient-centered care of hospitalized persons with acute injection-related infections. We describe the following components of a comprehensive approach for OUD with inpatient ID consultations: (1) how to screen for OUD; (2) how to initiate the 3 US Food and Drug Administration-approved medications for OUD (buprenorphine, methadone, and extended-release naltrexone); (3) how to manage acute pain and opioid-related conditions; and (4) how to link and integrate ID and OUD treatment after hospital discharge. These strategies reduce unplanned discharges and increase completion of recommended antimicrobial regimens.
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Affiliation(s)
- Nikhil Seval
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ellen Eaton
- Department of Medicine, Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sandra A Springer
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
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