83. A Descriptive Analysis of a Multi-disciplinary Approach to Opioid Use Disorder Treatment Within an Infectious Diseases Clinic

Abstract

Background Opioid overdose is the leading cause of injury-related death in the US. Kentucky ranks in the top 5 states for opioid overdose deaths. The rate of injection drug use-associated infections (IDU-AI) has risen; the University of Kentucky Infectious Diseases division (UKID) treated 401 endocarditis cases in 2018, of which 73% were IDU-AI. To curb overdose deaths, ease financial burden on healthcare, and improve patient outcomes, patients need tools for recovery from opioid use disorder (OUD). Access to OUD treatment in Kentucky and much of the US is limited. Poverty, unemployment, and legal issues are barriers. Methods UKID implemented a multi-disciplinary approach to expand access to medication assisted treatment (MAT). This is an ongoing study. Any patient ≥18 years old with IDU-AI and OUD is eligible for enrollment unless pregnant or incarcerated. At enrollment and at three additional time points, patients complete both a study specific and Government Performance and Results Act (GPRA) survey. Patients may start MAT and mental health counseling with UKID or be referred elsewhere and are eligible for transportation assistance and medical case management. Results To date, there have been 127 referrals. Of these, 87 (69%) were eligible and 54 enrolled (62% of eligible). Primary IVDU-AI includes HIV (n=4; 7%), HCV (n=5; 9%), HIV/HCV (n=3; 6%), endocarditis (n=32; 59%), and other (n=10; 19%). Patients are 48% male (n=26) and 91% white (n=91) with a median age of 34 years (IQR: 16); 35% are receiving MAT (n=19) with 14.8% (n=8) managed by UKID. Other service data are available for 51 patients. Naloxone was dispensed to 45 (88%) patients, 24 (47%) received relapse prevention services, 13 (25%) engaged in peer support, 9 (18%) participated in self-help groups, and 10 (20%) received transportation aid. Conclusion Increasing engagement in MAT and wrap-around services is an important touchpoint for OUD. We present a comprehensive program to achieve this for patients who would otherwise be discharged without follow-up for OUD. This program shows proof of concept that patients can be engaged in MAT by ID providers. Ongoing analysis will include longitudinal review of patient progress and outcomes, including hospital readmission, and a study to determine patients’ perceived impact on their quality of life. Disclosures All Authors: No reported disclosures

Temporal Trends of Infective Endocarditis in North America From 2000 to 2017—A Systematic Review

“…Despite the prevalence of PWID/IE in some rural areas, larger tertiary care centers in urban environments have also been impacted, in part related to the referral of IE patients for management expertise. For example, the prevalence of PWID in adult patients with IE seen recently in Boston, Massachusetts, and Lexington, Kentucky, has reached 46% and 73%, respectively [ 8 , 9 ].…”

Injection Drug Use

“…For institutions where resources have been available, a more traditional approach has included addiction medicine experts functioning as part of the endocarditis team, both in inpatient and ambulatory care settings. Another more recent option has included multispecialty care being provided in infectious diseases (ID) clinics with supportive staff to manage all aspects of addiction drug use (11). A call for addiction medicine expertise training of ID specialists represents another option with a more holistic approach (12).…”