Stretching the Scope — Becoming Frontline Addiction-Medicine Providers

Rapoport, Alison B; Rowley, Christopher F

doi:10.1056/nejmp1706492

Cited by 30 publications

(21 citation statements)

References 1 publication

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“…This is particularly relevant in the U.S., as some OAT programs are significantly more likely than others to provide low OAT doses to African Americans, who continue to experience a high prevalence of OUD and related harms (D’Aunno et al, 2019). Currently, clinical options for OAT delivery are expanding, and this treatment modality will become available in a larger number of North American settings experiencing disproportionately high levels of IDU-related morbidity and mortality (Rapoport and Rowley, 2017). Researchers and key stakeholders should leverage these opportunities to help address effective OAT dose levels to reduce the harms associated with OUD and help mitigate the risk of injection initiation assistance.…”

Section: Discussionmentioning

confidence: 99%

Opioid agonist treatment and the process of injection drug use initiation

Mittal

Jain

Sun

et al. 2019

Drug and Alcohol Dependence

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Background: Opioid agonist treatment (OAT) is an effective biomedical intervention to manage opioid use disorder among persons who inject drugs (PWID). Preliminary evidence suggests that OAT may also disrupt the social communicability of injection drug use (IDU) practices by established PWID. We therefore aim to investigate the association between OAT enrollment and initiating others into IDU among PWID in Vancouver, Canada. Methods: Preventing Injecting by Modifying Existing Responses (PRIMER; NIDA DP2-DA040256–01) is a prospective multi-cohort study seeking to identify structural interventions that reduce the risk that PWID initiate others into IDU. The present analysis was conducted using data from a participating cohort of PWID in Vancouver, Canada, between December 2014 and May 2017. Multivariable logistic regression models were built to assess the association between reporting active (i.e., within the past six months) OAT enrollment and assisting others in injection initiation. A final model was determined using a manual stepwise approach whereby covariates were excluded if their removal altered the coefficient of interest by <5%. Results: Participants (n=1740) were predominantly male (62.3%); 35.1% reported daily injecting (n=611); 860 (49.4%) reported active OAT enrollment, and 80 (4.6%) reported recently providing injection initiation assistance. In a multivariable model, participants who reported active OAT enrollment had significantly lower odds of recently providing injection initiation assistance (Adjusted Odds Ratio=0.52, 95% Confidence Interval: 0.31–0.87, P=0.01). Conclusion: Results suggest a protective association between OAT and the expansion of IDU practices among vulnerable populations, suggesting its potential use as ‘addiction treatment as prevention.’

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Section: Discussionmentioning

confidence: 99%

Opioid agonist treatment and the process of injection drug use initiation

Mittal

Jain

Sun

et al. 2019

Drug and Alcohol Dependence

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“…Further research is needed to examine the impact of addiction treatment for PWID who are being considered for OPAT. The impact of ID physicians engaging PWID with infections and providing medication treatment for substance use disorder in the context of OPAT also bears further examination [ 39 , 40 ]. In addition, ID physicians can further play a role in recommending appropriate treatments (ie, long-acting glycopeptides) for individuals who may not be suitable candidates for OPAT.…”

Section: Discussionmentioning

confidence: 99%

Outpatient Parenteral Antimicrobial Therapy Among People Who Inject Drugs: A Review of the Literature

Suzuki

Johnson

Montgomery

et al. 2018

Open Forum Infectious Diseases

109

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Hospitalizations for people who inject drugs (PWID) with infectious complications requiring prolonged antibiotic therapy are increasing in the context of the opioid epidemic. Although outpatient parenteral antimicrobial therapy (OPAT) is routinely offered to patients without a history of injection drug use (IDU), PWID are often excluded from consideration of OPAT. To better assess the evidence base for the safety and effectiveness of OPAT for PWID, we conducted a review of the published literature. Results suggest that OPAT may be safe and effective for PWID, with rates of OPAT completion, mortality, and catheter-related complications comparable to rates among patients without a history of IDU. Rates of hospital readmissions may be higher among PWID, but instances of misuse of the venous catheter were rarely reported. More research is needed to study the safety and effectiveness of OPAT among PWID, as well as studying the combination of OPAT and addiction treatment.

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“…For example, only a small number of ID providers queried (10%, n = 51) strongly agreed that their care setting provided comprehensive substance use treatment, highlighting that the majority of providers treat complex infection in PWID who lack access to treatment for underlying opioid use disorders. Respondents expressed diverse opinions regarding the potential role for ID providers in the management of addiction, and acquisition of a federal waiver to prescribe buprenorphine was rare among respondents, commensurate with national data reporting that approximately 4% of practicing physicians have waiver certification [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Infectious Diseases Physicians’ Perspectives Regarding Injection Drug Use and Related Infections, United States, 2017

Rapoport

Fischer

Santibañez

et al. 2018

Open Forum Infectious Diseases

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BackgroundIn the context of the opioid epidemic, injection drug use (IDU)–related infections are an escalating health issue for infectious diseases (ID) physicians in the United States.MethodsWe conducted a mixed methods survey of the Infectious Diseases Society of America’s Emerging Infections Network between February and April 2017 to evaluate perspectives relating to care of persons who inject drugs (PWID). Topics included the frequency of and management strategies for IDU-related infection, the availability of addiction services, and the evolving role of ID physicians in substance use disorder (SUD) management.ResultsMore than half (53%, n = 672) of 1273 network members participated. Of these, 78% (n = 526) reported treating PWID. Infections frequently encountered included skin and soft tissue (62%, n = 324), bacteremia/fungemia (54%, n = 281), and endocarditis (50%, n = 263). In the past year, 79% (n = 416) reported that most IDU-related infections required ≥2 weeks of parenteral antibiotics; strategies frequently employed for prolonged treatment included completion of the entire course in the inpatient unit (41%, n = 218) or at another supervised facility (35%, n = 182). Only 35% (n = 184) of respondents agreed/strongly agreed that their health system offered comprehensive SUD management; 46% (n = 242) felt that ID providers should actively manage SUD.ConclusionsThe majority of physicians surveyed treated PWID and reported myriad obstacles to providing care. Public health and health care systems should consider ways to support ID physicians caring for PWID, including (1) guidelines for providing complex care, including safe provision of multiweek parenteral antibiotics; (2) improved access to SUD management; and (3) strategies to assist those interested in roles in SUD management.

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Stretching the Scope — Becoming Frontline Addiction-Medicine Providers

Cited by 30 publications

References 1 publication

Opioid agonist treatment and the process of injection drug use initiation

Opioid agonist treatment and the process of injection drug use initiation

Outpatient Parenteral Antimicrobial Therapy Among People Who Inject Drugs: A Review of the Literature

Infectious Diseases Physicians’ Perspectives Regarding Injection Drug Use and Related Infections, United States, 2017

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