Curbing the opioid epidemic and related infectious diseases calls for routine testing and treatment of patients in clinics and hospitals, three addiction treatment and infectious diseases experts recommended in a series of action steps published in the Annals of Internal Medicine. The authors based their conclusions on proceedings from a National Academies of Sciences, Engineering and Medicine (NASEM) workshop on the subject, in which all participated.

The opioid crisis is claiming American lives every day. The number of drug overdoses has increased by 300% from 1999 to 2016, according to the Centers for Disease Control and Prevention (CDC). Many drug addicted individuals whose prescriptions are cut off turn to injected drugs, contributing to a rise in HIV, hepatitis C and other infections. The epidemic has caught the attention of all healthcare sectors, including the laboratory community. AACC has closely been following this topic, addressing the role of clinical labs in solving this health crisisat its recent 70th AACC Annual Scientific Meeting & Clinical Lab Expo in Chicago.

In wake of these troubling developments, NASEM held a workshop in March to discuss approaches for reducing infectious disease comorbidities caused by injected drug use. The meeting covered a number of topics, such as the connection between opioid use and outbreaks of viral hepatitis, HIV, and endocarditis in specific regions of the country, and working within existing public health, medical, and criminal justice systems to treat infection and prevent disease in injectable drug users. Participants discussed the availability of funds to carry out new strategies and also delved into topic of respectful treatment of patients.

NASEM issued a report on the proceedings, which underscored the need to bolster opioid use disorder (OUD) treatment and its intersecting infectious disease components in healthcare settings. Healthcare facilities offer the perfect opportunity to find and treat these individuals, but few have resources to do so. “The workshop proceedings and proposed strategies can provide a springboard for intensified and informed discussions about effective approaches to support the integration of infectious disease prevention and treatment into our comprehensive opioid strategy at the federal, state and local levels,” wrote Corinna Dan, RN, MPH, viral hepatitis policy advisor with the U.S. Department of Health and Human Services’ Office of HIV/AIDS and Infectious Disease Policy, and Adm. Brett P. Giroir, MD, assistant secretary for health, in a blog post about the workshop.

Based on these discussions, Carlos del Rio, MD, chair of the NASEM workshop committee and professor of medicine at Emory University School of Medicine in Atlanta, teamed up with two other workshop participants, Sandra A. Springer, MD, director of the Infectious Disease Outpatient Clinic at Yale University in New Haven, Connecticut, and P. Todd Korthuis, MD, MPH, program director of the addiction medicine fellowship at Oregon Health and Science University in Portland, to co-author a related commentary in the Annals of Internal Medicine.

“Treatment can save lives,” said Korthuis in a statement. “The national opioid epidemic can turn around if we embrace opioid use disorder as a chronic medical condition that needs treatment instead of a moral issue or the result of poor willpower.”

The article described five actions steps to target OUD and related infectious diseases:

  • Conduct OUD screening in all relevant healthcare settings;
  • Immediately prescribe effective medication treatment for OUD and/or for opioid withdrawal symptoms;
  • Develop hospital-based protocols that make it easier to initiate OUD treatment and link to community-based treatment upon discharge;
  • Boost OUD training to personnel in hospitals, medical schools, physician assistant schools, nursing schools, and residency programs; and
  • Increase states’ access to addiction care and funding to provide effective OUD therapies.

“All healthcare providers are needed to combat the OUD epidemic and its infectious consequences. Those who treat infectious complications of OUD are well-suited to screen for OUD and begin treatment with effective [Food and Drug Administration]-approved medications. Integrating our collective skills may make the difference between life and death for patients living with OUD,” the three experts concluded.