Integrating Responses
at the Intersection of
Opioid Use Disorder
and Infectious Disease
Epidemics
PROCEEDINGS OF A WORKSHOP
Anna Nicholson, Rapporteur
Board on Population Health and Public Health Practice
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by Contract No. 10003842 between the National Academy of Sciences and the Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-47794-9
International Standard Book Number-10: 0-309-47794-8
Digital Object Identifier: https://doi.org/10.17226/25153
Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2018 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Integrating responses at the intersection of opioid use disorder and infectious disease epidemics: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25153.
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WORKSHOP PLANNING COMMITTEE ON INTEGRATING INFECTIOUS DISEASE CONSIDERATIONS WITH RESPONSE TO THE OPIOID EPIDEMIC1
CARLOS M. DEL RIO (Chair), Hubert Professor and Chair, Rollins School of Public Health, Emory University
JOHN DREYZEHNER, Commissioner, Tennessee Department of Health
TRACI G. GREEN, Adjunct Associate Professor of Emergency Medicine, Adjunct Associate Professor of Epidemiology, Boston Medical Center
VAN INGRAM, Executive Director, Kentucky Office of Drug Control Policy
P. TODD KORTHUIS, Associate Professor of Medicine, Program Director, Addiction Medicine Fellowship, and Chief, Addiction Medicine Section, Oregon Health & Science University
NATASHA K. MARTIN, Associate Professor, University of California, San Diego
SANDRA ANN SPRINGER, Associate Professor of Medicine, Associate Clinical Professor of Nursing, Yale School of Medicine; Director, Infectious Disease Outpatient Clinic–Newington, and Attending Physician–West Haven, Veterans Affairs Connecticut Healthcare System, Newington
DACE SVIKIS, Deputy Director, Institute for Women’s Health, Virginia Commonwealth University
CHUCK WEXLER, Executive Director, Police Executive Research Forum
Health and Medicine Division Staff
KATHLEEN STRATTON, Scholar, Study Director
HOPE HARE, Administrative Assistant
ALEXIS WOJTOWICZ, Senior Program Assistant
ROSE MARIE MARTINEZ, Senior Director, Board on Population Health and Public Health Practice
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
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Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
JUDITH FEINBERG, West Virginia University
JAMES HUGHES, Emory University
P. TODD KORTHUIS, Oregon Health & Science University
CHARLES P. O’BRIEN, University of Pennsylvania
SANDRA SPRINGER, Yale University
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by HUGH H. TILSON, University of North Carolina School of Public Health. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies.
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Contents
Charge to the Workshop Attendees
Organization of the Proceedings
Geography of Infectious Diseases Related to the Opioid Epidemic
Modeling the Prevention of Infectious Diseases Among People Who Inject Drugs
Economic Implications of Treatment Programs
Perspectives of Patients and Providers
Role of Public Health Departments
Improving Care for Hospitalized Adults with Substance Use Disorder
Exploring Challenges and Opportunities in Rural America
4 EXPLORING OPPORTUNITIES IN CORRECTIONAL HEALTH, LAW, AND LAW ENFORCEMENT
Correctional Health and the Opioid Epidemic
Using Law to Address Addiction and Its Consequences
Opportunities for Law Enforcement and First Responders
Panel Discussion on Law and Law Enforcement
5 RESEARCH DIRECTIONS, POLICY INITIATIVES, AND POTENTIAL WAYS FORWARD
Research Directions and Policy Initiatives
Presentations by Session Rapporteurs
Boxes and Figures
BOXES
1-1 Impact of the Opioid Epidemic on Women
2-1 Network Effects in Hepatitis C Treatment Targeting Specific People Who Inject Drugs
2-2 Incremental Cost-Effectiveness Ratio
3-1 Misperceptions Around One-to-One Needle Exchange
3-2 Case Example of a Patient with Opioid Use Disorder
3-3 Multiple Epidemics in West Virginia
4-1 Ensuring the Safety of Responding Police Officers
4-2 Personal Stories of “Not My Child” Panelists
5-1 Highlights from Session Rapporteur Presentations
FIGURES
2-2 Incidence of reported acute hepatitis C in the United States (1982–2008)
2-3 Incidence of acute hepatitis C by age group in the United States (2000–2015)
2-4 Estimated hepatitis C antibody prevalence rate per 100,000 persons (2010)
2-5 Age-adjusted drug overdose death rates by opioid category, United States (1999–2016)
2-7 Estimated number of transmissions among individuals in U.S. care cascade (2009)
2-8 Effect of HCV screening and treatment on new HCV infections in the community
2-9 Efficiency frontier of HIV prevention packages
2-10 Effect of substance disorders on medical and behavioral health expenditures by age group
3-1 Overdose deaths by opioids in San Francisco (2006–2016)
3-2 Opioid-related hospitalizations in the United States (2005–2014)
3-3 Increasing rates of infectious diseases in the rural South
3-4 U.S. counties with physicians with waivers to prescribe buprenorphine
4-1 Opioid euphoria and withdrawal
4-2 Opioid effect versus log dose for opioid agonist, partial agonist, and antagonist
4-4 Cycle of implementation science
5-1 The Patient-Centered Outcomes Research Institute’s complementary role
Acronyms and Abbreviations
ACA |
Patient Protection and Affordable Care Act |
ACO |
accountable care organization |
AHRQ |
Agency for Healthcare Research and Quality |
ART |
antiretroviral therapy |
ASAM |
American Society of Addiction Medicine |
CDC |
Centers for Disease Control and Prevention |
CER |
clinical effectiveness research |
CMS |
Centers for Medicare & Medicaid Services |
CROI |
Conference on Retroviruses and Opportunistic Infections |
DOPE |
Drug Overdose Prevention and Education |
DUHI |
Drug User Health Initiative |
ED |
emergency department |
HBV |
hepatitis B virus |
HCUP |
Healthcare Cost and Utilization Project |
HCV |
hepatitis C virus |
HHS |
Department of Health and Human Services |
HIV |
human immunodeficiency virus |
HRSA |
Health Resources and Services Administration |
ICER |
incremental cost-effectiveness ratio |
IDSA |
Infectious Diseases Society of America |
IMPACT |
Improving Addiction Care Team |
MAT |
medication(s) for addiction treatment (or therapy); medication-assisted therapy (or treatment) |
MERT |
medically enhanced residential treatment |
MOUD |
medication for opioid use disorder |
MSM |
men who have sex with men |
NHANES |
National Health and Nutrition Examination Survey |
NIS |
Nationwide Inpatient Sample |
NOSE |
Naloxone prescription for Opioid Safety Evaluation |
NSP |
needle services program |
OAT |
opiate agonist therapy |
OHAIDP |
HHS Office of HIV/AIDS and Infectious Disease Policy |
OHSU |
Oregon Health & Science University |
OWH |
HHS Office on Women’s Health |
PCORI |
Patient-Centered Outcomes Research Institute |
PDMP |
prescription drug monitoring program |
PICC |
peripherally inserted central catheter |
PrEP |
preexposure prophylaxis |
PWID |
people who inject drugs |
PWUD |
people who use drugs |
RODS |
rapid opioid dependence screen |
SAMHSA |
Substance Abuse and Mental Health Services Administration |
SEP |
syringe exchange program |
SFDPH |
San Francisco Department of Public Health |
SSP |
syringe services program |
SUD |
substance use disorder |
WWID |
women who inject drugs |
WWUD |
women who use drugs |
Medications1
Term | Definition |
---|---|
Buprenorphine | A partial opioid agonist |
Naloxone | An opioid antagonist; the active ingredient in Narcan® |
Naltrexone | An opioid antagonist |
Suboxone® | Trade name for a combination of buprenorphine and naloxone |
Vivitrol® | Trade name for an extended release form of naltrexone |
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1 This text was revised after prepublication release.
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