Coordinated medical treatment of opioid use disorder and infectious disease

项目摘要 目前的阿片类药物使用障碍（OUD）流行导致感染增加，不仅包括HCV 和艾滋病毒，但也包括侵入性细菌感染，包括金黄色葡萄球菌菌血症，心内膜炎，皮肤 和软组织感染，以及骨和关节感染。同时发生OUD的住院患者 和相关感染提出了一个关键的时间进行干预，以改善传染病和阿片类药物 成瘾的结果。大多数医院，特别是在资源不足和农村地区，缺乏受过以下方面培训的医生： 即使在忙碌的学术性城市医院，OUD的治疗和对患者的标准护理通常包括 戒毒和转介门诊资源进行后续治疗。这要求严重OUD患者 耐受戒断症状，冒着过早出院的风险，以及在治疗失败后复发使用阿片类药物。 与OUD治疗转诊联系。结果包括由于担心复发而住院时间长， 如果患者离开医院，则不依从，OUD复发后再次入院，缺乏抗生素依从性 和再感染，导致不良的临床结果和高昂的医疗费用。医院设置， 这些感染正在治疗越来越多未经治疗的OUD患者。这提供了一个机会 让患者在治疗OUD的同时管理他们的感染。传染病（ID） 专家和住院医生是建设能力和增加获得医疗服务机会的关键和合理资源， 药物辅助治疗（MAT）。丁丙诺啡（LAB）的长效每月注射制剂 对于在医院环境中启动OUD治疗和在治疗后过渡到治疗具有潜在优势 释放到社区。我们建议测试一种新的护理模式（ID/LAB），其中阿片类药物使用障碍 (OUD)由ID专家和住院医师管理，同时管理OUD相关 感染，使用长效注射丁丙诺啡（LAB），然后尽快转诊后， 出院后，社区资源长期治疗OUD。成人入院治疗 OUD相关感染（N = 200）将在入院时确定，并按1：1随机分配至 ID/LAB或常规治疗（TAU），包括戒毒和转介到社区治疗， OUD与传染病的治疗并行。主要结果指标将是 入组OUD有效药物治疗（丁丙诺啡、美沙酮或注射）的患者 纳洛酮）。研究中心将是三家医院， 地理上多样化的，混合的城市和农村社区在美国东部与成功的合作， 治疗成瘾和传染病，OUD可以稳定，同时避免重复感染， 并且降低了由于感染或过量而导致的发病率和死亡率的风险。

Project Abstract The current opioid use disorder (OUD) epidemic has resulted a rise in infections including not only HCV and HIV, but also invasive bacterial infections including Staphylococcus Aureus bacteremia, endocarditis, skin and soft tissue infections, and bone and joint infections. Persons admitted to hospitals with co-occurring OUD and related infections presents a critical time to intervene, both to improve infectious disease and opioid addiction outcomes. Most hospitals, particularly in under-resourced and rural areas, lack physicians trained in treatment of OUD, and standard care for patients even in busy academic urban hospitals typically consists of detoxification and referral to outpatient resources for follow-up treatment. This asks patients with severe OUD to tolerate withdrawal symptoms, risking premature exit from hospital, and relapse to opioid use after failure to connect with OUD treatment referrals. Results include long lengths of stay due to concern about relapse and non-adherence if patients leave the hospital, and readmissions after OUD relapse, lack of antibiotic adherence and reinfection, leading to both poor clinical outcome and high healthcare costs. Hospital settings that manage these infections are treating increasing numbers of people with untreated OUD. This provides an opportunity to engage patients in treatment of their OUD while managing their infections. Infectious Disease (ID) specialists and hospitalists are a critical and logical resource to build capacity and increase access to medication-assisted treatment (MAT). An injectable long-acting monthly formulation of buprenorphine (LAB) has a potential advantage for initiating OUD treatment within hospital settings and bridging to treatment after discharge to the community. We propose to test a new model of care (ID/LAB) in which opioid use disorder (OUD) is managed by ID specialists and hospitalists concurrent with management of the OUD-related infections, using long-acting injectable buprenorphine (LAB), followed by referral as soon as possible after hospital discharge to community resources for long term treatment of OUD. Adults admitted to a hospital for infections related to OUD (N = 200) will be identified at hospital admission and randomly assigned 1:1 to ID/LAB or treatment as usual (TAU), consisting of detoxification and referral to community-based treatment for OUD in parallel with treatment of the infectious disease. The primary outcome measure will be the proportion of patients enrolled in effective medication treatment for OUD (buprenorphine, methadone, or injection naltrexone) at 3 months (12 weeks) after randomization. Study sites will be three hospitals serving geographically diverse, mixed urban and rural communities across the Eastern U.S. With successful co- treatment of addiction and infectious diseases, OUD could be stabilized, while repeat infections are avoided, and risk of morbidity and mortality due to infection or overdose reduced.