Coordinated medical treatment of opioid use disorder and infectious disease

项目摘要 目前阿片类药物使用障碍(OUD)的流行导致感染人数上升，其中不仅包括丙型肝炎病毒 和HIV，但也有侵袭性细菌感染，包括金黄色葡萄球菌菌血症、心内膜炎、皮肤 软组织感染，骨骼和关节感染。同时患有尿毒症的患者入院治疗 相关感染是进行干预的关键时期，以改善传染病和阿片类药物。 上瘾的后果。大多数医院，特别是在资源不足和农村地区，缺乏训练有素的医生 即使在繁忙的城市学术医院，OUD的治疗和患者的标准护理通常包括 戒毒和转诊到门诊资源进行后续治疗。这就要求患有严重尿失禁的患者 忍受戒断症状，冒着提前出院的风险，并在治疗失败后再次使用阿片类药物 与OUD治疗转介联系。结果包括由于担心复发而住院时间较长， 如果患者离开医院，并且复发后再次住院，缺乏抗生素依从性，则不遵守抗生素 和再感染，导致不良的临床结果和高昂的医疗费用。管理的医院设置 这些感染正在治疗越来越多的未经治疗的OUD患者。这提供了一个机会 在控制感染的同时，让患者参与OUD的治疗。传染病(ID) 专家和住院医生是建设能力和增加访问机会的关键和合理的资源 药物辅助治疗(MAT)。丁丙诺啡可注射长效月度制剂(LAB) 在医院内启动OUD治疗并在之后过渡到治疗方面具有潜在的优势 退还给社区。我们建议测试一种新的护理模式(ID/LAB)，在这种模式下，阿片类药物使用障碍 (OUD)由ID专家和住院医生管理，同时管理与OUD相关的 感染，使用长效注射丁丙诺啡(LAB)，然后尽快转诊 医院出院以社区资源长期治疗尿毒症。成人因以下原因入院 与OUD相关的感染(N=200)将在入院时确定，并随机分配1：1至 ID/Lab或照常治疗(TAU)，包括戒毒和转诊到社区治疗 与传染病的治疗同时进行。主要的结果衡量标准将是 接受有效药物治疗的患者的比例(丁丙诺啡、美沙酮或注射 随机分组后3个月(12周)给予纳曲酮。研究地点将是三家医院，为 地理位置多样，城乡混杂的社区遍布美国东部，成功地联合 对成瘾和传染病的治疗可以稳定下来，同时避免重复感染， 减少因感染或过量服药而致病和死亡的风险。

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.