THE CONTINUUM OF CARE IN HOSPITALIZED PATIENTS WITH OPIOID USE DISORDER AND INFECTIOUS COMPLICATIONS OF DRUG USE (CHOICE)

在美国，阿片类药物流行与艾滋病毒、丙型肝炎病毒和性传播感染以及感染性心内膜炎和全身性细菌感染的发病率上升有关。（1-3）鉴于这些平行的传染病流行与阿片类药物使用障碍之间存在明显的交集，我们必须确定预防获得这些感染的护理模式，并通过在整个连续护理过程中解决阿片类药物使用障碍问题来加强对现有感染的治疗。（4,5）许多阿片类药物使用障碍（OUD）患者没有接受医疗护理，因此，在这些高危人群中，住院是开始治疗和参与的合适时机。然而，解决成瘾的住院干预往往是次优的，不完整的，或限于住院时间。(6)此外，个别医院系统的观察性调查已经证明了干预措施的有效性，包括成瘾咨询小组、多学科查房和联动导航，在住院期间增加阿片类药物使用障碍的药物摄入，并在出院后与成瘾治疗联系起来。然而，目前还没有多中心调查来严格评估这些干预措施对长期感染结果的影响。

In the United States, there is an opioid epidemic which is associated with acquisition of HIV, HCV and STIs, as well as rising rates of infective endocarditis and systemic bacterial infections.(1-3) Given the clear intersection of these parallel epidemics of infectious diseases and opioid use disorder, it is critical that we identify models of care which prevent acquisition of these infections and enhance treatment of existing infections by addressing opioid use disorder throughout the continuum of care.(4,5) Many individuals with opioid use disorder (OUD) are not engaged in medical care, therefore, inpatient hospitalization represents an opportune time to initiate treatment and engagement among these high risk individuals. However, inpatient interventions to address addiction are often suboptimal, incomplete, or limited to the time of hospitalization.(6) Further, observational investigations in individual hospital systems have demonstrated the effectiveness of interventions, including addiction consult teams, multidisciplinary rounds, and linkage navigators, in increasing uptake of medications for opioid use disorder during hospitalization and linkage into addictions treatment after discharge. However, there have been no multi-center investigations to rigorously evaluate the impact of these interventions on long term infectious outcomes. This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction