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

在美国，与感染艾滋病毒、丙型肝炎病毒和性传播感染有关的阿片类药物流行，以及感染性心内膜炎和系统性细菌感染的发病率上升。(1-3)鉴于这些传染病和阿片类药物使用障碍的平行流行明显交叉，我们必须确定防止感染这些感染的护理模式，并通过在整个护理过程中解决阿片类药物使用障碍来加强对现有感染的治疗。(4，5)许多阿片使用障碍(OUD)患者并未从事医疗工作，因此，住院治疗是开始治疗和接触这些高危人群的好时机。然而，针对成瘾的住院干预措施往往是次优的、不完整的，或仅限于住院时间。(6)此外，在个别医院系统中的观察性调查表明，包括成瘾咨询小组、多学科查房和链接导航器在内的干预措施在增加住院期间阿片类药物使用障碍的药物摄取率以及出院后与成瘾治疗相关联方面是有效的。然而，还没有多中心的调查来严格评估这些干预措施对长期感染结果的影响。 这项研究是NIH帮助结束成瘾长期(Hear)倡议的一部分，该倡议旨在加快科学解决国家阿片类药物公共健康危机的速度。NIH Hear倡议支持整个NIH的研究，以改善阿片类药物滥用和成瘾的治疗

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