Opportunities to Improve
Opioid Use Disorder and
Infectious Disease Services
to a DUAL EPIDEMIC
Committee on the Examination of the Integration of
Opioid and Infectious Disease Prevention Efforts in Select Programs
Board on Population Health and Public Health Practice
Health and Medicine Division
A Consensus Study Report of
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International Standard Book Number-13: 978-0-309-65449-4
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Digital Object Identifier: https://doi.org/10.17226/25626
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2020. Opportunities to improve opioid use disorder and infectious disease services: Integrating responses to a dual epidemic. Washington, DC: The National Academies Press. https://doi.org/10.17226/25626.
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COMMITTEE ON THE EXAMINATION OF THE INTEGRATION OF OPIOID AND INFECTIOUS DISEASE PREVENTION EFFORTS IN SELECT PROGRAMS
CARLOS DEL RIO (Chair), Hubert Professor and Chair, Hubert Department of Global Health, Rollins School of Public Health, Emory University, and Professor of Medicine, Emory University School of Medicine
JULIE A. BALDWIN, Director, Center for Health Equity Research, Northern Arizona University
EDWIN CHAPMAN, Medical Director, Medical Home Development Group, LLC
HANNAH COOPER, Chair, Substance Use Disorders, Rollins School of Public Health, Emory University
DAVID GUSTAFSON, Professor Emeritus, Industrial and Systems Engineering, University of Wisconsin–Madison
HOLLY HAGAN, Professor and Codirector, Center for Drug Use and HIV/HCV Research, New York University College of Global Public Health
ROBIN P. NEWHOUSE, Distinguished Professor and Dean, Indiana University School of Nursing
JOSIAH “JODY” D. RICH, Professor of Medicine and Epidemiology, Brown University
SANDRA SPRINGER, Associate Professor of Medicine, Yale School of Medicine
DAVID L. THOMAS, Chief, Division of Infectious Diseases, Johns Hopkins University School of Medicine
National Academy of Medicine Gilbert S. Omenn Fellow
ELLEN F. EATON, Assistant Professor of Infectious Diseases, Department of Medicine, University of Alabama–Birmingham
ANDREW MERLUZZI, Program Officer
ANNA MARTIN, Administrative Assistant
REBECCA CHEVAT, Senior Program Assistant
MISRAK DABI, Financial Business Partner
ROSE MARIE MARTINEZ, Study Director
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This Consensus Study Report 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 report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by ANTONIA M. VILLARRUEL, University of Pennsylvania, and ELAINE L. LARSON, Columbia University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
Boxes, Figures, and Tables
Opioid use and infectious diseases are intertwined epidemics. Despite the fact that the United States is more than two decades into the opioid crisis—the cause of tens of thousands of deaths every year on its own—the health system has not sufficiently addressed the morbidity and mortality of drug use coupled with infectious diseases. This is at least in part due to traditional models of substance use disorder care wherein substance use disorder treatment is delivered independently of other medical care, thereby inhibiting the delivery of comprehensive care. As a result, the United States is experiencing a drastic increase in infectious diseases that spread with drug use.
This context places the importance of integrating services for opioid use disorder and infectious diseases in stark relief. Preventing and treating opioid use disorder can improve outcomes for patients with infectious diseases. At the same time, identifying and treating infectious diseases can minimize harm by decreasing the risk that the diseases will spread.
Yet, as this Consensus Study Report describes, significant barriers remain to integrating services for this dual epidemic. The committee authoring this report gathered evidence from 11 programs throughout the United States seeking to integrate their services for opioid use disorder and infectious diseases, as well as from the broader literature. The resulting evidence pointed toward a set of barriers to integration: policies at the federal and state levels, stigma, workforce needs, and lack of adherence to the best available evidence continue to prevent effective care from being delivered to patients who need it. With the current rates of infectious diseases and opioid use, the cost of inaction is high. Fortunately, there are
feasible strategies to address these barriers, as outlined in the committee’s recommendations.
As chair, I would like to thank my fellow committee members for their dedication to this study, their novel ideas, and their commitment to improving the public’s health. The committee would also like to express its great appreciation to the Department of Health and Human Services’ Office of Infectious Disease and HIV/AIDS Policy for sponsoring this work, and in particular Corinna Dan and Chinedu Okeke for their consultation.
Sincere gratitude is given to the individuals attempting to solve this dual epidemic every day. Through several hours of interviews, informants from the programs featured in this study shared their experiences and informed the committee’s work. Others provided information, presentations, and important perspective to the committee. Their commitment to their patients and to public health is evident throughout this report: Hilary Armstrong, Julie Dombrowski, Brad Finegood, Julia Hood, and Joe Tinsley (King County Department of Public Health); Laura Bamford (Philadelphia FIGHT Community Health Centers); Christopher Bositis (Greater Lawrence Family Health Centers); Jennifer Edelman (Yale School of Medicine); Honora Englander (Oregon Health & Science University); Emma Fabian (Evergreen Health); Judith Feinberg (West Virginia University); Michael Fingerhood (Johns Hopkins University School of Medicine); Aaron Fox (Bronx Transitions Clinic); Jason Halperin and Nick Van Sickels (CrescentCare); Heather Hauck (Health Resources and Services Administration); Sarah Henn (Whitman-Walker Health); Joyce Johnson (Stepworks Recovery Centers); Beth Keeney (LifeSpring Health Systems); Gregory Lucas (Johns Hopkins University School of Medicine); Paula Lum (University of California, San Francisco); Benjamin Oldfield (Yale School of Medicine); Barbara Schott and James Wilson (Plumas County Public Health Agency); Shira Shavit (Transitions Clinic Network); Andrew Talal (University of Buffalo); Steve Tierney (Southcentral Foundation); and Frank Vega (ARCare).
The committee could not have completed this report without the guidance and dedication of the National Academies staff who shepherded it through to its conclusion. We thank Rose Marie Martinez, Andrew Merluzzi, Anna Martin, and Rebecca Chevat for their efforts.
Carlos del Rio, Chair
Committee on the Examination of the Integration of Opioid and Infectious Disease Prevention Efforts in Select Programs