Integrating Responses at the Intersection of Opioid Use Disorder and Infectious Disease Epidemics Proceedings of a Workshop (2018) / Chapter Skim
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5 Research Directions, Policy Initiatives, and Potential Ways Forward
5 Research Directions, Policy Initiatives, and Potential Ways Forward
Pages 121-138
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. RESEARCH DIRECTIONS AND POLICY INITIATIVES Infectious Disease Society of America William Powderly provided an overview of the Infectious Disease Society of America (IDSA)
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Key Policy Issues Powderly explained that IDSA created a working group on the intersection of infectious diseases and opioid use to develop its policy as a professional society. The working group identified five key policy issues: 1.
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and the Health Resources and Services Administration (HRSA) for addiction training for clinicians -- including infectious disease specialists -- on the frontlines of the opioid epidemic.
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Involving the infectious disease community in advocacy is important because "the language of epidemics is the language of infectious diseases," he said. Patient-Centered Outcomes Research Institute Els Houtsmuller provided an overview of PCORI, an independent research institute authorized by Congress in 2010 and governed by a 21-member board of governors representing the entire health care community.
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SOURCE: As presented by Elisabeth Houtsmuller at the workshop Integrating Infectious Disease Considerations with Response to the Opioid Epidemic on March 13, 2018. Figure 5-1 illustrates how PCORI complements ongoing efforts.
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One study is looking at whether outcomes are improved through personalized MAT delivered in Federally Qualified Health Centers and complemented by a menu of services such as cognitive behavioral therapy and contingency management to increase treatment retention. To ensure that positive study outcomes are implemented, PCORI engages with relevant stakeholders, including payors, before the study even begins.
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, approximately 34 percent of enrollees in individual market plans did not have coverage that included addiction treatment services. Medicaid accounts for about one-fifth of all SUD treatment and about one-fourth of spending specifically on medications for treatment of opiate addiction.
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Tonko's Addiction Treatment Act, which would codify in statute that addiction specialist physicians may prescribe buprenorphine up to the 275 patient limit and eliminate the sunset date. Coverage would be expanded by allowing nurse practitioners and physician assistants to prescribe buprenorphine, but with a sunset date attached that ASAM wants to eliminate for that prescribing authority.
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A workshop participant asked the panelists to highlight changes in action, policy, or procedures that would make a meaningful difference at this intersection of infectious diseases and the opioid crisis. The panelists responded as follows: • Enact straightforward policy interventions to improve access, such as preventing gaps in care and addressing Medicaid restrictions.
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Todd Korthuis, program director for the Oregon Health & Science University's Addiction Medicine Fellowship, agreed that many of the lessons learned in the HIV epidemic are directly translatable to the opioid epidemic, and mused that "the country is ripe for a Ryan White for opioid use dis order." He noted that the research priority of the Office of AIDS Research focuses exclusively on viral suppression and transmission as outcomes for HIV research, and it misses the opportunity to better understand HIV as an infectious disease consequence of opioid use disorder -- "It doesn't help patients to have virologic suppression if they die of an opioid overdose.
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Anika Alvanzo, assistant professor of medicine at the Johns Hopkins University School of Medicine, offered her reflections on the second session: opportunities for, and barriers to, treatment and prevention. The rapporteur for the third session -- which focused on law, enforcement, and research and policy initiatives -- was Ellen Eaton, assistant professor of medicine at the University of Alabama at Birmingham School of Medicine.
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(Eaton) SOURCES: Adapted from comments by Anika Alvanzo, Jonathan Colasanti, and Ellen Eaton at the workshop Integrating Infectious Disease Considerations with Response to the Opioid Epidemic on March 13, 2018.
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Any PWID tested for HIV should also be tested for HCV and other diseases. The infectious disease aspect of the opioid epidemic is being debated in Congress; SAMHSA should have an infectious disease component (not necessarily entirely new programs)
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CDC and NIH grant funding are not sufficient; insurance companies must step up, take responsibility, and cover addiction treatment, and the only way to do that is to have mandated insurance coverage. Regarding naloxone access, del Rio mentioned that getting permission to stock naloxone in schools is another barrier because they may require that every prescription medication in the nurse's office be linked to a student.
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Korthuis highlighted the opportunity for professional society recommendations regarding quality metrics. For example, ASAM has recently released quality-of-care recommendations for specialty addiction treatment centers linked to various metrics, SAMHSA has similar metrics, and there are metrics related to Ryan White funding to which HRSA's HIV/ AIDS Bureau encourages providers to adhere for HIV care.
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Do you know yet what this is all about? SOURCE: Poem written and read by Veda Moore at the workshop Integrating Infectious Dis ease Considerations with Response to the Opioid Epidemic on March 13, 2018.
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She highlighted the need for more data on the specific effects of the opioid epidemic and infectious diseases on women, as well as the importance of providing programs and services that meet people where they are, including those that address women's specific needs. This requires acknowledging the relationships between drug use, violence, and trauma and providing services to address those co-occurring realities of women's lives, Tytel said.
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Wolitski called on participants to step out of their own self-interests and think beyond their academic training and professional positions about how to generate the largest benefit. The opioid epidemic is a national crisis that can be a catalyst for innovation and more fully integrated delivery systems or we could remain focused on individual threats and fail to create the systems changes that are needed to be more efficient and effective in public health and medical care programs.
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