Opportunities to Improve Opioid Use Disorder and Infectious Disease Services Integrating Responses to a Dual Epidemic (2020) / Chapter Skim
Currently Skimming:
2 Scope of the Problem
2 Scope of the Problem
Pages 35-46
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From page 35... ...
treatment, primary care, and infectious disease care. THE INTERPLAY BETWEEN OPIOID USE DISORDER AND INFECTIOUS DISEASES More than two decades into the opioid epidemic, the United States continues to battle this critical public health challenge (Kolodny et al., 2015)
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SOURCE: NIDA, 2019, via CDC WONDER. infectious diseases have long ravaged inner cities and continue to do so.
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. In addition, OUD increases the risks of other infectious diseases, such as sexually transmitted infections spread through high-risk sexual behaviors in exchange for drugs and/or money and HAV linked to poor sanitary conditions (Hartard et al., 2019; Villano et al., 1997)
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The CARE Act has been the payer of last resort to provide care for un- and under-insured persons living with HIV, especially in Medicaid non-expansion states. It also supported other behavioral support services, such as mental health care, SUD treatment, and housing assistance, all of which greatly improved HIV care (Cheever, 2016)
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Thus, the HIV care continuum shows the proportion of persons living with HIV who are engaged at each stage and allows public health officials and olicy p makers to measure progress and direct HIV resources most effectively. Several randomized controlled trials (e.g., HIV Prevention Trials Network and PARTNER studies)
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. Evidencebased treatment of OUD also requires treatment adherence, engagement in medical care, and support of comorbidities including mental health conditions and infectious diseases.
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. The 2 While this report primarily focuses on outpatient care settings, care for opioid use dis order and infectious diseases can be improved at many points along the health care system, including emergency departments, health care clinics, opioid treatment programs, and other settings.
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Modeled after the original HIV care continuum frameworks (Gardner et al., 2011) , the OUD care cascade provides a set of outcomes that are easily measurable and it allows providers, policy makers, and researchers to examine how various policy initiatives impact treatment, retention, and recovery.
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In this way, the OUD care cascade and the HIV care continuum can be used in tandem, given the comorbidity of these two illnesses. The same can be true for those with comorbid OUD and viral hepatitis or other chronic infectious diseases.
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Because of these unique stipulations, public SUD treatment services have historically developed and functioned independently of the overall health care system. As a result, there are a number of programs in operation that lack a significant evidence base.
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. To shed light on integrating OUD care and medical care for infectious diseases, the following chapters outline current barriers to integration and strategies for overcoming these barriers.
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