scholarly journals Partnering with State Health Departments to Address Injection-Related Infections during the Opioid Epidemic: Experience at a Safety Net Hospital

2021 ◽  
Author(s):  
Rebecca H Burns ◽  
Cassandra M Pierre ◽  
Jai G Marathe ◽  
Glorimar Ruiz-Mercado ◽  
Jessica L Taylor ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Medical Center ◽  
Safety Net ◽  
Opioid Use Disorder ◽  
Lessons Learned ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Persons Who Inject Drugs ◽  
Curative Therapy ◽  
Safety Net Hospital

Abstract Massachusetts is one of the epicenters of the opioid epidemic and has been severely impacted by injection-related viral and bacterial infections. A recent increase in newly diagnosed human immunodeficiency virus (HIV) infections among persons who inject drugs in the state highlights the urgent need to address and bridge the overlapping epidemics of opioid use disorder (OUD) and injection-related infections. Building on an established relationship between the Massachusetts Department of Public Health (MDPH) and Boston Medical Center (BMC), the Infectious Diseases section has contributed to the development and implementation of a cohesive response involving ambulatory, inpatient, emergency department and community-based services. We describe this comprehensive approach including the rapid delivery of antimicrobials for the prevention and treatment of HIV, sexually transmitted diseases, systemic infections such as endocarditis, bone and joint infections, as well as curative therapy for chronic hepatitis C virus (HCV) in a manner that is accessible to patients on the addiction-recovery continuum. We also provide an overview of programs that provide access to medications for opioid use disorder (MOUD), harm reduction services including overdose education and distribution of naloxone. Finally, we outline lessons learned to inform initiatives in other settings.

Estimating costs of hospitalizations associated with opioid use disorder or opioid misuse at a large, urban safety-net hospital—Denver, Colorado, 2017

2021 ◽  
Vol 218 ◽  
pp. 108306
Author(s):  
Aziza Arifkhanova ◽  
Emily McCormick Kraus ◽  
Alia Al-Tayyib ◽  
Julie Taub ◽  
Annette Encinias ◽  
...  
Keyword(s):  
Safety Net ◽  
Opioid Use Disorder ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Safety Net Hospital ◽  
Urban Safety

scholarly journals 2542. ID-Psych Addiction Rounds: A New Model to Address Opioid Use Disorder For Patients on the Infectious Disease Consult Service

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S883-S883
Author(s):  
William West ◽  
Benjamin Eckhardt ◽  
Gabriel M Cohen
Keyword(s):  
Substance Use ◽  
Clinical Characteristics ◽  
Safety Net ◽  
Opioid Use Disorder ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Consult Service ◽  
Case Conferences ◽  
Lost To Follow Up

Abstract Background ID physicians often treat the infectious sequelae of opioid use disorder (OUD) and are uniquely poised to link hospitalized patients to substance use resources. In a large safety net hospital, we launched a multi-disciplinary initiative to ensure that patients on the ID consult service with OUD were always offered medication-assisted treatment (MAT). We used infections as “sentinel” events to identify patients with OUD and described the clinical characteristics of the high-risk patient population jointly consulted by ID and Psychiatry teams. This healthcare workforce initiative aimed to expand the role of ID providers in the opioid epidemic and decrease barriers to buprenorphine prescribing. Methods Every 2 weeks, ID fellows identified patients on their consult lists with infectious complications of OUD. Focused discussions were then held with the Psychiatry service and discussion of each patient continued at subsequent case conferences with attention paid to re-engaging those lost to follow-up. We performed chart abstraction of demographic and clinical characteristics as part of a quality improvement initiative. Results From October 2018 to March 2019, 23 patients were discussed at 10 case conferences with input from attendings, fellows, housestaff, social workers, and representatives from a novel Primary Care Safety Net program. The average patient age was 43 (range 24–50). Patients were predominantly male (65%), heroin users (90%) with high rates of HIV (22%) and untreated HCV (40%). ID-related infections included endocarditis (39%), osteomyelitis (31%), skin and soft-tissue infections (17%) and spinal abscesses (17%). The median time for a patient to be presented at an ID-Psych Addiction Rounds was 7 days (IQR 4.5–11.5). The mean length of hospitalization was 30 days (range 2–112). MAT was initiated in 75% of patients (41% buprenorphine; 59% methadone). The 30-day lost to follow-up rate was exceedingly high, with 80% of post-hospital appointments being missed. Conclusion ID physicians can effectively link hospitalized patients with OUD to substance use resources. A multi-disciplinary approach is key to addressing the opioid epidemic. Future work should explore how to create effective post-hospital transitions to decrease those lost to follow-up. Disclosures All authors: No reported disclosures.

scholarly journals 1421. Assessing Serious Infections Common in Persons Who Inject Drugs in the United States and Tennessee

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S717-S718
Author(s):  
Michael Lowry ◽  
Christina Fiske ◽  
Peter F Rebeiro
Keyword(s):  
United States ◽  
Substance Use ◽  
Bacterial Infections ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Persons Who Inject Drugs ◽  
Discharge Data ◽  
Serious Infections ◽  
The Us

Abstract Background The opioid crisis is a public health emergency in the United States (US) and Tennessee (TN), and injection drug use predisposes users to a variety of serious infections. We therefore examined infection rates among persons who inject drugs (PWID) from 2001-2014 in the US and TN. Methods We conducted an ecological study using publicly available data including discharge diagnosis codes: the Healthcare Cost and Utilization Project (HCUP). We identified all persons from 2001-2014 with ICD-9 codes for bacterial infections common among PWID: endocarditis (IE), osteomyelitis (OM), septic arthritis (SpA), and skin/soft tissue infections (SSTI). We calculated rates of substance use and infection among all hospital discharges. Spearman’s rank correlation quantified the relationship between infection and reported hepatitis C seropositivity (HCV), Substance Abuse (SA) and opioid use disorder (OUD) rates. Poisson regression yielded incidence rate ratios (IRR) and 95% confidence intervals [-], and restricted cubic splines were fit to assess annual trends flexibly. Results Unadjusted rates of both substance use and infection among those discharged from hospitals were higher in the US overall than in TN from 2001-2014 (p< 0.05) (Figure 2,3). Overall infections, HCV (IRR=1.14 [1.12-1.17]), SSTI, OM, and SpA increased annually in the US; overall infections, HCV (IRR=1.14 [1.10-1.15]), and SSTI increased in TN. OUD (IRR=0.96 [0.94-0.98]) and IE (IRR=0.97 [0.97-0.98]) decreased in the US (Table 1). In the US, there were strong positive correlations between any other infection and HCV (ρ=0.87), IE and OUD (ρ=0.7), SSTI and HCV (ρ=0.9), OM and HCV (ρ=0.69), and SpA and HCV (ρ=0.68); IE was negatively correlated with HCV (ρ=-0.84). In TN, overall infections (ρ=0.68), and specifically SSTI (ρ=0.62), were correlated with HCV (Figure 1). Table 1 Figure 1 Figure 2 Conclusion Serious infections common in PWID are increasing in TN and the US; they correlate with HCV rates, which have risen significantly in hospitalized patients. Interestingly, opioid use disorder incidence from discharge data declined from 2001-2014 for both TN and the US, which may be due to coding lapses or shifts in type of opioid use with no well-known billing code. However, we must continue monitoring and mitigating both substance use and its sequelae. Disclosures All Authors: No reported disclosures

scholarly journals 868. HIV, Opioid Use Disorder, and Injection related Infections: Clinical Outcomes in 4 Academic Hospitals

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S525-S526
Author(s):  
John R Bassler ◽  
Hana Akselrod ◽  
Greer A Burkholder ◽  
Elana S Rosenthal ◽  
Christopher J Brokus ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Bacterial Infections ◽  
Addiction Treatment ◽  
Safety Net ◽  
Opioid Use Disorder ◽  
Hiv Treatment ◽  
Opioid Use ◽  
Research Support ◽  
Addiction Medicine ◽  
Research Grant

Abstract Background Because hospitals are a safety net for persons with injection drug use (IDU), they play a valuable role towards ending the HIV epidemic. The objective of this study is to evaluate the hospital outcomes of persons with HIV (PWH) and opioid use disorder (OUD). Methods CHOICE is a retrospective review of hospitalized persons with an infectious complication of OUD and IDU at University of Maryland, George Washington University, University of Alabama at Birmingham, and Grady Memorial Hospital. Participants were hospitalized between 1/2/2018-12/21/2018, had ICD9/10 diagnosis codes consistent with OUD and acute bacterial/fungal infection, and verification of OUD-associated infection. HIV was defined by chart review. We explored HIV viral load (VL), antiretroviral therapy (ART) and medications for opioid use disorder (MOUD) on admission, discharge, consultation, and community care. Overall CHOICE Study Enrollment Results Overall, 287 were admitted with OUD and infections over the study period; 22 had HIV of whom 3 (14%) were diagnosed during the admission. Of the HIV negative, 1 was discharged on PrEP. Of PWH, most were Black (55%), male (68%), and Medicaid recipients (77%); median age was 48. Median length of stay was 10 days. Common bacterial infections were skin/soft tissue (55%), Bacteremia (41%), and Osteomyelitis (18%). On admission, few were on antiretroviral therapy (ART; 32%) or MOUD (23%). Of the 13 with a VL during admission, 100% had viremia (median VL 6,226 copies/mL). During the admission, 81% were evaluated by Infectious Diseases consultant and 50% by Addiction Medicine. At discharge, 11 and 6 had documentation of an ART plan and MOUD receipt, respectively. In the year following the admission, of 21 with follow up data, a majority were evaluated in the emergency department (68%) and readmitted (57%). HIV Outcomes for Hospitalized Persons with Injection Related Bacterial Infections Conclusion For patients with IDU, hospitalization is a missed opportunity to address HIV treatment and prevention through PrEP, VL surveillance, and ART linkage. Because addiction treatment improves HIV outcomes, Addiction consultation should be standard of care but was under-utilized. Subsequent ED visits and readmissions suggest that hospitals provide continuity of care for patients with IDU who would benefit from HIV, HCV, and other services in acute settings. Disclosures Greer A. Burkholder, MD, MSPH, Eli Lilly (Grant/Research Support) Elana S. Rosenthal, MD, Gilead Sciences (Research Grant or Support)Merck (Research Grant or Support) Ellen Eaton, MD , Gilead (Grant/Research Support) Ellen Eaton, MD , Gilead (Individual(s) Involved: Self): Research Grant or Support

An Emergency Preparedness Response to Opioid-Prescribing Enforcement Actions in Maryland, 2018-2019

2021 ◽  
Vol 136 (1_suppl) ◽  
pp. 9S-17S
Author(s):  
Jessica C. Acharya ◽  
B. Casey Lyons ◽  
Vijay Murthy ◽  
Jennifer Stanley ◽  
Carly Babcock ◽  
...  
Keyword(s):  
Emergency Preparedness ◽  
Data Access ◽  
Opioid Use Disorder ◽  
Lessons Learned ◽  
Mitigation Strategies ◽  
Federal State ◽  
Opioid Use ◽  
Time Data ◽  
Enforcement Action ◽  
State And Local

Federal and state enforcement authorities have increasingly intervened on the criminal overprescribing of opioids. However, little is known about the health effects these enforcement actions have on patients experiencing disrupted access to prescription opioids or medication-assisted treatment/medication for opioid use disorder. Simultaneously, opioid death rates have increased. In response, the Maryland Department of Health (MDH) has worked to coordinate mitigation strategies with enforcement partners (defined as any federal, state, or local enforcement authority or other governmental investigative authority). One strategy is a standardized protocol to implement emergency response functions, including rapidly identifying health hazards with real-time data access, deploying resources locally, and providing credible messages to partners and the public. From January 2018 through October 2019, MDH used the protocol in response to 12 enforcement actions targeting 34 medical professionals. A total of 9624 patients received Schedule II-V controlled substance prescriptions from affected prescribers under investigation in the 6 months before the respective enforcement action; 9270 (96%) patients were residents of Maryland. Preliminary data indicate fatal overdose events and potential loss of follow-up care among the patient population experiencing disrupted health care as a result of an enforcement action. The success of the strategy hinged on endorsement by leadership; the establishment of federal, state, and local roles and responsibilities; and data sharing. MDH’s approach, data sources, and lessons learned may support health departments across the country that are interested in conducting similar activities on the front lines of the opioid crisis.

scholarly journals 213. A Comparison of Medication Assisted Therapy Treatment Strategies for Opioid Use Disorder in Persons who Inject Drugs and are Hospitalized with Serious Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S126-S126
Author(s):  
Laura Marks ◽  
Evan Schwarz ◽  
David Liss ◽  
Munigala Satish ◽  
David K Warren ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Hospital Readmissions ◽  
Treatment Strategies ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Readmission Rates ◽  
Persons Who Inject Drugs ◽  
Increased Risk ◽  
Hospital Patients ◽  
The Impact

Abstract Background Persons who inject drugs (PWID) with opioid use disorder (OUD) are at increased risk of invasive bacterial and fungal infections, which warrant prolonged, inpatient parenteral antimicrobial therapy. Such admissions are complicated by opioid cravings and withdrawal. Comparisons of medications for OUD during prolonged admissions for these patients have not been previously reported. The aim of this study was to evaluate the impact of different OUD treatment strategies in this population, and their impact on ED and hospital readmissions. Methods We retrospectively analyzed consecutive admissions for invasive bacterial or fungal infections in PWID, admitted between January 2016 and January 2019 at Barnes-Jewish Hospital. Patients in our cohort were required to receive an infectious diseases consult, and an anticipated antibiotic treatment duration of >2 weeks. We collected data on demographics, comorbidities, length of stay, microbiologic data, medications prescribed for OUD, mortality, and readmission rates. We compared 90-day readmission rates by OUD treatment strategies using Kaplan–Meier curves. Results In our cohort of 237 patients, treatment of OUD was buprenorphine (17.5%), methadone (25.3%), or none (56.2%). Among patients receiving OUD treatment, 30% had methadone tapers and/or methadone discontinued upon discharge. Patient demographics were similar for each OUD treatment strategy. Infection with HIV (2.8%), and hepatitis B (3%), and hepatitis C (67%) were similar between groups. Continuation of medications for OUD was associated with increased completion of parenteral antibiotics (odds ratio 2.11; 95% confidence interval 1.70–2.63). When comparing medications for OUD strategies, methadone had the lowest readmission rates, followed by buprenorphine, and no treatment (P = 0.0013) (figure). Discontinuation of methadone during the admission or upon discharge was associated with the highest readmission rates. Conclusion Continuation of OUD treatment without tapering, was associated with improved completion of parenteral antimicrobials in PWID with invasive bacterial or fungal infections lower readmission rates. Tapering OUD treatment during admission was associated with higher readmission rates. Disclosures All authors: No reported disclosures.

Calcium and magnesium infusions for prevention of oxaliplatin-induced peripheral neuropathy.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 387-387
Author(s):  
M. Bupathi ◽  
G. Mahmud ◽  
J. Kovar ◽  
E. Wang ◽  
T. E. O'Brien
Keyword(s):  
Peripheral Neuropathy ◽  
Cumulative Dose ◽  
Medical Center ◽  
Demographic Data ◽  
Performance Status ◽  
Safety Net ◽  
Control Group ◽  
Minority Population ◽  
Tumor Type ◽  
Safety Net Hospital

387 Background: Oxaliplatin plays an important role in chemotherapy regimens for colorectal and other GI malignancies. Debilitating peripheral neuropathy (PN) often develops with use of this drug. One study (Grothey A et al, ASCO 2009, abst #4025) has shown that pre- and post-oxaliplatin infusions with calcium (Ca) and magnesium (Mg) may reduce this toxicity. To confirm this in an unselected indigent minority population, a retrospective review was performed comparing development of PN in oxaliplatin exposed patients treated with or without Ca/Mg. Methods: Records of patients who received oxaliplatin from 1/2008 to 12/2009 at MetroHealth Medical Center, a large safety net hospital in Cleveland, OH, were reviewed. 47 patients received Ca/Mg + oxaliplatin and 46 oxaliplatin alone. Data collected included age, race, gender, insurance status, performance status, tumor type, stage, concomitant diseases (DM and EtOH), number of cycles and cumulative dose of oxaliplatin. PN was determined using the Common Terminology Criteria of Adverse Events (CTCAE) version 3.0. Patients were followed 6 months after completion of oxaliplatin. Results: Demographic data was similar between the two groups. Colorectal cancer compromised 77% of the treatment group and 85% of control group. Patients who received Ca/Mg had significantly less PN in all three grades (1-3) compared with the control group (grade 1 89.4% vs. 71.7%, grade II 10.6% vs. 19.6%, grade 3 0% vs. 8.7%, respectively). The cumulative dose of oxaliplatin did not differ between the two groups (Ca/Mg median 1,143 range 260-2,169; control median 1,425 range 137-2,635). The combined total grades 2 and 3 in both the treatment and control (10.6% vs. 28.3%, p = 0.038) favored use of Ca/Mg. Conclusions: This small, retrospective study confirms that Ca/Mg infusions reduce the incidence of clinically significant (grade 2/3) PN in pts receiving oxaliplatin. No significant financial relationships to disclose.

scholarly journals Robotic TAPP Ventral Hernia Repair: Early Lessons Learned at an Inner City Safety Net Hospital

2018 ◽  
Vol 22 (1) ◽  
pp. e2017.00070 ◽  
Author(s):  
Michael Kennedy ◽  
Kaylene Barrera ◽  
Andrew Akelik ◽  
Yohannes Constable ◽  
Michael Smith ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Inner City ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
Safety Net ◽  
Lessons Learned ◽  
Safety Net Hospital
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