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

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.

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Interpersonal Trauma Among Women and Men Receiving Buprenorphine in Outpatient Treatment for Opioid Use Disorder

Violence Against Women ◽

10.1177/10778012211032715 ◽

2021 ◽

pp. 107780122110327

Author(s):

Caitlin E. Martin ◽

Anna Beth Parlier-Ahmad ◽

Lori Beck ◽

Nicholas D. Thomson

Keyword(s):

Substance Use ◽

Interpersonal Trauma ◽

Opioid Use Disorder ◽

Sex And Gender ◽

Opioid Use ◽

Cross Sectional Survey ◽

Cross Sectional ◽

And Gender ◽

Public Health Strategies

People with opioid use disorder (OUD) are vulnerable to negative health outcomes related to substance use and psychosocial issues, such as interpersonal trauma (IPT). Participants receiving buprenorphine completed a cross-sectional survey (July–September 2019). OUD outcomes were prospectively abstracted over a 28-week timeframe. More than a third reported recent IPT (40% women, 36% men). Sexual violence was more common among women than men ( p = .02). For women only, IPT was associated with substance use during follow-up (β = 20.72, 95% CI: 4.24, 37.21). It is important for public health strategies in the opioid crisis to address IPT using sex- and gender-informed approaches.

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab208 ◽

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.

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Medication for Opioid Use Disorder Service Provision and Telephone Counseling: A Concurrent Mixed-Methods Approach

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18116163 ◽

2021 ◽

Vol 18 (11) ◽

pp. 6163

Author(s):

Rosemarie Martin ◽

Augustine W. Kang ◽

Audrey A. DeBritz ◽

Mary R. Walton ◽

Ariel Hoadley ◽

...

Keyword(s):

Substance Use ◽

Mixed Methods ◽

Telephone Counseling ◽

Opioid Use Disorder ◽

Appropriate Technology ◽

Counseling Services ◽

Opioid Use ◽

Qualitative Evidence ◽

Positive Experiences ◽

Anxiety Depression

Using quantitative and qualitative evidence, this study triangulates counselors’ perspectives on the use of telemedicine in the context of Opioid Use Disorder (OUD) treatment. A concurrent mixed-methods design examined counselors’ experiences with telephone counseling during the COVID-19 pandemic. N = 42 counselors who provided OUD counseling services completed a close-ended, quantitative survey examining their experiences in addressing clients’ anxiety, depression, anger, substance use, therapeutic relationship, and substance use recovery using telephone counseling. The survey also assessed comfort, convenience, and satisfaction with telephone counseling. Counselors also completed open-ended responses examining satisfaction, convenience, relationship with patients, substance use, and general feedback with telephone counseling. The synthesis of quantitative and qualitative evidence indicated that a majority of counselors had positive experiences with using telephone counseling to provide services to clients undergoing OUD treatment. Convenience, greater access to clients, and flexibility were among the reasons cited for their positive experience. However, counselors also expressed that the telephone counseling was impersonal, and that some clients may have difficulties accessing appropriate technology for telehealth adoption. Findings suggest that further research with counselors is needed to identify the key elements of an effective integration of telephone counseling with traditional in-person treatment approaches in the post-pandemic era.

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