Sandra A. Springer, MD; P. Todd Korthuis, MD, MPH; Carlos del Rio, MD
Disclaimer: This article reflects the views of the authors.
Acknowledgment: The authors thank Kathleen Stratton, PhD, from the Board on Population Health and Public Health Practice, Health and Medicine Division within the National Academies of Sciences, Engineering, and Medicine, for organizing the workshop and serving as study director, as well as the other members of the Workshop Planning Committee.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1203.
Corresponding Author: Sandra A. Springer, MD, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Springer: Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510.
Dr. Korthuis: Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L-475, Portland, OR 97239-3098.
Dr. del Rio: Hubert Department of Global Health, Rollins School of Public Health and Department of Medicine, Emory University School of Medicine, 1518 Clifton Road NE, Room 7011, Atlanta, GA 30322.
Author Contributions: Conception and design: S.A. Springer, P.T. Korthuis, C. Del Rio.
Analysis and interpretation of the data: S.A. Springer, C. Del Rio.
Drafting of the article: S.A. Springer, C. Del Rio.
Critical revision of the article for important intellectual content: S.A. Springer, P.T. Korthuis, C. Del Rio.
Final approval of the article: S.A. Springer, P.T. Korthuis, C. Del Rio.
Administrative, technical, or logistic support: C. Del Rio.
Collection and assembly of data: S.A. Springer, C. Del Rio.
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In this video, Carlos del Rio, MD, offers additional insight into the article, "Integrating Treatment at the Intersection of Opioid Use Disorder and Infectious Disease Epidemics in Medical Settings."
Joshua A. Barocas
Boston University School of Medicine and Boston Medical Center
July 28, 2018
Conflict of Interest:
I will am an instructor for the Providers Clinical Support System course discussed in this comment
Professional societies need to support educational trainings in opioid use disorder for members
I read with great interest the article by Springer et al entitled “Integrating Treatment at the Intersection of Opioid Use Disorder and Infectious Disease Epidemics in Medical Settings: A Call for Action After a National Academies of Sciences, Engineering, and Medicine Workshop”(1). Exceptional leadership has been displayed by the U.S. Department of Health and Human Services and all the participants in the recently convened workshop. The five Action Steps provide a framework from which we can continue to fight the opioid epidemic.While hospitals and clinics should ensure that protocols are implemented for screening, immediate treatment, and linkage to care for persons with opioid use disorder (OUD), professional societies can also play a significant role. Competing demands for time, including clinical care, administrative duties, and research present barriers to entry for many specialists who want to join the fight against the opioid epidemic (2, 3). As such, professional societies should integrate educational and training opportunities into their annual meetings and conferences. This would lower the barrier to entry to many specialists who may want to seek training opportunities, but because of competing demands, may not be able to do so.Offering educational and training opportunities in OUD at national and international meetings is a low hanging fruit to involve specialists. Buprenorphine waiver trainings are available for minimal to no charge, and there is no shortage of instructors willing to teach these courses. The 2018 IDWeek Program Committee displayed exceptional leadership in supporting a buprenorphine waiver training course as a pre-conference session. This four-hour workshop, paired with a four-hour online course completed after the live course will allow infectious disease providers to obtain the waiver to prescribe buprenorphine to their patients with OUD and gain the knowledge needed regarding the use of buprenorphine to manage opioid dependence in the clinical setting. Most importantly, this course will reach infectious disease providers who might otherwise not have the time, hospital resources, or administrative support to be trained. I urge other professional societies to follow the lead of the IDWeek Program Committee and integrate educational opportunities related to OUD into their national and international meetings. In doing so, individual providers will become empowered to join the frontlines of this fight.1. Springer SA, Korthuis PT, Del Rio C. Integrating Treatment at the Intersection of Opioid Use Disorder and Infectious Disease Epidemics in Medical Settings: A Call for Action After a National Academies of Sciences, Engineering, and Medicine Workshop. Ann Intern Med. 2018.2. Andrilla CHA, Coulthard C, Larson EH. Barriers Rural Physicians Face Prescribing Buprenorphine for Opioid Use Disorder. Ann Fam Med. 2017;15(4):359-62.3. Andraka-Christou B, Capone MJ. A qualitative study comparing physician-reported barriers to treating addiction using buprenorphine and extended-release naltrexone in U.S. office-based practices. Int J Drug Policy. 2018;54:9-17.
Simeon D. Kimmel MD, MA, Raagani Jawa MD, MPH, Alexander Y. Walley, MD, MSc, Tamar F. Barlam, MD, MSc
Boston Medical Center
July 27, 2018
We applaud Springer et al’s call to integrate addiction treatment into routine care for patients with infectious complications from opioid use disorder (OUD)(1). The authors argue for 5 actions to address the overlapping epidemics of infectious diseases and substance use disorders: 1) implement OUD screening in all healthcare settings, 2) immediately prescribe medications for OUD and opioid withdrawal symptoms, 3) develop protocols to facilitate in-hospital initiation of methadone, buprenorphine, and naltrexone with linkage to longitudinal care, 4) increase training in OUD diagnosis and treatment for medical trainees, and 5) increased access to addiction care and funding for states to provide medications for OU D. We believe that implementing these 5 crucial steps will require a new generation of interdisciplinary leaders. To train this specialized workforce, in 2016, Boston Medical Center launched a joint Infectious Disease and Addiction Medicine Fellowship. Our combined fellowship program seeks to train clinician-researchers and educators who will innovate and lead programs to improve care for patients with infectious complications of addiction. They will educate other physicians, staff, and trainees in our hospitals and medical schools. The clinical program includes a year of ID specialty consultation training, followed by a second year focused on addiction training that includes the inpatient addiction consult service and an outpatient low barrier addiction medication clinic, as well as rotations in methadone clinics, inpatient addiction facilities, and syringe service programs. Fellows also rotate in clinics focused on specialized populations with addiction including adolescents, pregnant women, and homeless individuals. Weaved throughout the fellowship is a longitudinal clinic focused on management and evaluation of patients with co-morbid HIV and substance use disorders, hepatitis C in addition to hospital follow up care and outpatient ID consultation. For example, ID-addiction fellows care for patients with endocarditis while hospitalized, then follow them after discharge in clinic, prescribing addiction medication and intravenous antibiotics and then subsequently initiating and managing hepatitis C treatment. As they have done throughout the HIV epidemic, infectious disease physicians have a particular opportunity and responsibility to engage patients with infectious complications from injecting drugs(2,3). We encourage other academic medical centers caring for patients with infectious complications of addiction to join us in training a new generation of clinicians to meet the needs of patients with addiction and associated infectious complications.Sincerely,Simeon D. Kimmel MD, MAFellow in Infectious Diseases and Addiction Medicine Boston Medical Center Raagani Jawa MD, MPHFellow in Infectious Diseases and Addiction MedicineBoston Medical Center Alexander Y. Walley, MD, MScDirector, Addiction Medicine Fellowship, Boston Medical CenterAssociate Professor of Medicine, Boston University School of MedicineTamar F. Barlam, MD, MScDirector, Infectious Disease Fellowship Program, Boston Medical Center Associate Professor of Medicine, Boston University School of MedicineReferences:1. Springer SA, Korthuis PT, del Rio C. Integrating Treatment at the Intersection of Opioid Use Disorder and Infectious Disease Epidemics in Medical Settings: A Call for Action After a National Academies of Sciences, Engineering, and Medicine Workshop. Ann Intern Med [Internet]. 2018 Jul 13 [cited 2018 Jul 20]; Available from: http://annals.org/article.aspx?doi=10.7326/M18-12032. Rapoport AB, Rowley CF. Stretching the Scope — Becoming Frontline Addiction-Medicine Providers. N Engl J Med [Internet]. 2017 Aug 24 [cited 2017 Sep 27];377(8):705–7. Available from: http://www.nejm.org/doi/10.1056/NEJMp17064923. Fanucchi L, Lofwall MR. Putting Parity into Practice — Integrating Opioid-Use Disorder Treatment into the Hospital Setting. N Engl J Med [Internet]. 2016 Sep [cited 2017 Sep 28];375(9):811–3. Available from: http://www.nejm.org/doi/10.1056/NEJMp1606157
Sandra A. Springer MD, P. Todd Korthuis MD, & Carlos del Rio MD
Yale School of Medicine; Oregon Health and Science University; Rollins School of Public Health and Department of Medicine, Emory University School of Medicine
December 11, 2018
Reply to Comments
We applaud the excellent actions by Dr. Kimmel and colleagues at Boston Medical Center (BMC) in creating a joint Infectious Disease (ID) and Addiction Medicine fellowship program. This is an excellent example of how ID specialists can be trained in treating opioid use disorders (OUD) with infectious diseases. We enthusiastically agree with their suggestion to encourage other academic medical centers to incorporate additional training within their ID fellowship programs. In addition we applaud Dr. Barocas at BMC in the endorsement and uptake of buprenorphine waiver training for ID physicians. The excellent example of Dr. Barocas and colleagues providing such training this year at IDWeek where ID physicians attend in high numbers should be hailed as standard practice at all professional medical society meetings and something that we encourage IDSA to do every year at IDWeek. We call on other organizers of meetings where ID physicians frequent like the Conference on Retroviruses and Opportunistic Infections (CROI), the International AIDS Conference and Viral Hepatitis meetings to initiate either pre-conference or within conference sessions to educate clinicians on OUD screening and treatment, provide buprenorphine waiver training, and provide sessions where successful implementation of such integrated practices of addiction and ID can be discussed.
Springer SA, Korthuis PT, del Rio C. Integrating Treatment at the Intersection of Opioid Use Disorder and Infectious Disease Epidemics in Medical Settings: A Call for Action After a National Academies of Sciences, Engineering, and Medicine Workshop. Ann Intern Med. 2018;169:335–336. [Epub ahead of print 13 July 2018]. doi: 10.7326/M18-1203
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Published: Ann Intern Med. 2018;169(5):335-336.
Published at www.annals.org on 13 July 2018
Infectious Disease, Tobacco, Alcohol, and Other Substance Abuse.
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