Report outlines integrated care recommendations for opioid use and infectious disease

Dr. Josiah Rich, an addiction specialist and Brown professor, contributed to a report by the National Academies of Science, Engineering and Medicine on how to integrate care for the intertwined epidemics of opioid use and infectious disease.

PROVIDENCE, R.I. [Brown University] — Drug overdoses involving opioids kill tens of thousands of people each year in the U.S., but that’s only part of the harm that the opioid epidemic has caused. The rise in opioid use is also driving dramatic increases in infections from HIV, hepatitis C virus and staphylococcus aureus as well as sexually transmitted infections, according to a report issued this week by the National Academies of Science, Engineering and Medicine.

The report, coauthored by Dr. Josiah Rich, a professor of medicine and epidemiology at Brown University and director of the Center for Prisoner Health and Human Rights at the Miriam Hospital in Providence, offers recommendations for integrating care for opioid use disorder (OUD) and infectious disease.

Photo of Josiah Rich
Dr. Josiah Rich

“The sharing of needles, risky sexual behaviors and decreased access to health care create an intimate link between OUD and infectious disease,” Rich said. “Integrating care for both is more efficient, more effective and can reduce stigma. But there are policy, funding, training, organizational and logistical obstacles that keep the two siloed. This report provides direction on how to break down those silos to provide integrated care and prevention.”

Standalone OUD clinics, primary care clinics and correctional institutions see thousands of people with concurrent OUD and infectious diseases annually and should be leveraged as integrated care sites, the report says. However, some organizations are unable to provide integrated services because of restrictions on the types of services they can provide. Some state Medicaid laws do not allow billing for medical care and behavioral health services on the same day. Many providers are currently barred from prescribing buprenorphine, a drug shown to be effective in treating OUD. Few correctional institutions perform OUD screening or medication treatment, which increases the risk for continued opioid use and infectious disease exposure after release.

In all, the report identifies nine major barriers to the integration of OUD and infectious disease care and makes sets of recommendations for addressing each of them. Rich says he’s hopeful that many of the recommendations will be implemented in the near future.

“We debriefed the team at Health and Human Services who commissioned the study and there was a sense that they have been thinking along similar lines,” Rich said. “Of course, many of these recommendations will require funding, but we are optimistic that members of Congress understand the dire needs of these devastating and interwoven epidemics.”

The complete report is available at the National Academies website.

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