Coordinated medical treatment of opioid use disorder and infectious disease

阿片类药物使用障碍和传染病的协调医疗

• 批准号: 10457318
• 负责人: KATHLEEN T. BRADY
• 金额: $ 126.78万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-18 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10457318
• 关键词: Accident and Emergency department; Acquired Immunodeficiency Syndrome; Address; Adherence; Adult; Aftercare; American; Antibiotics; Bacteremia; Bacterial Infections; Blood; Buprenorphine; Caring; Cessation of life; Clinical; Clinical Trials Network; Collaborations; Communicable Diseases; Communities; Complex; Consultations; Dimensions; Drug Metabolic Detoxication; Endocarditis; Enrollment; Epidemic; FDA approved; Failure; Formulation; Funding; Geography; HIV; HIV Infections; HIV/HCV; Health Care Costs; Hepatitis C virus; Hospitalists; Hospitalization; Hospitals; Individual; Infection; Injectable; Injections; Intervention; Length of Stay; Measures; Medical; Methadone; Modeling; Morbidity - disease rate; Naltrexone; National Center for Advancing Translational Sciences; National Institute of Drug Abuse; Nosocomial Infections; Opiate Addiction; Opioid; Osteomyelitis; Outcome; Outcome Measure; Outpatients; Overdose; Overdose reduction; Patient Care; Patient Noncompliance; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Physicians; Population; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Records; Regimen; Relapse; Research; Resources; Risk; Rural Community; Site; Skin Tissue; Soft Tissue Infections; Specialist; Staphylococcus aureus; Testing; Therapeutic; Time; Training; Urban Community; Urban Hospitals; Urine; Withdrawal Symptom; addiction; antimicrobial; base; community based treatment; craving; disease transmission; effective therapy; follow-up; hospital readmission; improved; infection management; infectious disease treatment; injection drug use; joint infection; medical specialties; medication-assisted treatment; mortality; opioid epidemic; opioid use; opioid use disorder; patient population; premature; pressure; primary outcome; rural area; standard care; treatment as usual; uptake

Project Abstract The current opioid use disorder (OUD) epidemic has resulted a rise in infections including not only HCV and HIV, but also invasive bacterial infections including Staphylococcus Aureus bacteremia, endocarditis, skin and soft tissue infections, and bone and joint infections. Persons admitted to hospitals with co-occurring OUD and related infections presents a critical time to intervene, both to improve infectious disease and opioid addiction outcomes. Most hospitals, particularly in under-resourced and rural areas, lack physicians trained in treatment of OUD, and standard care for patients even in busy academic urban hospitals typically consists of detoxification and referral to outpatient resources for follow-up treatment. This asks patients with severe OUD to tolerate withdrawal symptoms, risking premature exit from hospital, and relapse to opioid use after failure to connect with OUD treatment referrals. Results include long lengths of stay due to concern about relapse and non-adherence if patients leave the hospital, and readmissions after OUD relapse, lack of antibiotic adherence and reinfection, leading to both poor clinical outcome and high healthcare costs. Hospital settings that manage these infections are treating increasing numbers of people with untreated OUD. This provides an opportunity to engage patients in treatment of their OUD while managing their infections. Infectious Disease (ID) specialists and hospitalists are a critical and logical resource to build capacity and increase access to medication-assisted treatment (MAT). An injectable long-acting monthly formulation of buprenorphine (LAB) has a potential advantage for initiating OUD treatment within hospital settings and bridging to treatment after discharge to the community. We propose to test a new model of care (ID/LAB) in which opioid use disorder (OUD) is managed by ID specialists and hospitalists concurrent with management of the OUD-related infections, using long-acting injectable buprenorphine (LAB), followed by referral as soon as possible after hospital discharge to community resources for long term treatment of OUD. Adults admitted to a hospital for infections related to OUD (N = 200) will be identified at hospital admission and randomly assigned 1:1 to ID/LAB or treatment as usual (TAU), consisting of detoxification and referral to community-based treatment for OUD in parallel with treatment of the infectious disease. The primary outcome measure will be the proportion of patients enrolled in effective medication treatment for OUD (buprenorphine, methadone, or injection naltrexone) at 3 months (12 weeks) after randomization. Study sites will be three hospitals serving geographically diverse, mixed urban and rural communities across the Eastern U.S. With successful co- treatment of addiction and infectious diseases, OUD could be stabilized, while repeat infections are avoided, and risk of morbidity and mortality due to infection or overdose reduced.

项目摘要 当前的阿片类药物使用障碍（OUD）流行导致感染不仅增加了HCV 和艾滋病毒，但还包括侵袭性细菌感染，包括金黄色葡萄球菌细菌，心内膜炎，皮肤 以及软组织感染以及骨和关节感染。与同时发生的Oud一起录取的医院的人 相关感染带来了干预的关键时间，既可以改善感染性疾病和阿片类药物 成瘾结果。大多数医院，尤其是在资源不足和农村地区的医院，缺乏接受培训的医生 即使在繁忙的学术城市医院中，OUD的治疗以及患者的标准护理通常包括 排毒和转介到门诊资源以进行后续治疗。这问严重的OUD患者 容忍戒断症状，​​冒着过早出院的风险 与OUD治疗转介连接。结果包括长时间的住宿，因为人们担心复发和 不遵守患者如果患者离开医院，并且在OUD复发后的再入院，缺乏抗生素依从性 并重新感染，导致临床结果不佳和医疗保健成本较高。管理的医院设置 这些感染正在治疗越来越多的未经处理的OUD的人。这提供了机会 吸引患者在管理感染的同时治疗自己的OUD。传染病（ID） 专家和医院主义者是建立能力并增加获​​得能力的关键和逻辑资源 药物辅助治疗（MAT）。丁丙诺啡（实验室）的可注射长效的每月配方 具有在医院环境中启动Oud治疗的潜在优势，并在 解雇社区。我们建议测试一种新的护理模型（ID/LAB），其中阿片类药物使用障碍 （OUD）由ID专家和住院医生与与Oud相关的管理人员进行管理 感染，使用长效注射丁丙诺啡（实验室），然后尽快转诊 出院到社区资源，以进行长期治疗。成年人被送往医院 与OUD相关的感染（n = 200）将在住院时发现，并随机分配1：1 ID/LAB或治疗照常（TAU），包括排毒和转诊至基于社区的治疗 与传染病的治疗并行。主要结果指标将是比例 参加有效的OUD药物治疗的患者（丁丙诺啡，美沙酮或注射 随机分组后的3个月（12周），纳曲酮）。研究站点将是三家服务的医院 在美国东部的地理上多样化，混合城市和农村社区，成功合作 对成瘾和传染病的治疗，可以稳定OUD，同时避免重复感染， 以及由于感染或过量降低的发病率和死亡率的风险。

项目成果

Inpatient Low-dose Transitions From Full Agonist Opioids Including Methadone Onto Long-acting Depot Buprenorphine: Case Series From a Multicenter Clinical Trial.

住院患者从包括美沙酮在内的全激动阿片类药物到长效丁丙诺啡的低剂量过渡：来自多中心临床试验的病例系列。

• DOI: 10.1097/adm.0000000000001136
• 发表时间: 2023
• 期刊: Journal of addiction medicine
• 影响因子: 5.5
• 作者: Seval,Nikhil;Nunez,Johnathan;Roth,Prerana;Schade,Meredith;Strong,Michelle;Frank,CynthiaA;Litwin,AlainH;Levin,FrancesR;Brady,KathleenT;Nunes,EdwardV;Springer,SandraA
• 通讯作者: Springer,SandraA