Infectious disease monitoring — more care needed to control impacts of opioid crisis

Infectious disease monitoring — more care needed to control impacts of opioid crisis
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In early June, the U.S, House of Representatives passed a package of bills addressing America’s opioid epidemic that would offer a step forward in controlling the spread of infectious diseases that bring patients to our hospitals and clinics in Kentucky. Now Senate action is needed to advance these policies and strengthen our response to this public health crisis.

Just a few years ago here at the Bluegrass Care Clinic in Lexington, Ky. where we care for people living with HIV across the Eastern half of Kentucky, just a handful of our patients acquired HIV through injecting drugs. Today, it’s one in 10 for our newly enrolled patients.

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The impact of America’s opioid crisis are stark in Kentucky where opioid epidemics across 54 counties pose risks of HIV outbreaks, but they reflect realities across America, where overdose deaths have climbed five-fold in the last decade and a half and the number of new hepatitis C infections has tripled.

 

Our state has taken a multifaceted approach to addressing this complex epidemic including new programs to improve access and linkage to medical and addiction care, adoption of syringe exchange programs — now numbering 49 throughout the state, and addiction-specific training requirements for provider licensure.

Despite these efforts, we are only just beginning to have an evidence — based understanding of the crisis at large. We still have an urgent need for more information to drive comprehensive responses to address the ongoing opioid crisis and its consequences. At the same time the fast growth of the crisis continues to highlight a serious need to ensure that trained health providers are ready and available.

In addition to the data we have on increases in infections more commonly associated with injection drug use, infectious diseases clinicians across the country, including at the University of Kentucky, are reporting notable increases in other serious bacterial infections for which we have no national system of monitoring or tracking.

These include endocarditis, a heart valve infection, as well as skin, soft tissue, bone and joint infections. Because these conditions are more likely to require hospitalization, they should sound the alarm that a community’s opioid epidemic is worsening. But, too often, patterns showing the infections are on the rise go unnoticed. In Kentucky and nationally, we see an urgent need to enhance our ability to track and monitor infections among injection drug users to improve our ability to prevent infections before outbreaks occur.

To do this, and effectively provide the scope of care needed, we need a robust workforce of infectious diseases and HIV providers on the frontlines. ID physicians are uniquely trained to address complex infections such as those associated with the opioid epidemic. Nationally fewer physicians are pursuing specialty training in infectious diseases, a subspecialty with relatively lower compensation, due to mounting medical school debt. As a result, we struggle to recruit and retain new ID physicians to Kentucky—particularly to rural areas where the need is dire.

We have also seen firsthand that by coordinating care for addiction and related infectious diseases through a multi-disciplinary team approach, we can improve patient outcomes and prevent the spread of infections. More support for these collaborative care approaches is needed in addition to having more providers trained on this care model.

Those are some of the challenges that the comprehensive package of bipartisan bills called House Resolution 6, passed by the House in June, is intended to address. Reflecting the complexity of the opioid epidemic, it would enhance monitoring of infections associated with the opioid epidemic by the Centers for Disease Control and Prevention to better respond to opioid-use disorder related infections. In addition, the bill would create a loan forgiveness program for health-care providers, including infectious diseases and HIV providers, caring for individuals with opioid use disorder.

Key Senate committees also have passed legislation that includes similar provisions. Full Senate passage and funding these important new programs through the fiscal year 2019 federal appropriations process are critical next steps to enhancing our response to the opioid crisis and the growing rise in infectious diseases associated with it.

From where we sit in Kentucky, there’s no time to waste, and the bills under consideration would help to lessen the impact of the opioid epidemic. We hope Congress will do what it takes to ensure that a bill including the infectious diseases prevention and workforce provisions is signed into law and fully funded so we and other healthcare providers can do what it takes to lessen and eventually end the multi-faceted impacts of the opioid crisis.


Alice Thornton, MD is chief of infectious diseases at the University of Kentucky in Lexington, Medical Director of the Bluegrass Care Clinic, and an HIV Medicine Association board member. Nicole Leedy, MD is the associate director of the University of Kentucky in Lexington Infectious Diseases Fellowship Program and an infectious diseases physician.