Examination of the Integration of Opioid and Infectious Disease Prevention Efforts in Select Programs

Consensus

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Opioid use and infectious diseases are intertwined epidemics. Despite the fact that the United States is more than two decades into the opioid crisis - the cause of tens of thousands of deaths every year on its own - the health system has not sufficiently addressed the morbidity and mortality of drug use coupled with infectious diseases. This is at least in part due to traditional models of substance use disorder care wherein substance use disorder treatment is delivered independently of other medical care, thereby inhibiting the delivery of comprehensive care. As a result, the United States is experiencing a drastic increase in infectious diseases that spread with drug use.

Opportunities to Improve Opioid Use Disorder and Infectious Disease Services examines current efforts to integrate care and describes barriers, such as inadequate workforce and training; lack of data integration and sharing; and stigma among people who use drugs and have also been diagnosed with an infectious disease. The conclusions and recommendations of this report will help to promote patient-centered, integrated programs to address this dual epidemic.

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216 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-65449-1
ISBN Ebook: 0-309-65450-5
DOI: https://doi.org/10.17226/25626

Suggested citation

National Academies of Sciences, Engineering, and Medicine. 2020. Opportunities to Improve Opioid Use Disorder and Infectious Disease Services: Integrating Responses to a Dual Epidemic. Washington, DC: The National Academies Press.

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Carlos del Rio

Carlos del Rio, M.D., is the Hubert Professor and Chair of the Department of Global Health, a professor of epidemiology at the Rollins School of Public Health, and a professor of medicine in the Division of Infectious Diseases at Emory University School of Medicine. He is also principal investigator and co-Director of the Emory Center for AIDS Research. Dr. del Rio is a native of Mexico, where he attended medical school at Universidad La Salle, graduating in 1983. He did his internal medicine and infectious diseases residencies at Emory University. In 1989 he returned to Mexico, where he was Executive Director of the National AIDS Council of Mexico (CONASIDA, the Federal agency of the Mexican Government responsible for AIDS Policy throughout Mexico), from 1992 through 1996. In November 1996, he returned to Emory where he has been involved in patient care, teaching and research. Dr. del Rio was Chief of the Emory Medical Service at Grady Memorial Hospital from 2001–2009 and since 2017 is the Interim Executive Associate Dean for Emory at Grady. Dr. del Rio’s research focuses on the early diagnosis, access to care, engagement in care, compliance with antiretrovirals, and the prevention of HIV infection. He has worked for over a decade with hard-to-reach populations, including persons who use drugs, to improve outcomes of those infected with HIV and to prevent infection with those at risk. He is also interested in the translation of research findings into practice and policy. Dr. del Rio is conducting a National Institute on Drug Abuse-funded study entitled “Improving physician opioid prescribing for HIV-infected patients with chronic pain”. He is co-PI of the National Institutes of Health-funded Emory–Centers for Disease Control and Prevention (CDC) HIV Clinical Trials Unit, Clinical Site Leader for the Adult AIDS Clinical Trials Group and the site PI for the HIV Prevention Trials Network of the National Institute of Allergy and Infectious Diseases. His international work includes collaborations in the countries of Georgia, Ethiopia, Kenya, Thailand, Vietnam, and Mexico. He has also worked on emerging infections, such as pandemic influenza, and was a member of the World Health Organization Influenza A (H1N1) Clinical Advisory Group and of the CDC Influenza A (H1N1) Task Force during the 2009 pandemic.

Julie A. Baldwin

Julie A. Baldwin, Ph.D., is director of a new center on health equity research, and a professor in the Department of Health Sciences in the College of Health and Human Services at Northern Arizona University (NAU). Prior to that, she was on the faculty at the University of South Florida (USF) College of Public Health in the Department of Community and Family Health. Before joining USF, she served as a tenured faculty member at Northern Arizona University, with a joint appointment in the Mel and Enid Zuckerman Arizona College of Public Health. She has worked for over 28 years with tribal communities in northern Arizona to design culturally relevant health promotion programs for youth and their families.
Dr. Baldwin’s research over the years has focused on both infectious and chronic disease prevention targeting children, adolescents, and families. Cross-cutting themes which have characterized her work include: utilizing community-based participatory research approaches, working with underserved and/or marginalized populations, and addressing health disparities by developing and implementing culturally competent public health interventions. She has been PI or Co-PI of several federally funded projects from such agencies as CDC, NIMH, NIAAA, NIDA, NIMHD, the Robert Wood Johnson Foundation and HRSA/AMERSA-SAMHSA/CSAT. For over 28 years, Dr. Baldwin has had a consistent program of applied research addressing HIV/AIDS and substance abuse prevention in youth, with a special emphasis on American Indian adolescents and their families. She continues to contribute significantly to this field of research today, as the Co-Director of a NIDA Research Education grant, the “Institute for Translational Research in Adolescent Behavioral Health” and Co-Director of another NIDA grant entitled, the “Intertribal Talking Circle for the Prevention of Substance Abuse in Native Youth.”
She earned her doctorate in Behavioral Sciences and Health Education in 1991 from the Johns Hopkins University School of Hygiene and Public Health. As an enrolled member of the Cherokee Nation of Oklahoma, she has made a life-long commitment to serving diverse communities and to advocating for health promotion programs for children, adolescents and families.

Edwin Chapman

Edwin C. Chapman, M.D., is the Chief Medical Officer of Medical Home Development Group, a multi-specialty physician led, physician owned Medical Service Organization headquartered in Washington, DC. Dr. Chapman has delivered high quality care in Washington, DC for 40 years, specializing in Internal Medicine and Addiction Medicine. He currently collaborates with the Howard University Urban Health Initiative as an Adjunct Assistant Professor, Department of Behavioral Health and Psychiatry investigating the complex mix of addiction, undertreated mental illness, infectious diseases (AIDS & hepatitis C), criminal behavior, and chronic diseases. Using an innovative “virtual office telemedicine design,” that initiative brought together the Departments of Behavioral Health and Psychiatry, Family and Community Medicine, Internal Medicine, and Pediatrics in a successful collaboration with the DC Department of Community Health addressing the needs of opioid addicted index patients and their entire families.

Hannah Cooper

Hannah Cooper, Sc.D., is the Rollins Chair in Substance Use Disorders. Dr. Cooper is a professor and vice chair in the Department of Behavioral Sciences and Health Education at Rollins, co-director of the Prevention Science Core at the Emory Center for AIDS Research and director of Rollins’ Socio-Contextual Determinants of Health certificate program. Dr. Cooper’s research primarily focuses on social determinants of HIV-related outcomes, particularly among people who use drugs. She currently leads five NIH-funded studies on these topics—including the CARE2HOPE project, which studies substance misuse and related harms among people who inject opioids in rural Kentucky. Her work has been cited in the National HIV/AIDS Strategy for the United States and has been published in numerous preeminent journals including the American Journal of Public Health, the Journal of Urban Health and Social Science & Medicine. Dr. Cooper received her bachelor’s from Yale, followed by her Sc.D. in health and social behavior from Harvard, then completed her postdoctoral fellowship in drug use and HIV at the National Development and Research Institutes. Since joining Rollins in 2008, Dr. Cooper has gained the respect of colleagues and collaborators across the University. She was recognized for her outstanding leadership qualities with the Emory Williams Teaching Award in 2015.

David H. Gustafson

Dave Gustafson, Ph.D., directs the University of Wisconsin-Madison’s Center for Health Enhancement Systems Studies. His research interests focus on developing systems engineering tools to support sustainable individual and organizational improvement in addiction, cancer and aging. NIATx grew to a network of more 3,000 addiction treatment agencies and has conducted nationwide experiments to test the effectiveness of quality improvement models to enhance access to and retention in addiction treatment. His other implementation research interests focus on developing systems engineering tools to encourage individual and organizational change. His individual change research develops and tests computer systems (CHESS) to help people deal with serious illness The addiction program–ACHESS–has been used by over 6,000 patients. Randomized trials found that ACHESS reduced risky drinking, improved retention in treatment and abstinence. Other versions of CHESS have also improved outcomes in areas such as breast, lung and colon cancer as well as HIV and asthma. Dr. Gustafson and his colleagues have produced models to predict and explain implementation, sustainability and diffusion of innovations, as well as models to measure quality of care and understand customer needs. He is an author on over 300 reviewed publications including seven books. He is a member of the National Academy of Engineering, and Fellow of the Association for Health Services Research, the American Medical Informatics Association, the WK Kellogg Foundation and the Institute for Healthcare Improvement, which he co-founded and was board vice-chair. He co-chaired the federal Science Panel on Interactive Communications in Health, served on several NIH Study Sections and is a member of the National Advisory Council of the Substance Abuse and Mental Health Services Administation. He serves on two National Academies committees.

Holly Hagan

Holly Hagan, Ph.D., is a Professor at New York University College of Global Public Health and Co-Director of the NIDA P30 Center for Drug Use and HIV|HCV Research. She is trained as an infectious disease epidemiologist with an emphasis on methods to study disease causation and control. Her research has addressed the etiology, epidemiology, natural history, prevention and treatment of blood-borne and sexually transmitted infections among people who use drugs (PWUD). Currently, she studies the epidemiology and response to the opioid and overdose epidemics, and she is the Chair of the Executive Steering Committee for the Rural Opioid Initiative funded by NIH, CDC, SAMHSA and the Appalachian Regional Commission. Dr. Hagan is a member of the WHO Global Burden of Disease Study Diseases and Injuries Group, she served on the National Academies of Sciences, Engineering, and Medicine Committee on the Prevention and Control of Viral Hepatitis in the United States, and she has been an advisor to the U.S. Department of Health and Human Services, the CDC, and the Canadian Institutes of Health on national programs to detect, diagnose and treat HCV infections.

Robin P. Newhouse

Robin P. Newhouse, Ph.D., R.N., FAAN, is the dean of the Indiana University (IU) School of Nursing and an IU distinguished professor. Her research focuses on health system interventions to improve care processes and patient outcomes. She has published extensively on health services improvement interventions, acute care quality issues, and evidence-based practice. Dr. Newhouse was appointed to the Methodology Committee of the Patient Centered Outcomes Research Institute (PCORI) and currently is serving as the committee’s chair. She has served on multiple National Academies of Sciences, Engineering, and Medicine committees and is the immediate past chair of the AcademyHealth Board. Dr. Newhouse was inducted into the Sigma Theta Tau International Honor Society of Nursing Nurse Researcher Hall of Fame in 2014 and received the American Nurses Credentialing Center President’s Award in 2015. In 2017, Dr. Newhouse was elected as a member of the National Academy of Medicine (NAM). Dr. Newhouse currently is serving as the lead investigator for Indiana University’s Grand Challenge: Responding to the Addictions Crisis. This Grand Challenge is a $50 million initiative in partnership with the state and major healthcare systems in Indiana to reduce substance use disorders, the number of people that die because of an opioid overdose, and the number of babies born exposed to substances that result in neonatal abstinence syndrome. Dr. Newhouse is also principal investigator of two current studies. The first study tests the effectiveness and implementation of a Screening Brief Intervention Referral to Treatment (SBIRT) toolkit to identify people who use substances and get them the help that they need across settings that range from critical access hospitals to academic health centers. The second study assesses the workforce available to address the addictions crisis across the state and will create a web-based resource for clinicians to use to refer people who use substances to treatment when indicated

Josiah D. Rich

Josiah (Jody) D. Rich, M.D., M.P.H (NAM), is Professor of Medicine and Epidemiology at Brown University, and a practicing infectious disease and addiction specialist providing care to patients at The Miriam Hospital and the Rhode Island Department of Corrections since 1994. He has published close to 200 peer-reviewed publications, predominantly in the overlap between infectious diseases, addictions, and incarceration. He is the Director and Co-Founder of The Center for Prisoner Health and Human Rights at The Miriam Hospital (www.prisonerhealth.org) and Co-Founder of the nationwide Centers for AIDS Research Collaboration on HIV in Corrections initiative. Dr. Rich has advocated for public health policy changes to improve the health of people with addiction, including improving legal access to sterile syringes and increasing drug treatment for incarcerated and formerly incarcerated populations. He has had continuous NIH research funding for over 2 decades. His primary areas of interest and expertise are in the overlap between infectious diseases and illicit substance use, the treatment and prevention of HIV infection, and the care and prevention of disease in addicted and incarcerated individuals. More recently he has focused on addressing the opioid overdose epidemic. He has testified in congress multiple times and served as an expert advisor to Rhode Island Governor Gina Raimondo’s Overdose Prevention and Intervention Task Force since its inception in 2015.

Sandra A. Springer

Sandra Springer, M.D., is an associate professor of medicine in the Department of Internal Medicine, Section of Infectious Diseases at the Yale School of Medicine. She is also the Director of the Infectious Disease (ID) Clinic at the Newington site and an attending ID physician at the West Haven site of the VA Connecticut Healthcare System. She is board-certified in internal medicine, infectious diseases and addiction medicine. She has significant clinical and research experience with use of medications for the treatment of opioid and alcohol use disorders among persons living with HIV, persons in the Criminal justice system, and persons in the community in both inpatient and outpatient settings. She developed the first protocol to use buprenorphine to improve HIV treatment outcomes as relapse prevention for released prisoners with OUD and HIV. She has conducted randomized controlled trials and evaluated the impact of extended-release naltrexone (XR-NTX), approved for treatment of both alcohol and opioid use disorders, as a PI for a NIAAA funded study among prisoners with HIV and alcohol use disorders; and as PI for a NIDA-funded study among prisoners and jail detainees with OUD and HIV. Both studies found that XR-NTX improved HIV viral suppression 6 months after release to the community. She currently is co-leading two NIDA-funded studies evaluating the impact of medications for OUD (methadone, buprenorphine) on immunobiological outcomes among persons with OUD with and without HIV; and evaluating the impact of buprenorphine, methadone and extended-release naltrexone on HIV latency and persistence among persons with OUD and HIV. She was a working group member of the National Academies of Sciences, Engineering, and Medicine historic meeting calling for action to integrate OUD and infectious disease treatment; a current member of ASAM’s National Practice Guideline Expert PaneI for Medication Treatment for OUD; and current member of the IDSA and HIVMA Working Group on Infectious Disease Issues In the Opioid Epidemic. She has presented her work at numerous national and international conferences, and has published over 100 manuscripts, book chapters and abstracts regarding the subject of HIV, criminal justice system and substance use disorders.

David L. Thomas

David L. Thomas, M.D., is the Stanhope Bayne-Jones Professor of Medicine and Director of Infectious Diseases at the Johns Hopkins School of Medicine. His nearly 30-year career has been based in East Baltimore where through his research, clinical care, and administrative roles, he has accumulated knowledge of the intersection of the opioid epidemic and infectious diseases. His particular area of focus has been viral hepatitis and HIV. His lab has produced some of the seminal findings regarding hepatitis viruses among persons who inject drugs and the influence of HIV on those outcomes. He also has clinical expertise caring for infectious diseases complications of opioid addiction through his role as an infectious diseases consultant at the Johns Hopkins Hospital. He has served on multiple panels including for the NAM, NIH, CDC, and the related professional societies (AASLD and IDSA), as Associate Editor for leading journals such as Clinical Infectious Diseases and the Journal of Clinical Investigation and was recognized by the Infectious Diseases Society of America with their Citation Award for his work pioneering the AASLD/IDSA hepatitis C guidance.

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Examination of the Integration of Opioid and Infectious Disease Prevention Efforts in Select Programs

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Examination of the Integration of Opioid and Infectious Disease Prevention Efforts in Select Programs

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Featured publication

Opportunities to Improve Opioid Use Disorder and Infectious Disease Services: Integrating Responses to a Dual Epidemic

Description

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Committee

Sponsors

Staff

Major units and sub-units

Contact

Contact us

Provide feedback

Request materials

More like this

Review of the draft United by Nature assessment

Modernizing Mathematics Education for Grades 9-14

Health Care Financing to Improve Availability of Affordable Contraception: Identifying Promising Practices

National Cooperative Highway Research Program

Review of the draft United by Nature assessment

Modernizing Mathematics Education for Grades 9-14

Harm Reduction Services for People Who Use Drugs: Exploring Data Collection, Evidence Gaps, and Research Needs - A Workshop

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Strategic Plan and Blueprint for Addressing Thalassemia in the United States