Integrated outpatient treatment of opioid use disorder and injection-related infections: A description of a new care model

Prev Med. 2019 Nov:128:105760. doi: 10.1016/j.ypmed.2019.105760. Epub 2019 Jun 26.

Abstract

Persons with opioid use disorder (OUD) hospitalized with severe, injection-related infections (SIRI) are frequently hospitalized for the duration of IV antibiotic treatment due to concerns regarding their eligibility for outpatient parenteral antimicrobial therapy (OPAT), which is the standard of care for prolonged IV antibiotic courses for patients without drug use. As part of a pilot study, a novel, integrated care model was developed where patients with OUD and SIRI receive addiction consultation and buprenorphine induction while hospitalized, followed by ongoing management in an outpatient clinic that combines office-based opioid treatment with buprenorphine pharmacotherapy and counseling services with OPAT. Through three illustrative case vignettes the outpatient model is described along with challenges, lessons learned and future directions.

Keywords: Buprenorphine; Endocarditis; Intravenous; Opiate-related disorders; Substance abuse; Vascular access devices.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ambulatory Care / standards*
  • Anti-Infective Agents / therapeutic use*
  • Buprenorphine / therapeutic use*
  • Delivery of Health Care, Integrated / standards*
  • Female
  • Humans
  • Infections / drug therapy*
  • Infections / etiology
  • Male
  • Middle Aged
  • Narcotic Antagonists / therapeutic use*
  • Opiate Substitution Treatment / methods
  • Opioid-Related Disorders / drug therapy*
  • Pilot Projects
  • Practice Guidelines as Topic

Substances

  • Anti-Infective Agents
  • Narcotic Antagonists
  • Buprenorphine