The Crossover Between Substance Use Disorder and Infectious Disease Care

Segment Description: Hermione Hurley, MD, MCBhB, physician with Denver Health & Hospital Authority, discusses the intersection of substance use disorder and infectious disease.

Interview transcript: (modified slightly for readability)

Dr. Hurley: On Wednesday at IDWeek 2019, I was part of a panel discussion with a number of other participants.We all form part of an IDSA opioid working group, and we took on trying to discuss practical responses from our regions to help clinicians and providers work towards combining infectious disease and substance use care. I had a colleague from Kentucky who talked about some collaborative efforts that they made towards getting teams together in an inpatient setting to try and help with the increase we're seeing in endocarditis. I had another colleague who spoke about what they're doing in Maine to actually help with reaching out to communities and increase harm reduction activities. I spoke about what an individual provider in an ID clinic can use in their day-to-day practice, and 5 techniques to really help people get started even if they feel the problem is overwhelming. And, finally, I had another colleague who spoke about criminal justice and helping people who are justice-involved navigate between ID and substance use care.

I think that there are a number of clinicians, especially infectious disease, who are starting to see the complications of substance use treatment in their everyday practice and are feeling sort of overwhelmed and frustrated. I know that that's how I felt when I had my X waiver and I wasn't quite sure what to do with my X waiver, how to start prescribing buprenorphine. I was lucky enough to do an addiction fellowship after my infectious disease fellowship, but I'm not sure that everyone has the time or need to do that. And so I spoke about 5 ways that people can actually start introducing substance use care into their ID practice, whether it be inpatient or outpatient. One of the things that I think is really important is that we use person-first language. We're actually really good at this as ID clinicians already. We've had experience [with] how not to introduce stigma into our language when we're helping people who are living with HIV. So I try very hard to avoid labeling techniques, both in my discussions, but also in how I write my notes and how I correspond.

The next thing I tried to suggest is that you work towards providing naloxone to as many people as you possibly can. It's very hard to naloxone yourself, but you can actually help save someone else. One of the studies I've read recently says that when they gave naloxone to everyone who came into an opioid treatment program, 30% of the people who received it used it within 3 months, usually on someone else. So I'm quite over it, I say, "I'm giving this to you so you can help save a life. Come and get a refill anytime you need." I use prescriptions; I charge to insurance, and this is a really great place that people can get maybe a local grant to help being able to provide that even if they don't get covered by insurance or they're not a Medicaid expansion site. I like treating the whole person. I recently came back from a conference in Montreal, which was the International Conference on Hepatitis and Substance Users. One of the things that they really stressed was the idea of treating whole people, not just hepatitis C, not just HIV, but thinking about things like self care, good sleep, treating co-morbid anxiety disorders, and really helping people with loneliness and isolation. Those can be really big triggers.

I vaccinate like crazy. I love vaccination. And my clients are really quite open to vaccination, especially for things that disproportionately affect my patients, so hepatitis A, hepatitis B, we're opening an influenza clinic in our methadone clinic, and we use like a pop-up model for vaccination. It's really hard for nurses who are dispensing so many doses of methadone to stop the line, but we we asked our public health department to come into our clinic and they were very successful at offering vaccination even a couple of times a week. Then I spoke about using medications and medications in particular can be very effective in the office. It's great to have a methadone clinic nearby, but if you don't, I think buprenorphine is a great, safe medicine that can make a big difference in a number of clients' lives.