Researchers argue for new ID subspecialty covering addiction
Infectious disease physicians are in a “unique position” to concurrently address patients with an infection, such as HIV or hepatitis C virus, and substance use disorders, and researchers noted that the successful management of infections requires a “holistic approach” that acknowledges and treats the underlying “complex biopsychosocial factors” that fuel addiction.
In a study published in Clinical Infectious Diseases, David P. Serota, MD, MSc, assistant professor of medicine at the University of Miami Miller School of Medicine, and colleagues made a case for creating a new subspecialty within ID that would focus on addiction and substance use disorders (SUDs).
According to Kinna Thakarar, MD, MPH, assistant professor of medicine at Maine Medical Center and Tufts University School of Medicine and who was not involved in the study, infections associated with injection drug use (IDU) are becoming “increasingly common” and it would be feasible to integrate addiction care within the ID specialty.
“The creation of a more formal ID/addiction subspecialty will help grow the cadre of physicians with dual expertise in these fields and help meet clinical, administrative/policy, and research needs in the setting of the ID/substance use disorder syndemic,” she told Infectious Disease News.
Serota explained in an email interview that treatment is incomplete only if the acute complication of SUD, ie, infection, is addressed. He highlighted the many years spent on treating HIV and HCV as evidence that addiction management can be incorporated into the scope of an ID practice.
“In the world of HIV and hepatitis C treatment, comanagement of these chronic infections and addiction is associated with improved ID-related outcomes. Management of addiction is an integral piece of holistic HIV primary care,” Serota said.
To integrate potential ID and addiction dual specialists, the researchers aimed to define the role they would play in clinical care, health administration and research.
“In clinical care, ID/addiction physicians are able to help patients through the acute stabilization phase of IDU-associated infections in the hospital, as well as facilitate a smooth transition to the outpatient setting by providing comprehensive treatment of their infection and addiction,” Serota told Infectious Disease News. “In health administration and policy, there is a role for ID/addiction physicians to guide project development, implementation of evidence based best practices, to reduce institutional stigma toward people who use drugs, and to advocate for federal/state/local policies that advance access to addiction treatment and harm reduction.”
Although Serota and Thakarar said guidance on the management of patients with SUD and IDU-associated infections would be helpful, they both believe there is more to be done before that stage comes.
Serota pointed to the challenges of overhauling “older approaches to addiction and conventional wisdom” as a barrier to new guidelines.
“The idea that addiction is a moral failing and that recovery simply takes a strong willpower remain prevalent,” he said. “Ideas about treating IDU-associated infections are deeply ingrained, such as patients must remain inpatient for 6 weeks of IV antibiotics, or people who use drugs cannot have a peripherally inserted central catheter.”
Moreover, more research is needed regarding patient outcomes, according to Serota, while Thakarar called for more research into ID and addiction, as well as collaboration between addiction medicine specialists and ID clinicians.
However, Thakarar disclosed that integration is possible, and the idea of an addiction subspecialty has backing from others in the field.
“Here at Maine Medical Center (MMC), ID fellows receive additional training in addiction medicine during fellowship and are expected to obtain their buprenorphine waiver during their second year; we are planning a more formal relationship with the MMC addiction medicine fellowship to create an actual ID/addiction medicine track for fellows,” she said. “There is a lot of positive energy around making this a more formal subspecialty, and the need is definitely there.” – by Marley Ghizzone
Disclosures: Serota reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.