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Modeling the impact of harm reduction for opioid use disorder on infectious disease prevention

Introduction Opioid use disorder (OUD) can lead to injection drug use, which is an important risk factor for blood-borne viruses such as HIV and hepatitis C virus (HCV), among other infections. Indeed, the burden of blood-borne viruses among people who inject drugs (PWID) is high globally. A systematic review and meta-analysis [ ] found that 17.8% (95% uncertainty interval [UI], 10.8–24.8) of PWID are living with…

Notes on harm reduction and the opioid epidemic in the United States

Introduction All societies that have had access to psychoactive drugs have used them. There are multiple positive aspects of psychoactive drug use, from creating positive mood states, to stress and pain relief, to increasing social bonding, to simple preservation of health (for much of human history it was safer to drink locally available wine or beer than locally available water). Psychoactive drug use also has many…

HIV pre-exposure prophylaxis for people who inject drugs

HIV prevention in people who inject drugs According to the CDC, 9% of incident HIV cases in the United States are directly attributable to injection drug use [ ]. Among people who inject drugs (PWID), the risk for HIV and other blood-borne pathogens is primarily related to injecting behaviors, including sharing needles, syringes, and other injecting and drug preparation equipment. Data from the National HIV Behavioral…

Inpatient opioid use disorder treatment for the infectious disease physician

Introduction Infections are a common cause of hospitalization for patients with opioid use disorders (OUDs). In 2012, there were 530,000 OUD-related hospitalizations with a total estimated healthcare cost of $15 billion [ ], approximately 6.500 of those admissions were related to infections, doubled from the previous decade, with an associated total cost of $700 million [ ]. This is an underestimate in the context of the…

Outpatient opioid use disorder treatment for the ID physician

Infectious disease (ID) physicians have long treated the common complications of opioid use disorder (OUD) and injection drug use. Such complications encountered in patients with OUD include HIV, viral hepatitis (HBV, HCV), tuberculosis, skin and soft tissue infections (cellulitis, abscesses, necrotizing fasciitis), endovascular infections and complications (infective endocarditis, osteomyelitis, discitis), and internal abscesses (e.g., brain, epidural), among others. ID physicians, however, have not traditionally considered management…

Opioid use disorder and endocarditis

Opioid use disorder and endocarditis The increasing use of opioids over the past decade has resulted in a crisis of overdose and death in the United States that has also been accompanied by an increase in infectious complications related to injection drug use (IDU). It has been well described in the medical literature that there is an increased risk of hepatitis C and HIV infections in…

Opioid use disorder and Chronic Hepatitis B

Introduction Chronic hepatitis B virus (HBV) infection affects over 240 million individuals worldwide [ ]. Detection of the disease is dependent on active surveillance and testing by healthcare providers. Due to the high risk of transmission, the Center for Disease Control (CDC) recommends HBV screening in all individuals with opioid use disorders [ ]. Prompt identification of chronic infection and vaccination of susceptible persons at initial…

Opioid use disorder and HCV (hepatitis C virus)

Introduction Hepatitis C virus (HCV) has a significant impact on the healthcare system in the United States and the Centers for Disease Control and Prevention (CDC) estimates that the number of deaths associated with HCV has surpassed the combined deaths from 60 other nationally notifiable infectious conditions, including HIV (human immunodeficiency virus) and tuberculosis [ ]. The last 5 years however have seen a dramatic change…

Opioid use disorder and HIV

Injection drug use is an important HIV risk factor Transmission among People Who Inject Drugs (PWID) early in the HIV epidemic Soon after the identification of acquired immune deficiency syndrome (AIDS), it became clear that injection drug use was a major risk factor for the acquisition of human immunodeficiency virus (HIV). Des Jarlais and colleagues tested for HIV antibodies in stored sera from people who inject…

Opioid use disorder, infectious diseases, and the criminal justice system

Background on criminal justice in the United States In the United States, the rate of incarceration has skyrocketed over the last 50 years, ignited by the “Tough on Crime” as well as the “War on Drugs” political pushes of the 1970s and disproportionately affecting people of color and people with mental health illnesses. The lifetime likelihood of incarceration for black men in the United States is…

Opioid use disorder and rural America

Acknowledgements Dr. Akhtar is supported in part by the National Institute on Drug Abuse award number 2UG3DA044826. Dr. Feinberg is supported in part by the National Institute on Drug Abuse award number 2UG3DA044825 and the National Institute of General Medical Sciences award number 5U54GM104942-04. Opioid use disorder burden in rural communities Although the overall prevalence of drug use in rural areas is lower than that in…

The case of Scott County: injection drug use and the HIV and hepatitis C virus outbreak

Background The syndemic of injection drug use (IDU) and HIV infection has been well recognized since the origin of the HIV epidemic. Although transmission in persons who inject drugs (PWID) was documented in 1977 [ ], phylogenetic analysis suggests that the HIV infection was circulating in this population as early as 1970 [ ]. Following rapid spread in this population, it is estimated that at least…

The epidemiology of the opioid overdose epidemic in the United States

Acknowledgments I gratefully acknowledge research funding from the US National Institutes of Health, National Institute of Drug Abuse Grant DA037820. I thank Dr. Sarah Mars for extensive feedback and Dr. Jay Unick for creating Fig. 1.1 . Introduction The opioid overdose epidemic is the latest phase of a multidecade exponential increase in drug-related mortality in the United States [ ]. The severity of the current crisis has…

Influenza Virus: A Public Health Concern

Abstract Influenza is a disease that represents an important public health concern. The ability of influenza viruses to undergo genetic mutations and become the cause of global epidemics (pandemics) has been a constant worry to public health experts. Over the past century, four influenza pandemics (Spanish flu, 1918; Asian flu, 1957; Hong Kong flu, 1968; swine flu, 2009) have occurred. The 1918 pandemic was the most…

Middle East Respiratory Syndrome Coronavirus

Abstract Unlike the coronaviruses causing severe acute respiratory syndromes, namely SARS-CoV and SARS-CoV-2 (the cause of Coronavirus Disease-2019 [COVID 19]), which developed rapid and aggressive person-to-person spread, the coronavirus that causes Middle Eastern respiratory syndrome (MERS-CoV) has yet to develop significant person-to-person spread. It remains a highly dangerous pathogen nonetheless. Roughly 2500 cases have been reported to date, with a 35% case fatality rate; however, actual…

Severe Acute Respiratory Syndrome and Coronavirus Disease 2019

Acknowledgment The previous edition of this chapter was written by Dr. Eileen Schneider. Abstract Within the past 20 years, three novel coronaviruses have emerged from the animal kingdom to infect humans, with devastating disease and economic consequences. They were severe acute respiratory syndrome–coronavirus disease (SARS-CoV), Middle East respiratory syndrome (MERS), and SARS-CoV-2 (COVID-19). This chapter discusses SARS-CoV and introduces readers to the currently emerging SARS-CoV-2 (COVID-19).…

Ebola and Other Emerging Viral Hemorrhagic Fevers

Clinical Vignette A man in his 50s presented to a facility managing patients infected with Ebola virus disease in Guinea. He had abdominal distension, was slow to speak, and had a mildly ataxic gait. Three weeks earlier he had participated in a family funeral, and several members of that funeral party had been admitted to the unit. He denied symptoms and reported that he, being the…

Neuroangiostrongyliasis (Rat Lungworm Disease)

Abstract Neuroangiostrongyliasis (NAS), or rat lungworm disease (RLWD), is an important emerging infection spreading around the world. It is caused by Angiostrongylus cantonensis, a nematode parasite, and is the commonest parasitic cause of eosinophilic meningitis. Infection can also cause cranial nerve (CN) palsies, encephalitis, and radiculomyelitis. Another form of the disease, ocular angiostrongyliasis, is very rare but occurs when a larval worm invades the eye. Initial…

Zika Virus Disease and Congenital Zika Virus Infection

Abstract Zika virus (ZIKV) is a flavivirus primarily transmitted to humans by mosquitoes, mainly Aedes aegypti . Other commonly recognized transmission modes include sexual and intrauterine transmission. Following recognition of ZIKV transmission in Africa and Asia during the 1900s, outbreaks subsequently occurred in Pacific Island nations from 2007 and the Americas from 2015. Incidence subsequently declined, but available information suggests probable low-level ongoing transmission in parts…

Tularemia

Acknowledgment The authors would like to acknowledge Dr. Jo Hoffman who contributed to the previous edition of this chapter. Abstract Tularemia is a zoonotic bacterial infection that occurs throughout the Northern hemisphere; it is caused by several subspecies of the gram-negative coccobacillus Francisella tularensis . A wide variety of animals can be infected with F. tularensis , and the bacteria can also be carried by insects.…