The Continuum of Care in Hospitalized Patients with Opioid Use Disorder and Infectious Complications of Drug Use (CHOICE)
The Research Need
People who inject opioids have high rates of serious infections that may require hospitalization (including systemic bacterial infections and heart infections), as well as chronic infections such as HIV and hepatitis C virus. If opioid use disorder is not addressed, these infections can relapse or recur, leading to preventable emergency department visits, hospitalizations, and deaths due to infection or opioid use. Pilot data obtained from four university hospitals show that we have incomplete understanding of how to optimize interventions to best reduce opioid-related harms and prevent further serious infections in these patients. There is a pressing need to understand the impact of interventions to address opioid use disorder across a patient’s continuum of care – both during initial hospitalization and after discharge – to improve long-term health of people who inject drugs.
About the Program
This program will evaluate patients hospitalized with an infectious complication of injection drug use and identify and understand gaps in care that arise across the continuum of care. That includes hospitalization, the transition from inpatient to outpatient care, and the year after discharge. The program will develop an informed intervention to eliminate barriers and improve health outcomes in this population.
This implementation research will be a collaboration of scientists at four academic medical centers that collectively represent a broad framework of the U.S. healthcare system. Together, these institutions treat a range of patients from both urban and rural regions, Black- and White-predominant communities, and states with and without Medicaid expansion.
The research will include retrospective analyses of patient data – as well as planning, implementation, and final effectiveness analyses of a package of interventions. This research will also determine which interventions are prioritized by institutions involved in the study, as well as which programs are the most successful, using a variety of outcome metrics. The research will also determine which interventions can generate revenue toward sustainability.
Through the Helping to End Addiction Long-term® Initiative, or NIH HEAL Initiative®, NIH has awarded research grants and administrative supplements to the CHOICE program to inform treatment of infectious complications of injection drug use across the continuum of care.
Research examples supported by this program include:
- Conducting a prospective analysis to evaluate adults hospitalized with infections associated with injection of opioids
- Assessing the presence and impact of interventions to address opioid use disorder during and after hospitalization
- Evaluating long-term outcomes of serious bacterial infections, HIV, hepatitis C virus, and opioid use disorder
- Using data from site-specific analyses and engaging key stakeholders at each site, and identifying institutional priorities and feasibility for a larger, multi-site study
- Conducting a 3-year study across all four sites to enhance use of medications for opioid use disorder as well as reduce infections and readmissions among patients hospitalized with an infectious complication of injection drug use
Participating NIH Institutes, Centers, and Offices
Henry Masur, M.D.
NIH Clinical Center
View Other Research Programs in This Focus Area
- Behavioral Research to Improve Medication-Based Treatment (BRIM)
- Enhancing the National Drug Abuse Treatment Clinical Trials Network to Address Opioids
- Harm Reduction Approaches to Reduce Overdose Death
- HEALing Communities Study
- Improving Delivery of Healthcare Services for Polysubstance Use
- Justice Community Opioid Innovation Network (JCOIN)
- Recovery Research Networks