Addressing the Intersection of Infectious Disease Epidemics and Opioid and Substance Use Epidemics.

The current opioid use disorder (OUD) and nonopioid substance use epidemics in the United States have resulted in an increase in infections among persons who use drugs (PWUD), magnifying the morbidity and mortality associated with illicit substance use. Such infections that are increasing related to illicit opioid and other drug use include hepatitis C virus (HCV), hepatitis B virus, human immunodeficiency virus (HIV), invasive bacterial and fungal infections (including Staphylococcus aureus bacteremia, fungemia, endocarditis, skin and soft tissue infections), and bone and joint infections, among others. Illicitly manufactured fentanyl or heroin combined with stimulants like cocaine and methamphetamine has led to new HIV outbreaks among PWUD throughout the country as well as increased overdose deaths. Persons with co-occurring drug use–related infections represent some of the most severely ill patients. Integrating treatment for the underlying substance use disorder with the associated infectious disease is an important opportunity to intervene, both to improve patients’ outcomes and to reduce the public health risk of infectious disease transmission.

Sandra A. Springer, MD, Editor

Carlos del Rio, MD, Editor

In this special issue of Infectious Disease Clinics of North America that is devoted to Infectious Complications of Opioid Use and Other Substance Use Disorders, specific articles discuss the impact substance use, and specifically, opioid use has had on individual infectious diseases like HIV, HCV, endocarditis, skin and soft tissue infections, and bone and joint infections, as well as the management of these infections with the substance use disorders within the hospital, the community, and the criminal justice settings. Furthermore, this issue includes specific articles on the geography of infectious disease related to the opioid epidemic. The special issue is strengthened by including specific articles addressing the microbiology and algorithms to diagnose infections related to substance use as well as specific potential novel antimicrobial treatments to consider using for those with infectious diseases related to substance use. Importantly, this special issue also addresses harm reduction services like syringe service programs on the impact of reducing infectious disease complications of opioid and other substance use as well as the management of pain in persons with co-occurring opioid and other substance use disorders in the setting of associated infectious disease complications. Last, a commentary focuses on the lessons learned from earlier responses to the HIV epidemic in the United States that could be used to combat the current opioid and other substance use epidemics that are fueling new HIV and other infectious disease epidemics. Since the time the articles in this special issue were written and accepted in January of 2019 the COVID-19 pandemic has changed the world and considerations of integration of treatments of both infectious diseases and opioid use disorder prevention and treatments are even more urgent.