Patients admitted to OTPs present with a full range of medical problems. Among the more prevalent are infectious diseases including HIV/AIDS, TB, STDs and hepatitis, the contraction and transmission posing serious public health risk and life threatening illness. Approximately 25-30% of patients receiving methadone treatment in the US were infected with HIV (AATOD 1998, Gourevitch & Friedland, 2000). It is estimated that 70-90% of injection drug users have serologic evidence of exposure to HCV (NIH 2002). Even though the incidence of reported cases of TB and syphilis peaked in 1992, the incidence of infections among high risk groups (including homeless, incarcerated, HIV infected and some immigrant groups) increased 2.1 % in 2001 (CDC 2003c).

Since infectious disease is so prevalent among the OTP patient population, it is our ethical obligation to be alert and knowledgeable in identifying, and facilitating preventive and comprehensive treatment measures for our patients. Screening and treatment for many of these medical problems lie outside the scope of resources and expertise offered by an OTP. However OTPs should be responsible for establishing links with medical providers and programs skilled in offering screening and treatment for these common transmittable diseases. (SAMHSA, CSAT TIP 43).

The OTP setting may be the only access point to the health care system. It is not appropriate or feasible for an OTP to provide for all of the elements of our patients’ health care needs. However it is our responsibility to provide information, access and management for patient needs. OTPs should be at the forefront in the provision of the comprehensive care for our patients. These principles offer parameters that address the role of the OTP in the prevention, identification and treatment of high risk medical illness and infectious disease. OTPs should:

1) Provide access to comprehensive medical care including screening, immunization where appropriate and treatment for medical, psychiatric illness and high risk infectious diseases. How this is provided depends on the resources available to the OTP. Whether provided by on site medical clinics, affiliation agreements with hospitals or community agencies, or by referral to community or public health services, provision of services should be a top priority for every OTP.

2) When referring patients to and/or contracting with other organizations for services, the OTP must ensure that any disclosure of information that identifies patients as having an alcohol or drug problem is made in compliance with the requirements of the federal alcohol and drug confidentiality law (42 C.F.R. Part 2) and HIPAA.

3) Provide a leadership role with community medical care providers to establish linkage and advocacy for safe, accessible and respectful care for our patients.

4) Encourage State agencies to identify financial and health care resources to support programs for testing, immunization and treatment of infectious disease.

5) Establish protocols for the provision of these services for patients on admission and periodically throughout the treatment process.

6) Provide on-going monitoring of patients access to screening and follow-up, and case management of medical treatment for high risk medical illness and transmittable diseases.

7) Provide ongoing education with periodic updates on infectious disease prevention and treatment to patients (and family members).

8) Assure that all staff has access to the most updated information on transmittable diseases to disseminate to patients.

9) Offer immunization resources for staff to access where appropriate.

OTPs have an obligation and unique opportunity to make a significant impact on the health and safety of our patients and community. Whether services are directly integrated as part of an OTP or offered by referral to community partners, these services should be considered an essential part of comprehensive care for opioid dependent patients.