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Belden C, Kopak A, Coules C, Friesen T, Hall J, Shukla S. Building bridges to outpatient treatment services for post-overdose care via paramedic buprenorphine field initiation. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 162:209364. [PMID: 38626851 DOI: 10.1016/j.josat.2024.209364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/19/2024] [Accepted: 04/07/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Despite sustained efforts to reduce opioid-related overdose fatalities, rates have continued to rise. In many areas, overdose response involves emergency medical service (EMS) personnel administering naloxone and transporting patients to the emergency department (ED). However, a substantial number of patients decline transport, and many EDs do not provide medication for opioid use disorder (MOUD). One approach to filling this gap involves delivering MOUD to overdose patients in the field with trained post-overdose EMS teams who can initiate buprenorphine. In this MOUD field initiation pilot program, a trained EMS Community Paramedicine team initiates buprenorphine in the field and links patients to care. The program includes three pathways to treatment with the first designed for EMS to initiate buprenorphine after overdose reversal when the patient is in withdrawal from naloxone; a second pathway initiates buprenorphine after overdose when the patient is not in withdrawal; and a third enables self-referral via a connection to the community EMS team not necessarily related to a recent overdose. METHODS We conducted a retrospective cohort study of the MOUD field initiation pilot program. Data are from 28 patients who entered care immediately post-overdose initiation of buprenorphine, 21 patients who initiated on buprenorphine while not in naloxone withdrawal, and 37 patients who self-referred to treatment following outreach efforts by paramedicine and peer support professionals. RESULTS A total of 118 patients initiated buprenorphine during the 12-month study period and 104 (83 %) visited the clinic for their first appointment. Over two thirds (68 %, n = 80) remained engaged in care after 30 days. Retained patients tended to be male, white, uninsured, food insecure, have unstable housing, lack reliable transportation, and report prior involvement with the criminal legal system. CONCLUSION The initial 12-month period of the pilot program demonstrated the feasibility of initiating buprenorphine at the site of overdose without requiring transport to the ED and offer self-referral pathways for people experiencing barriers to treatment. Specialized EMS can play a critical role in expanding access to MOUD treatment by bridging the gap between overdose and comprehensive community-based care.
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Affiliation(s)
- Charles Belden
- Mountain Area Health Education Center, 121 Hendersonville Rd, Asheville, NC 28803, USA.
| | - Albert Kopak
- Mountain Area Health Education Center, 121 Hendersonville Rd, Asheville, NC 28803, USA.
| | - Courtney Coules
- Mountain Area Health Education Center, 121 Hendersonville Rd, Asheville, NC 28803, USA.
| | - Tessa Friesen
- Mountain Area Health Education Center, 121 Hendersonville Rd, Asheville, NC 28803, USA.
| | - Justin Hall
- Buncombe County Emergency Medical Services, 164 Erwin Hills Rd, Asheville, NC 28806, USA.
| | - Shuchin Shukla
- Mountain Area Health Education Center, 121 Hendersonville Rd, Asheville, NC 28803, USA
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Casillas SM, Stokes EK, Vivolo-Kantor AM. Comparison of emergency medical services and emergency department encounter trends for nonfatal opioid-involved overdoses, nine states, United States, 2020-2022. Ann Epidemiol 2024:S1047-2797(24)00103-0. [PMID: 38942400 DOI: 10.1016/j.annepidem.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/17/2024] [Accepted: 06/25/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Opioid-involved overdoses, especially those involving synthetic opioids like fentanyl, have driven increases in overdose morbidity and mortality. Emergency medical services (EMS) and emergency department (ED) data can each provide near real-time information on trends in nonfatal opioid-involved overdoses; however, minimal data exist on the comparability of trends in these two data sources. METHODS EMS data from biospatial© and ED data from CDC's Drug Overdose Surveillance and Epidemiology system and National Syndromic Surveillance Program were queried for nine states. Counts of total encounters, opioid-involved overdose encounters, and rates of opioid-involved overdoses per 10,000 total encounters were calculated for each data source from 2020-2022. Trends in monthly counts and rates were assessed using Joinpoint regression. RESULTS On average, EMS data captured 1.8 times more monthly opioid-involved overdose encounters than ED data. Trends in the counts of opioid-involved overdose encounters were similar in both data sources with increases and decreases occurring during roughly the same periods. Overall, trends in rates of opioid-involved overdose encounters were also comparable. CONCLUSIONS EMS and ED data provide complementary information for understanding overdose trends. Study findings underscore the importance of implementing post-overdose response protocols by both EMS and ED providers to ensure patient receive services irrespective of care setting.
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Affiliation(s)
- Shannon M Casillas
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway MS S106-8, Atlanta, GA, 30341.
| | - Erin K Stokes
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway MS S106-8, Atlanta, GA, 30341
| | - Alana M Vivolo-Kantor
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway MS S106-8, Atlanta, GA, 30341
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Langabeer JR, Bakos-Block C, Cohen AS, Alam I, Gopal B, Cardenas-Turanzas M, Weltge AF, Persse D, Champagne-Langabeer T. Disposition Outcomes Following Prehospital Use of Naloxone in a large metropolitan city in the United States. PREHOSP EMERG CARE 2024:1-23. [PMID: 38905264 DOI: 10.1080/10903127.2024.2369774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 06/03/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES During a drug overdose, research suggests individuals may not call 9-1-1 out of fear of criminal justice concerns. Of those that call, research is inconclusive about the disposition of the emergency transport. We evaluated transport outcomes for adults with opioid-related overdose in the Emergency Medical Services (EMS) of a large metropolitan city in the United States. METHODS We reviewed the EMS incident report database from the patient care record system for years 2018 to 2022. We queried all records, searching for relevant terms, and two reviewers cross-checked the database to identify cases that did not result in death at the scene. Study outcome was defined as hospital transportation or no transportation. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for hospital transport with patient age, sex, race and ethnicity as the independent variables. RESULTS We identified 5,482 cases of nonfatal opioid-related overdose. Of these, 4,984 (90.9%) were transported to the hospital; 37 (0.7%) were placed in police custody; 304 (5.5%) were not transferred; and 157 (2.9%) had unknown outcomes. Among 5,288 with data on the transport outcome, the majority were male (65%), and the highest proportion were White (39%). Compared to those who were not transported, each 1-year increase in age was related to a 2% increase in the odds of transportation (OR: 1.02, 95% CI: 1.01-1.02). Compared to White patients, Black and Hispanic patients were 43% OR: 1.43, 95% CI: 1.07-1.90) and 44% (OR: 1.44, 95% CI: 1.03-2.00) more likely to be transported. CONCLUSIONS Individuals with suspected opioid-related overdose who call 9-1-1 are most often transported to the hospital. Current EMS procedures are successful at on-scene treatment and transportation; however, data on the long-term impact of opioid-related overdoses are still needed.
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Affiliation(s)
- James R Langabeer
- Houston Emergency Opioid Engagement System, McWilliam School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Texas
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Texas
| | - Christine Bakos-Block
- Houston Emergency Opioid Engagement System, McWilliam School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Texas
| | - A Sarah Cohen
- Houston Emergency Opioid Engagement System, McWilliam School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Texas
| | | | - Bhanumathi Gopal
- Houston Emergency Opioid Engagement System, McWilliam School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Texas
| | - Marylou Cardenas-Turanzas
- Houston Emergency Opioid Engagement System, McWilliam School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Texas
| | - Arlo F Weltge
- Houston Emergency Opioid Engagement System, McWilliam School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Texas
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Texas
| | - David Persse
- Houston Fire Department, Emergency Medical Services, City of Houston, Texas
| | - Tiffany Champagne-Langabeer
- Houston Emergency Opioid Engagement System, McWilliam School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Texas
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Naumann J, Benson J, Lamberson M, Hunt S, Moran W, Stevens MW, Wolfson D. At-risk patient documentation and naloxone dispersal for a rural statewide EMS "Naloxone Leave Behind" program. J Am Coll Emerg Physicians Open 2024; 5:e13186. [PMID: 38766594 PMCID: PMC11099750 DOI: 10.1002/emp2.13186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/21/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
Objectives For successful Naloxone Leave Behind (NLB) programs, Emergency Medical Services (EMS) must identify patients at-risk for opioid overdose. We describe the first year of Vermont's NLB program and report rates of EMS documentation of at-risk patients with subsequent distribution of NLB kits in the subgroup of those refusing transport to an emergency department (ED). Methods This retrospective cohort review of all EMS encounters over 1 year compared on-scene EMS documented to retrospective chart reviewidentified at-risk patients eligible for NLB kit dispersal. EMS was educated to identify at-risk patients through statewide mandatory training modules. At-risk patients were identified by electronic chart review using the same training criteria. As per protocol, patients identified as at-risk by EMS who refuse ED transport are eligible for NLB. NLB-appropriate patients by retrospective chart review without NLB protocol use documentation by EMS were considered "missed." Results Of 110,701 EMS encounters, 2507 (2.4%) were at-risk by chart review. Among these, 793 refused transport to an ED. In this chart-review at-risk non-transported group, EMS documented 407 (51.3%) patients as at-risk by documenting use of the NLB protocol. Of these 407, EMS provided 141 (34.6%) with NLB kits. Fifteen (3.7%) patients refused kits. There were 386 (48.7%) potentially "missed" opportunities for NLB dispersal. Conclusion EMS documented 51.3% of patients eligible for NLB dispersal, with 34.6% receiving kits. There was no documentation for 48.7% of chart-review at-risk patients, suggesting "missed" distribution opportunities. This study highlights the need for improved EMS identification of at-risk patients, EMS documentation adherence, and NLB kit provision.
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Affiliation(s)
- Jesse Naumann
- Department of Emergency MedicineLarner College of Medicine, University of VermontBurlingtonVermontUSA
| | - Jamie Benson
- Department of RadiologyUniversity of VermontBurlingtonVermontUSA
- Division of Acute Care SurgeryDepartment of SurgeryUniversity of VermontBurlingtonVermontUSA
| | - Miles Lamberson
- Department of Emergency MedicineLarner College of Medicine, University of VermontBurlingtonVermontUSA
| | - Samantha Hunt
- Department of Emergency MedicineLarner College of Medicine, University of VermontBurlingtonVermontUSA
- Department of Emergency MedicineDartmouth HealthBurlingtonVermontUSA
| | - William Moran
- Division of Emergency PreparednessResponse, and Injury PreventionVermont Department of HealthBurlingtonVermontUSA
| | - Martha W. Stevens
- Department of Emergency MedicineLarner College of Medicine, University of VermontBurlingtonVermontUSA
| | - Daniel Wolfson
- Department of Emergency MedicineLarner College of Medicine, University of VermontBurlingtonVermontUSA
- Division of Emergency PreparednessResponse, and Injury PreventionVermont Department of HealthBurlingtonVermontUSA
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Taylor JL, Gott J, Weisenthal K, Colicchio P, Dyer S, Komaromy MS. Post-Overdose Extended-Release Buprenorphine Initiation Facilitated by a Partnership Between Emergency Medical Services and an Outpatient Substance Use Disorder Observation Unit. SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241249386. [PMID: 38736211 DOI: 10.1177/29767342241249386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
BACKGROUND People who experience a nonfatal opioid overdose and receive naloxone are at high risk of subsequent overdose death but experience gaps in access to medications for opioid use disorder. The immediate post-naloxone period offers an opportunity for buprenorphine initiation. Limited data indicate that buprenorphine administration by emergency medical services (EMS) after naloxone overdose reversal is safe and feasible. We describe a case in which a partnership between a low-barrier substance use disorder (SUD) observation unit and EMS allowed for buprenorphine initiation with extended-release injectable buprenorphine after naloxone overdose reversal. CASE A man in his 40's with severe opioid use disorder and numerous prior opioid overdoses experienced overdose in the community. EMS was activated and he was successfully resuscitated with intranasal naloxone, administered by bystanders and EMS. He declined emergency department (ED) transport and consented to transport to a 24/7 SUD observation unit. The patient elected to start buprenorphine due to barriers attending opioid treatment programs daily. His largest barrier was unsheltered homelessness. His severe opioid withdrawal symptoms were successfully treated with 16/4 mg sublingual buprenorphine/naloxone and 300 mg extended-release injectable buprenorphine (XR-buprenorphine), without precipitated withdrawal. Two weeks later, he reported no interval fentanyl use. DISCUSSION We describe the case of a patient successfully initiated onto XR-buprenorphine in the immediate post-naloxone period via a partnership between an outpatient low-barrier addiction programs and EMS. Such partnerships offer promise in expanding buprenorphine access and medication choice, particularly for the high-risk population of patients who decline ED transport.
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Affiliation(s)
- Jessica L Taylor
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Jacqueline Gott
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Department of Nursing, Boston Medical Center, Boston, MA, USA
| | - Karrin Weisenthal
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Paige Colicchio
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Sophia Dyer
- Department of Emergency Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
- Boston Emergency Medical Services, Boston, MA, USA
| | - Miriam S Komaromy
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
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Marshall KD, Derse AR, Weiner SG, Joseph JW. Revive and Refuse: Capacity, Autonomy, and Refusal of Care After Opioid Overdose. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:11-24. [PMID: 37220012 DOI: 10.1080/15265161.2023.2209534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient's interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation.
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Sudan HK, Boyle Q, Kerr T, Sekhon M, Illes J. Revive and Survive: A Critical Lens on the Refusal of Care After Opioid Overdose. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:30-33. [PMID: 38635425 DOI: 10.1080/15265161.2024.2327280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
| | | | - Thomas Kerr
- The University of British Columbia
- British Columbia Centre on Substance Use
| | - Mypinder Sekhon
- The University of British Columbia
- Vancouver General Hospital
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Larach DB, Waljee JF, Bicket MC, Brummett CM, Bruehl S. Perioperative opioid prescribing and iatrogenic opioid use disorder and overdose: a state-of-the-art narrative review. Reg Anesth Pain Med 2023:rapm-2023-104944. [PMID: 37931982 PMCID: PMC11070448 DOI: 10.1136/rapm-2023-104944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND/IMPORTANCE Considerable attention has been paid to identifying and mitigating perioperative opioid-related harms. However, rates of postsurgical opioid use disorder (OUD) and overdose, along with associated risk factors, have not been clearly defined. OBJECTIVE Evaluate the evidence connecting perioperative opioid prescribing with postoperative OUD and overdose, compare these data with evidence from the addiction literature, discuss the clinical impact of these conditions, and make recommendations for further study. EVIDENCE REVIEW State-of-the-art narrative review. FINDINGS Nearly all evidence is from large retrospective studies of insurance claims and Veterans Health Administration (VHA) data. Incidence rates of new OUD within the first year after surgery ranged from 0.1% to 0.8%, while rates of overdose events ranged from 0.01% to 0.8%. Higher rates were seen among VHA patients, which may reflect differences in data completeness and/or risk factors. Identified risk factors included those related to substance use (preoperative opioid use; non-opioid substance use disorders; preoperative sedative, anxiolytic, antidepressant, and gabapentinoid use; and postoperative new persistent opioid use (NPOU)); demographic attributes (chiefly male sex, younger age, white race, and Medicaid or no insurance coverage); psychiatric comorbidities such as depression, bipolar disorder, and PTSD; and certain medical and surgical factors. Several challenges related to the use of administrative claims data were identified; there is a need for more granular retrospective studies and, ideally, prospective cohorts to assess postoperative OUD and overdose incidence with greater accuracy. CONCLUSIONS Retrospective data suggest an incidence of new postoperative OUD and overdose of up to 0.8% during the first year after surgery, but prospective studies are lacking.
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Affiliation(s)
- Daniel B Larach
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer F Waljee
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark C Bicket
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Garrey SK, Locke S, Pollari C, Li J, Takemoto E. Post-traumatic stress disorder and risk of first-time and repeated opioid-related hospitalizations among World Trade Center Health Registry enrollees. Psychiatry Res 2023; 328:115462. [PMID: 37734242 DOI: 10.1016/j.psychres.2023.115462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023]
Abstract
In 2021, and average of 220 deaths from opioid-related overdoses occurred daily in the US. Recent evidence suggests there is an association between post-traumatic stress disorder (PTSD) and increased opioid misuse, while little is known about opioid-related hospitalizations. This study used data from the World Trade Center Health Registry (WTCHR), a longitudinal cohort consisting of individuals directly exposed to the September 11th terrorist attacks with a high prevalence of resulting PTSD (3.8-29.6%). We linked WTCHR data to New York State hospitalization data to examine the question: do opioid-related hospitalizations (first time and repeated) differ by PTSD status. In a study sample of 37,968 adults, 145 experienced at least one episode of opioid-related hospitalization and 64 had repeated episodes during the study period. We found that in the 13-years post-9/11, individuals with PTSD had a significantly higher risk of a first-time opioid-related hospitalization (Hazard Ratio: 3.6, 95% CI: 2.7, 5.0) and repeated opioid-related hospitalizations (Hazard Ratio: 3.9, 95% CI: 2.7, 5.8) than those who did not have PTSD. Improved treatment of and increased screenings for PTSD may reduce the likelihood of opioid misuse in this population and consequently overdoses, hospitalizations, and healthcare costs.
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Affiliation(s)
- Sascha K Garrey
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY 11101, United States
| | - Sean Locke
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY 11101, United States
| | - Cristina Pollari
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY 11101, United States
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY 11101, United States.
| | - Erin Takemoto
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY 11101, United States
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Patch K, Huang C, Hendriks S, Wasserman D, Parrish M, Grady C. "It's Pretty Sad If You Get Used to It": A Qualitative Study of First Responder Experiences with Opioid Overdose Emergencies. PREHOSP EMERG CARE 2023:1-8. [PMID: 37436072 DOI: 10.1080/10903127.2023.2236200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/30/2023] [Accepted: 07/09/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND First responders play a vital role in the United States opioid drug overdose crisis, a public health emergency that has claimed many lives. OBJECTIVE We sought to investigate first responders' experiences and attitudes toward opioid overdose emergencies and the ongoing crisis, as well as emotional effects, coping strategies, and support systems. METHODS A convenience sample of first responders (n = 18) at the Columbus Fire Division, with experience responding to opioid emergencies, participated in semi-structured telephone interviews between September 2018 and February 2019. Interviews were recorded, transcribed verbatim, and analyzed using content analysis for themes. RESULTS While almost all participants described overdose emergencies as routine, they recalled some as memorable and emotionally impactful. Almost all respondents were frustrated by the high rates of overdose among their patients and the lack of sustainable improvements in outcomes, yet expressed a strong moral commitment to caring for patients and saving lives. Themes of burnout, compassion fatigue, and hopelessness emerged, as did themes of increased compassion and empathy. Support for personnel experiencing emotional difficulty was either lacking or underutilized. Further, many felt public policies should prioritize more permanent resources and improve access to care, and believed that people who use drugs should face greater accountability. CONCLUSION First responders perceive a moral and professional duty to treat patients who overdose, despite their frustrations. They may benefit from additional occupational support to cope with the resultant emotional effects of their role in the crisis. Addressing macro-level factors contributing to the overdose crisis and improving patient outcomes could also positively affect first responder wellbeing.
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Affiliation(s)
- Kyle Patch
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Caroline Huang
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Saskia Hendriks
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - David Wasserman
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland
| | | | - Christine Grady
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland
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Perlmutter D, Wettemann C, Fockele CE, Frohe T, Williams W, Holland N, Oliphant-Wells T, Meischke H, van Draanen J. "Another tool in the toolkit"-Perceptions, suggestions, and concerns of emergency service providers about the implementation of a supervised consumption site. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104005. [PMID: 36972652 PMCID: PMC10164065 DOI: 10.1016/j.drugpo.2023.104005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/17/2023] [Accepted: 03/11/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND As Supervised Consumption Sites (SCS) are implemented in the United States, it is important to consider the needs and perceptions of impacted stakeholders. Emergency service providers (ESP) have a central role in responding to the overdose epidemic. This study intended to assess the how ESP perceive the potential implementation of an SCS in their community, as well as solicit program design and implementation-related concerns and suggestions. METHODS In-depth interviews were conducted by videoconference with 22 ESP, including firefighters, paramedics, police, and social workers in King County, Washington, USA. Data were analyzed using a thematic analysis approach. RESULTS Participants expressed the importance of feeling safe while responding to calls where drug use is involved and highlighted how this perception would be linked to ESP response times to calls from an SCS. Suggestions for improving the perceived safety of an SCS included training program staff in de-escalation as well as planning the layout of the SCS to accommodate ESP. The inadequacy of the emergency department as a point of care for PWUD was also identified as a theme, and some participants expressed enthusiasm regarding the prospect of the SCS as an alternative destination for transport. Finally, support for the SCS model was conditional on the appropriate utilization of emergency services and a reduction in call volume. Participants listed clarifying roles and pursuing opportunities for collaboration as ways to ensure appropriate utilization and maintain positive working relationships. CONCLUSION This study builds on literature regarding stakeholder perceptions of SCS by focusing on the perceptions of a critically important stakeholder group. Results enhance understanding of what motivates ESP to support SCS implementation in their community. Other novel insights pertain to ESP thoughts about alternative care delivery models and strategies for emergency department visit diversion.
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Affiliation(s)
- David Perlmutter
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Fourth Floor, 98195 Seattle, WA, USA
| | - Courteney Wettemann
- Research with Expert Advisors on Drug Use, University of Washington, Seattle, WA, USA
| | | | - Tessa Frohe
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Will Williams
- Research with Expert Advisors on Drug Use, University of Washington, Seattle, WA, USA
| | - Nathan Holland
- Research with Expert Advisors on Drug Use, University of Washington, Seattle, WA, USA
| | | | - Hendrika Meischke
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Fourth Floor, 98195 Seattle, WA, USA
| | - Jenna van Draanen
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Fourth Floor, 98195 Seattle, WA, USA; Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, USA.
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Goldfarb SS, Graves K, Geletko K, Hansen MD, Kinsell H, Harman J. Racial and Ethnic Differences in Emergency Department Wait Times for Patients with Substance Use Disorder. J Emerg Med 2023; 64:481-487. [PMID: 36997432 DOI: 10.1016/j.jemermed.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/03/2023] [Accepted: 02/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Substance use-related morbidity and mortality rates are at an all-time high in the United States, yet there remains significant stigma and discrimination in emergency medicine about patients with this condition. OBJECTIVES The purpose of this study was to determine whether there are racial and ethnic differences in emergency department (ED) wait times among patients with substance use disorder. METHODS The study uses pooled data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2016 to 2018. The dependent variable is length of time the patient with a diagnosis of substance use disorder waited in the ED before being admitted for care. The independent variable is patient race and ethnicity. Adjusted analyses were conducted using a generalized linear model. RESULTS There were a total of 3995 reported ED events among patients reporting a substance use disorder in the NHAMCS sample between 2016 and 2018. After adjusting for covariates, Black patients with substance use disorder were significantly more likely to wait longer in the ED (35% longer) than White patients with substance use disorder (p < 0.01). CONCLUSIONS The findings showed that Black patients with substance use disorder are waiting 35% longer, on average, than White patients with the same condition. This is concerning, given that emergency medicine is a critical frontline of care, and often the only source of care, for these patients. Furthermore, longer wait times can increase the likelihood of leaving the ED without being seen. Programs and policies should address potential stigma and discrimination among providers, and EDs should consider adding people with lived experiences to the staff to serve as peer recovery specialists and bridge the gap for care.
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Affiliation(s)
- Samantha Sittig Goldfarb
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Katelyn Graves
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Karen Geletko
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Megan Deichen Hansen
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Heidi Kinsell
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| | - Jeff Harman
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
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Ray B, Richardson NJ, Attaway PR, Smiley-McDonald HM, Davidson P, Kral AH. A national survey of law enforcement post-overdose response efforts. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:199-205. [PMID: 36820614 DOI: 10.1080/00952990.2023.2169615] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Background: Law enforcement agencies in the US have provided naloxone to officers and developed initiatives to follow-up after a non-fatal overdose. However, the prevalence and characteristics of these efforts have yet to be documented in research literature.Objectives: We sought to understand the national prevalence of naloxone provision among law enforcement and examine the implementation of post-overdose follow-up.Methods: We administered a survey on drug overdose response initiatives using a multimodal approach (online and mail) to a nationally representative sample of law enforcement agencies (N = 2,009; 50.1% response rate) drawn from the National Directory of Law Enforcement Administrators database. We further examine a subsample of agencies (N = 1,514) that equipped officers with naloxone who were also asked about post-overdose follow-up.Results: We found 81.7% of agencies reported officers were equipped with naloxone; among these, approximately one-third (30.3%) reported follow-up after an overdose. More than half (56.8%) of agencies indicated partnership in follow-up with emergency medical services as the most common partner (68.8%). There were 21.4% of agencies with a Quick Response Team, a popular national post-overdose model, and were more likely to indicate partnership with a substance use disorder treatment provider than when agencies were asked generally about partners in follow-up (74.5% and 26.2% respectively).Conclusion: Many law enforcement agencies across the US have equipped officers with naloxone, and about one-third of those are conducting follow-up to non-fatal overdose events. Post-overdose follow-up models and practices vary in ways that can influence treatment engagement and minimize harms against persons who use drugs.
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Affiliation(s)
- Bradley Ray
- RTI International, Research Triangle Park, NC, USA
| | | | | | | | - Pete Davidson
- Department of Medicine, Division Global Public Health, University of California, San Diego, CA, USA
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Carroll G, Solomon KT, Heil J, Saloner B, Stuart EA, Patel EY, Greifer N, Salzman M, Murphy E, Baston K, Haroz R. Impact of Administering Buprenorphine to Overdose Survivors Using Emergency Medical Services. Ann Emerg Med 2023; 81:165-175. [PMID: 36192278 DOI: 10.1016/j.annemergmed.2022.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVE To evaluate the efficacy and safety of utilizing emergency medical services units to administer high dose buprenorphine after an overdose to treat withdrawal symptoms, reduce repeat overdose, and provide a next-day substances use disorder clinic appointment to initiate long-term treatment. METHODS This was a retrospective matched cohort study of patients who experienced an overdose and either received emergency medical services care from a buprenorphine-equipped ambulance or a nonbuprenorphine-equipped ambulance in Camden, New Jersey, an urban community with high overdose rates. There were 117 cases and 123 control patients in the final sample. RESULTS Compared with a nonbuprenorphine-equipped ambulance, exposure to a buprenorphine-equipped ambulance was associated with greater odds of engaging in opioid use disorder treatment within 30 days of an emergency medical services encounter (unadjusted odds ratio: 5.62, 95% confidence interval, 2.36 to 13.39). Buprenorphine-equipped ambulance engagement did not decrease repeat overdose compared to the comparison group. Patients who received buprenorphine experienced a decrease in withdrawal symptoms. Their clinical opiate withdrawal scale score decreased from an average of 9.27 to 3.16. buprenorphine-equipped ambulances increased on-scene time by 6.12 minutes. CONCLUSION Patients who encountered paramedics trained to administer buprenorphine and able to arrange prompt substance use disorder treatment after an acute opioid overdose demonstrated a decrease in opioid withdrawal symptoms, an increase in outpatient addiction follow-up care, and showed no difference in repeat overdose. Patients receiving buprenorphine in the out-of-hospital setting did not experience precipitated withdrawal. Expanded out-of-hospital treatment of opiate use disorder is a promising model for rapid access to buprenorphine after an overdose in a patient population that often has limited contact with the health care system.
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Affiliation(s)
- Gerard Carroll
- Department of Emergency Medicine, Cooper University Health Care, Camden, NJ.
| | | | - Jessica Heil
- Division of Addiction, Cooper University Health Care, Camden, NJ
| | - Brendan Saloner
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Esita Y Patel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Noah Greifer
- Harvard University Institute for Quantitative Social Science, Cambridge, MA
| | - Matthew Salzman
- Department of Emergency Medicine, Cooper University Health Care, Camden, NJ
| | - Emily Murphy
- Department of Emergency Medicine, Cooper University Health Care, Camden, NJ
| | - Kaitlan Baston
- Division of Addiction, Cooper University Health Care, Camden, NJ
| | - Rachel Haroz
- Department of Emergency Medicine, Cooper University Health Care, Camden, NJ
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Bailey A, Harrington C, Evans EA. A scoping review of community-based post-opioid overdose intervention programs: implications of program structure and outcomes. HEALTH & JUSTICE 2023; 11:3. [PMID: 36707446 PMCID: PMC9883127 DOI: 10.1186/s40352-022-00201-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/14/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND An emergent intervention to address the opioid epidemic is the use of multidisciplinary outreach teams which connect an individual in the community to healthcare resources after the experience of an opioid overdose. While these interventions are receiving federal funding, less is known empirically to inform future interventions. Understanding the process and outcomes of these interventions is advisable due to the novel partnerships of public health and law enforcement agencies who sometimes hold divergent goals. The objective of the present review was to describe program structure and evaluated outcomes of community-based post-overdose interventions. RESULTS A search of PubMed, PsycInfo, and Web of Science yielded 5 peer-reviewed articles that detail the implementation and outcomes of interventions delivered in the United States published from 2001 to July 2021. Most interventions used a multidisciplinary outreach team and referenced first responder data to contact individuals who recently experienced an overdose at their residence. Services offered often included referral to substance use treatment, recovery coaches, and social services. Method of outreach, evaluation measures, and outcomes varied. From the available literature, facilitators of program engagement included communication, information sharing, and leadership buy-in among multidisciplinary partners. CONCLUSIONS Future studies could benefit from exploration of service provision in rural areas, for family affected by overdose, and for minoritized populations. Community-based post-overdose interventions utilizing a law enforcement partnership are emergent with promising yet limited examples in empirical literature.
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Affiliation(s)
- Amelia Bailey
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003 USA
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI 02912 USA
| | - Calla Harrington
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003 USA
| | - Elizabeth A. Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003 USA
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Olding M, Boyd J, Kerr T, Fowler A, McNeil R. (Re)situating expertise in community-based overdose response: Insights from an ethnographic study of overdose prevention sites (OPS) in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103929. [PMID: 36529032 PMCID: PMC10184134 DOI: 10.1016/j.drugpo.2022.103929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/20/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
Overdose Prevention Sites (OPS) are low-barrier services where people may use illicit drugs under the monitoring of staff trained to provide life-saving care in the event of an overdose. In British Columbia (BC), Canada, OPS have been rapidly scaled-up as a community-based response to the overdose crisis and are staffed primarily by community members who are also people who use drugs (PWUD). While it is known that PWUD perform vital roles in OPS and other community-based overdose interventions, the expertise and expert knowledge of PWUD in this work remains under-theorised. This study draws on 20 months of ethnographic fieldwork in Vancouver, BC (July 2018 to March 2020), to explore how OPS responders who are PWUD developed and enacted expertise in overdose response. Ethnographic fieldwork focused on four OPS located in Vancouver's Downtown Eastside (DTES) and Downtown South neighbourhoods. Methods included 100 hours of observation in the sites and surrounding areas, three site-specific focus groups with OPS responders (n=20), and semi-structured interviews with OPS responders (n=14) and service users (n=23). Data was analysed with the aim of characterizing the knowledge underpinning responders' expertise, and the arrangements which allow for the formation and enactment of expertise. We found that OPS responders' expertise was grounded in experiential knowledge acquired through their positionality as PWUD and members of a broader community of activists engaged in mutual aid. Responders became skilled in overdose response through frequent practice and drew on their experiential and embodied knowledge of overdose to provide care that was both technically proficient and responsive to the broader needs of PWUD (e.g. protection from criminalization and stigmatizing treatment). Responders emphasized that the spatial arrangements of OPS supported the development of expertise by facilitating more specialized and comprehensive overdose care. OPS became sites of collective expertise around overdose management as responder teams developed shared understandings of overdose management, including processes for managing uncertainty, delegating team responsibilities, and sharing decision-making. This research re-situates theoretical understandings of expertise in community-based overdose response with implications for overdose prevention interventions. Findings underscore the experiential and embodied expertise of PWUD as community-based responders; the importance of supportive environments and team-based approaches for overdose response; and the benefits of community-driven training that extends beyond technical skills of overdose identification and naloxone administration.
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Affiliation(s)
- Michelle Olding
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Al Fowler
- East Vancouver Activist, Vancouver, BC, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada; Yale School of Medicine, New Haven, CT, United States.
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Casillas SM, Scholl L, Mustaquim D, Vivolo-Kantor A. Analysis of trends and usage of ICD-10-CM discharge diagnosis codes for poisonings by fentanyl, tramadol, and other synthetic narcotics in emergency department data. Addict Behav Rep 2022; 16:100464. [DOI: 10.1016/j.abrep.2022.100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/01/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
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18
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Shin SS, LaForge K, Stack E, Pope J, Leichtling G, Larsen JE, Leahy JM, Seaman A, Hoover D, Chisholm L, Blazes C, Baker R, Byers M, Branson K, Korthuis PT. "It wasn't here, and now it is. It's everywhere": fentanyl's rising presence in Oregon's drug supply. Harm Reduct J 2022; 19:76. [PMID: 35818072 PMCID: PMC9275036 DOI: 10.1186/s12954-022-00659-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Illicit fentanyl has contributed to a drastic increase in overdose drug deaths. While fentanyl has subsumed the drug supply in the Northeastern and Midwestern USA, it has more recently reached the Western USA. For this study, we explored perspectives of people who use drugs (PWUD) on the changing drug supply in Oregon, experiences of and response to fentanyl-involved overdose, and recommendations from PWUD to reduce overdose risk within the context of illicit fentanyl’s dramatic increase in the recreational drug supply over the past decade. Methods We conducted in-depth interviews by phone with 34 PWUD in Oregon from May to June of 2021. We used thematic analysis to analyze transcripts and construct themes. Results PWUD knew about fentanyl, expressed concern about fentanyl pills, and were aware of other illicit drugs containing fentanyl. Participants were aware of the increased risk of an overdose but remained reluctant to engage with professional first responders due to fear of arrest. Participants had recommendations for reducing fentanyl overdose risk, including increasing access to information, harm reduction supplies (e.g., naloxone, fentanyl test strips), and medications for opioid use disorder; establishing drug checking services and overdose prevention sites; legalizing and regulating the drug supply; and reducing stigma enacted by healthcare providers. Conclusion PWUD in Oregon are aware of the rise of fentanyl and fentanyl pills and desire access to tools to reduce harm from fentanyl. As states in the Western USA face an inflection point of fentanyl in the drug supply, public health staff, behavioral health providers, and first responders can take action identified by the needs of PWUD. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00659-9.
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Affiliation(s)
- Sarah S Shin
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA.
| | - Kate LaForge
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA
| | - Erin Stack
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA
| | - Justine Pope
- Comagine Health, 650 NE Holladay Street #1700, Portland, OR, 97232, USA
| | | | - Jessica E Larsen
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Judith M Leahy
- Acute and Communicable Disease Prevention, Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - Andrew Seaman
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA.,Old Town Clinic/Central City Concern, Portland, OR, USA.,Better Life Partners, Hanover, NH, USA
| | - Daniel Hoover
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Laura Chisholm
- Injury and Violence Prevention Program, Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - Christopher Blazes
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Robin Baker
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
| | | | - Katie Branson
- Injury and Violence Prevention Program, Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - P Todd Korthuis
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA.,School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
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Wightman RS, Nelson LS. Naloxone Dosing in the Era of Fentanyl: The Path Widens by Traveling Down It. Ann Emerg Med 2022; 80:127-129. [DOI: 10.1016/j.annemergmed.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Indexed: 11/01/2022]
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20
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Smiley-McDonald HM, Attaway PR, Richardson NJ, Davidson PJ, Kral AH. Perspectives from law enforcement officers who respond to overdose calls for service and administer naloxone. HEALTH & JUSTICE 2022; 10:9. [PMID: 35212812 PMCID: PMC8874742 DOI: 10.1186/s40352-022-00172-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/02/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND Many law enforcement agencies across the United States equip their officers with the life-saving drug naloxone to reverse the effects of an opioid overdose. Although officers can be effectively trained to administer naloxone, and hundreds of law enforcement agencies carry naloxone to reverse overdoses, little is known about what happens on scene during an overdose call for service from an officer's perspective, including what officers perceive their duties and responsibilities to be as the incident evolves. METHODS The qualitative study examined officers' experiences with overdose response, their perceived roles, and what happens on scene before, during, and after an overdose incident. In-person interviews were conducted with 17 officers in four diverse law enforcement agencies in the United States between January and May 2020. RESULTS Following an overdose, the officers described that overdose victims are required to go to a hospital or they are taken to jail. Officers also described their duties on scene during and after naloxone administration, including searching the belongings of the person who overdosed and seizing any drug paraphernalia. CONCLUSION These findings point to a pressing need for rethinking standard operating procedures for law enforcement in these situations so that the intentions of Good Samaritan Laws are upheld and people get the assistance they need without being deterred from asking for future help.
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Affiliation(s)
- Hope M Smiley-McDonald
- Division for Applied Justice Research, RTI International, Research Triangle Park, North Carolina, USA.
| | - Peyton R Attaway
- Division for Applied Justice Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Nicholas J Richardson
- Division for Applied Justice Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Peter J Davidson
- Department of Medicine, Division Global Public Health, University of California, San Diego, La Jolla, California, USA
| | - Alex H Kral
- Community Health Research Division, RTI International, Berkeley, California, USA
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Metcalf SA, Saunders EC, Moore SK, Walsh O, Meier A, Auty S, Bessen SY, Marsch LA. Compassion, stigma, and professionalism among emergency personnel responding to the opioid crisis: An exploratory study in New Hampshire, USA. J Am Coll Emerg Physicians Open 2022; 3:e12641. [PMID: 35059691 PMCID: PMC8758975 DOI: 10.1002/emp2.12641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/21/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Drug overdoses are the leading cause of death in the United States for those under 50 years of age, and New Hampshire has been disproportionately affected, resulting in increased encounters with the emergency response system. The ensuing impact on emergency personnel has received little attention. The present study aimed to explore the experiences and perspectives of emergency personnel responding to the opioid crisis in NH, with a focus on their views toward people who use opioids. METHODS Thirty-six emergency personnel (emergency department clinicians, n = 18; emergency medical service providers, n = 6; firefighters, n = 6; and police officers, n = 6) in 6 New Hampshire counties were interviewed about their experiences responding to overdoses and their perspectives on individuals who use opioids. Directed content analysis was used to identify themes in the transcribed, semistructured interviews. The results were reviewed for consensus. RESULTS Several categories of themes were identified among emergency personnel's accounts of their overdose response experiences and perspectives, including varied degrees of compassion and stigma toward people who use opioids; associations between compassion or stigma and policy- and practice-related themes, such as prehospital emergency care and the role of emergency departments (EDs); and primarily among personnel expressing compassion, a sense of professional responsibility that outweighed personal biases. CONCLUSIONS Despite the magnitude of the ongoing opioid crisis, some emergency personnel in New Hampshire have sustained or increased their compassion for people who use opioids. Others' perspectives remain or have become increasingly stigmatizing. The associations of compassion and stigma with various policy- and practice-related themes warrant further investigation.
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Affiliation(s)
- Stephen A. Metcalf
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Elizabeth C. Saunders
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
| | - Sarah K. Moore
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
| | - Olivia Walsh
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
- Mandel School of Applied Social SciencesCase Western Reserve UniversityClevelandOhioUSA
| | - Andrea Meier
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
| | - Samantha Auty
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
- Boston University School of Public HealthBostonMassachusettsUSA
| | - Sarah Y. Bessen
- Geisel School of Medicine at Dartmouth CollegeHanoverNew HampshireUSA
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Lisa A. Marsch
- Center for Technology and Behavioral HealthGeisel School of Medicine at Dartmouth CollegeLebanonNew HampshireUSA
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