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Yangchen T, Rodriguez M, Baird J, Hallowell BD, Daly MM, Berk J, Gaither R, Wightman RS, Beaudoin FL, Chambers LC. Trends in recurrent overdose and treatment initiation following emergency department visits for opioid overdose between 2016 and 2021. Drug Alcohol Depend 2024; 262:111379. [PMID: 38968835 PMCID: PMC11329345 DOI: 10.1016/j.drugalcdep.2024.111379] [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: 12/04/2023] [Revised: 05/30/2024] [Accepted: 06/09/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Overdose remains a pressing public health concern in the United States, particularly with the emergence of fentanyl and other potent synthetic opioids in the drug supply. We evaluated trends in recurrent overdose and opioid use disorder (OUD) treatment initiation following emergency department (ED) visits for opioid overdose to inform response efforts. METHODS This retrospective cohort study used electronic health record and statewide administrative data from Rhode Island residents who visited EDs for opioid overdose between July 1, 2016, and June 30, 2021, a period with fentanyl predominance in the local drug supply. The primary outcome was recurrent overdose in the 365 days following the initial ED visit. OUD treatment initiation within 180 days following the initial ED visit was considered as a secondary outcome. Trends in study outcomes were summarized by year of the initial ED visit. RESULTS Among 1745 patients attending EDs for opioid overdose, 20 % (n=352) experienced a recurrent overdose within 365 days, and this percentage was similar by year (p=0.12). Among patients who experienced any recurrent overdose, the median time to first recurrent overdose was 88 days (interquartile range=23-208), with 85 % (n=299/352) being non-fatal. Among patients not engaged in OUD treatment at their initial ED visit, 33 % (n=448/1370) initiated treatment within 180 days; this was similar by year (p=0.98). CONCLUSIONS Following ED visits for opioid overdose in Rhode Island from 2016-2021, the one-year risk of recurrent overdose and six-month treatment initiation rate remained stable over time. Innovative prevention strategies and improved treatment access are needed.
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Affiliation(s)
- Tenzin Yangchen
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - McClaren Rodriguez
- Substance Use Epidemiology Program, Rhode Island Department of Health, Providence, RI, USA
| | - Janette Baird
- Department of Emergency Medicine, Brown University, Providence, RI, USA
| | - Benjamin D Hallowell
- Substance Use Epidemiology Program, Rhode Island Department of Health, Providence, RI, USA
| | - Mackenzie M Daly
- Research, Data Evaluation, and Compliance Unit, Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals, Providence, RI, USA
| | - Justin Berk
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Rachel Gaither
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Rachel S Wightman
- Department of Emergency Medicine, Brown University, Providence, RI, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Laura C Chambers
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
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Treitler P, Crystal S, Cantor J, Chakravarty S, Kline A, Morton C, Powell KG, Borys S, Cooperman NA. Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose. JAMA Netw Open 2024; 7:e243614. [PMID: 38526490 PMCID: PMC10964115 DOI: 10.1001/jamanetworkopen.2024.3614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/30/2024] [Indexed: 03/26/2024] Open
Abstract
Importance Patients treated in emergency departments (EDs) for opioid overdose often need drug treatment yet are rarely linked to services after discharge. Emergency department-based peer support is a promising approach for promoting treatment linkage, but evidence of its effectiveness is lacking. Objective To examine the association of the Opioid Overdose Recovery Program (OORP), an ED peer recovery support service, with postdischarge addiction treatment initiation, repeat overdose, and acute care utilization. Design, Setting, and Participants This intention-to-treat retrospective cohort study used 2014 to 2020 New Jersey Medicaid data for Medicaid enrollees aged 18 to 64 years who were treated for nonfatal opioid overdose from January 2015 to June 2020 at 70 New Jersey acute care hospitals. Data were analyzed from August 2022 to November 2023. Exposure Hospital OORP implementation. Main Outcomes and Measures The primary outcome was medication for opioid use disorder (MOUD) initiation within 60 days of discharge. Secondary outcomes included psychosocial treatment initiation, medically treated drug overdoses, and all-cause acute care visits after discharge. An event study design was used to compare 180-day outcomes between patients treated in OORP hospitals and those treated in non-OORP hospitals. Analyses adjusted for patient demographics, comorbidities, and prior service use and for community-level sociodemographics and drug treatment access. Results A total of 12 046 individuals were included in the study (62.0% male). Preimplementation outcome trends were similar for patients treated in OORP and non-OORP hospitals. Implementation of the OORP was associated with an increase of 0.034 (95% CI, 0.004-0.064) in the probability of 60-day MOUD initiation in the half-year after implementation, representing a 45% increase above the preimplementation mean probability of 0.075 (95% CI, 0.066-0.084). Program implementation was associated with fewer repeat medically treated overdoses 4 half-years (-0.086; 95% CI, -0.154 to -0.018) and 5 half-years (-0.106; 95% CI, -0.184 to -0.028) after implementation. Results differed slightly depending on the reference period used, and hospital-specific models showed substantial heterogeneity in program outcomes across facilities. Conclusions and Relevance In this cohort study of patients treated for opioid overdose, OORP implementation was associated with an increase in MOUD initiation and a decrease in repeat medically treated overdoses. The large variation in outcomes across hospitals suggests that treatment effects were heterogeneous and may depend on factors such as implementation success, program embeddedness, and availability of other hospital- and community-based OUD services.
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Affiliation(s)
- Peter Treitler
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- Boston University School of Social Work, Boston, Massachusetts
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
- School of Social Work, Rutgers University, New Brunswick, New Jersey
- School of Public Health, Rutgers University, Piscataway, New Jersey
| | - Joel Cantor
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Sujoy Chakravarty
- Department of Health Sciences, Rutgers University, Camden, New Jersey
| | - Anna Kline
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Cory Morton
- School of Social Work, Rutgers University, New Brunswick, New Jersey
- Center for Prevention Science, Rutgers University, New Brunswick, New Jersey
- Northeast and Caribbean Prevention Technology Transfer Center, Rutgers University, New Brunswick, New Jersey
| | - Kristen Gilmore Powell
- School of Social Work, Rutgers University, New Brunswick, New Jersey
- Center for Prevention Science, Rutgers University, New Brunswick, New Jersey
- Northeast and Caribbean Prevention Technology Transfer Center, Rutgers University, New Brunswick, New Jersey
| | - Suzanne Borys
- Division of Mental Health and Addiction Services, New Jersey Department of Human Services, Trenton
| | - Nina A. Cooperman
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
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3
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Simonetti JA, Holliday R, Mignogna J, Thomas S, Smith A, Betz M, Brenner LA, Sayre G. Patients' Perspectives on Medication-Related Suicide Prevention Interventions Delivered in Emergency Settings. Psychiatr Serv 2024; 75:275-282. [PMID: 37933134 DOI: 10.1176/appi.ps.20230178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Encouraging patients at risk for suicide to reduce access to potentially lethal medications and drugs is a key component of evidence-based suicide prevention. However, little research has been done to inform interventions for reducing intentional self-harm. METHODS Semistructured interviews were conducted with 28 U.S. veterans who sought emergency care from the Veterans Health Administration between 2021 and 2023 to explore veterans' perspectives on medication-related interventions, including opinions on intervention components (e.g., medication return envelopes). Matrix analysis was used to aggregate data into categories, which were predefined by using constructs from the health belief model (e.g., perceived benefits). RESULTS The participating veterans generally endorsed interventions as acceptable and were particularly supportive of distributing medication return envelopes. However, they often conceptualized these efforts as steps to prevent unintentional overdose or theft-not necessarily to prevent suicide-and rarely indicated that such interventions were appropriate for themselves. Across the interviews, participants identified important facilitators to care, such as ensuring that interventions were convenient and accounted for the perceived cost of disposing medications. Perspectives on engaging family or friends in interventions were mixed. The importance of the interventions was more readily acknowledged among participants with previous opioid use exposure-perspectives that appeared to stem from lived experiences. CONCLUSIONS This study contributes important foundational knowledge that can be used to inform research and clinical initiatives aimed at preventing medication- and drug-related suicides.
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Affiliation(s)
- Joseph A Simonetti
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
| | - Ryan Holliday
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
| | - Joseph Mignogna
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
| | - Suzanne Thomas
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
| | - Alexandra Smith
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
| | - Marian Betz
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
| | - Lisa A Brenner
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
| | - George Sayre
- U.S. Department of Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, Colorado (Simonetti, Holliday, Mignogna, Thomas, Smith, Brenner); Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, Colorado (Simonetti, Sayre); Departments of Psychiatry (Holliday), Physical Medicine and Rehabilitation (Mignogna, Brenner), and Emergency Medicine (Betz), University of Colorado Anschutz Medical Campus, Aurora; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora (Betz); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle (Sayre)
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Krawczyk N, Rivera BD, Chang JE, Lindenfeld Z, Franz B. Initiatives to Support the Transition of Patients With Substance Use Disorders From Acute Care to Community-based Services Among a National Sample of Nonprofit Hospitals. J Addict Med 2024; 18:115-121. [PMID: 38015653 PMCID: PMC10939963 DOI: 10.1097/adm.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND Hospitals are a key touchpoint to reach patients with substance use disorders (SUDs) and link them with ongoing community-based services. Although there are many acute care interventions to initiate SUD treatment in hospital settings, less is known about what services are offered to transition patients to ongoing care after discharge. In this study, we explore what SUD care transition strategies are offered across nonprofit US hospitals. METHODS We analyzed administrative documents from a national sample of US hospitals that indicated SUD as a top 5 significant community need in their Community Health Needs Assessment reports (2019-2021). Data were coded and categorized based on the nature of described services. We used data on hospitals and characteristics of surrounding counties to identify factors associated with hospitals' endorsement of transition interventions for SUD. RESULTS Of 613 included hospitals, 313 prioritized SUD as a significant community need. Fifty-three of these hospitals (17%) offered acute care interventions to support patients' transition to community-based SUD services. Most (68%) of the 53 hospitals described transition strategies without further detail, 23% described scheduling appointments before discharge, and 11% described discussing treatment options before discharge. No hospital characteristics were associated with offering transition interventions, but such hospitals were more likely to be in the Northeast, in counties with higher median income, and states that expanded Medicaid. CONCLUSIONS Despite high need, most US hospitals are not offering interventions to link patients with SUD from acute to community care. Efforts to increase acute care interventions for SUD should identify and implement best practices to support care continuity.
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Affiliation(s)
- Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine
| | - Bianca D. Rivera
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine
| | - Ji E. Chang
- Department of Public Health Policy and Management, New York University School of Global Public Health
| | - Zoe Lindenfeld
- Department of Public Health Policy and Management, New York University School of Global Public Health
| | - Berkeley Franz
- Ohio University Heritage College of Osteopathic Medicine; Appalachian Institute to Advance Health Equity Science (ADVANCE)
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5
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Kirk MR, Dawkins AD, Wei X, Ajumobi O, Lee LC, Oman R, Woodard S, Wagner KD. What makes a peer? Characteristics of certified peer recovery support specialists in an emergency department-based intervention. PLoS One 2023; 18:e0289920. [PMID: 38060503 PMCID: PMC10703250 DOI: 10.1371/journal.pone.0289920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 07/28/2023] [Indexed: 12/18/2023] Open
Abstract
Providing brief interventions by certified peer recovery support specialists (CPRSS) in the emergency department (ED) following a drug related visit is a promising method of service engagement and has garnered national attention. This study examines CPRSS's perceptions of the qualities that enable them to deliver interventions in the ED. We conducted qualitative interviews with 14 CPRSSs working in EDs. Interview topics included how the participants became involved with CPRSS work, experiences working in the ED, how the ED differs from other settings, and what interactions with patients look like. Interviews were digitally recorded, transcribed, and analyzed for emerging categories. Three categories were identified relating to CPRSS work: (1) how they approach peer work, (2) inherent qualities required to do the work, regardless of the setting, and (3) context-specific skills required to do the work in the ED. When describing their approach to this work, participants talked about CPRSS work as their life calling and their passion. Participants also identified certain qualities that all CPRSS workers possess, regardless of the setting, including the ability to build rapport, strong listening skills, and a shared lived experience. Lastly, participants identified how specific hard and soft skills help them to navigate organizational and structural challenges in the ED. The unique conditions of the ED and the required qualities of a CPRSS should be considered when implementing an ED-based intervention.
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Affiliation(s)
- Mia R. Kirk
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
| | - Ashley D. Dawkins
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
| | - Xing Wei
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
| | - Olufemi Ajumobi
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
| | - Lisa C. Lee
- Roots to Wings Consulting, LLC, Reno, Nevada, United States of America
| | - Roy Oman
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
| | - Stephanie Woodard
- Division of Public and Behavioral Health, Bureau of Behavioral Health, Wellness and Prevention, State of Nevada, Carson City, Nevada, United States of America
| | - Karla D. Wagner
- School of Public Health, University of Nevada, Reno, Reno, Nevada, United States of America
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Bhondoekhan F, Li Y, Gaither R, Daly MM, Hallowell BD, Chambers LC, Beaudoin FL, Marshall BD. The impact of polysubstance use patterns on engagement of substance use disorder treatment among emergency department patients at high risk of opioid overdose. Addict Behav Rep 2023; 18:100512. [PMID: 37636893 PMCID: PMC10450842 DOI: 10.1016/j.abrep.2023.100512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/30/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
Background Substance use patterns are diverse, and multiple substances are often involved in fatal and nonfatal overdoses. Additionally, polysubstance use is associated with greater difficulty accessing and remaining in substance use disorder (SUD) treatment. The aim of this study was to identify substance use patterns and determine their association with SUD treatment engagement among emergency department (ED) patients at risk of opioid overdose. Methods This was a sub-analysis of a randomized controlled trial comparing two behavioral interventions for individuals at two EDs in Rhode Island from 2018 to 2021. Past six-month substance use frequency for eight substances plus injection drug use was self-reported at trial enrollment, and SUD treatment engagement within 90 days after enrollment was obtained using administrative data linkages. Latent class analysis identified substance use patterns and multivariable log-binomial models estimated the association with SUD treatment engagement. Results Among 607 participants, there were four substance use patterns: 1) low reported use (n = 295), 2) frequent injection and heroin use (n = 131), 3) high frequency broad polysubstance use (n = 62), and 4) low frequency broad polysubstance use (n = 119). Compared to participants with the low reported use pattern, those with the frequent injection and heroin pattern had a greater likelihood of SUD treatment engagement (adjusted risk ratio = 1.28; 95% confidence interval = 1.02-1.61). Conclusions Distinct and meaningful polysubstance use patterns showed differential SUD treatment engagement after ED discharge. Nuanced relationships between substance use patterns and treatment highlight the necessity for tailored harm reduction, treatment, and recovery services.
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Affiliation(s)
- Fiona Bhondoekhan
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
| | - Yu Li
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
| | - Rachel Gaither
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
| | - Mackenzie M. Daly
- Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, 14 Harrington Rd, Cranston, RI 02920, USA
| | | | - Laura C. Chambers
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
| | - Francesca L. Beaudoin
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
| | - Brandon D.L. Marshall
- Brown University School of Public Health, Department of Epidemiology, 121 South Main Street, Providence, RI 02903, USA
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Krawczyk N, Rivera BD, Chang JE, Grivel M, Chen YH, Nagappala S, Englander H, McNeely J. Strategies to support substance use disorder care transitions from acute-care to community-based settings: a scoping review and typology. Addict Sci Clin Pract 2023; 18:67. [PMID: 37919755 PMCID: PMC10621088 DOI: 10.1186/s13722-023-00422-w] [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: 04/03/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Acute-care interventions that identify patients with substance use disorders (SUDs), initiate treatment, and link patients to community-based services, have proliferated in recent years. Yet, much is unknown about the specific strategies being used to support continuity of care from emergency department (ED) or inpatient hospital settings to community-based SUD treatment. In this scoping review, we synthesize the existing literature on patient transition interventions, and form an initial typology of reported strategies. METHODS We searched Pubmed, Embase, CINAHL and PsychINFO for peer-reviewed articles published between 2000 and 2021 that studied interventions linking patients with SUD from ED or inpatient hospital settings to community-based SUD services. Eligible articles measured at least one post-discharge treatment outcome and included a description of the strategy used to promote linkage to community care. Detailed information was extracted on the components of the transition strategies and a thematic coding process was used to categorize strategies into a typology based on shared characteristics. Facilitators and barriers to transitions of care were synthesized using the Consolidated Framework for Implementation Research. RESULTS Forty-five articles met inclusion criteria. 62% included ED interventions and 44% inpatient interventions. The majority focused on patients with opioid (71%) or alcohol (31%) use disorder. The transition strategies reported across studies were heterogeneous and often not well described. An initial typology of ten transition strategies, including five pre- and five post-discharge transition strategies is proposed. The most common strategy was scheduling an appointment with a community-based treatment provider prior to discharge. A range of facilitators and barriers were described, which can inform efforts to improve hospital-to-community transitions of care. CONCLUSIONS Strategies to support transitions from acute-care to community-based SUD services, although critical for ensuring continuity of care, vary greatly across interventions and are inconsistently measured and described. More research is needed to classify SUD care transition strategies, understand their components, and explore which lead to the best patient outcomes.
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Affiliation(s)
- Noa Krawczyk
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10065, USA.
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, Room 5-53, New York, USA.
| | - Bianca D Rivera
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10065, USA
| | - Ji E Chang
- Department of Public Health Policy and Management, NYU School of Global Public Health, New York, NY, 10003, USA
| | - Margaux Grivel
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, New York, NY, 10003, USA
| | - Yu-Heng Chen
- Department of Criminal Justice, Temple University, Philadelphia, PA, 19102, USA
| | | | - Honora Englander
- Department of Medicine, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Jennifer McNeely
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, 10065, USA
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8
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Krawczyk N, Rivera BD, Chang JE, Grivel M, Chen YH, Nagappala S, Englander H, McNeely J. Strategies to support substance use disorder care transitions from acute-care to community-based settings: A Scoping review and typology. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.24.23289042. [PMID: 37162840 PMCID: PMC10168484 DOI: 10.1101/2023.04.24.23289042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Acute-care interventions that identify patients with substance use disorders (SUDs), initiate treatment, and link patients to community-based services, have proliferated in recent years. Yet, much is unknown about the specific strategies being used to support continuity of care from emergency department (ED) or inpatient hospital settings to community-based SUD treatment. In this scoping review, we synthesize the existing literature on patient transition interventions, and form an initial typology of reported strategies. Methods We searched Pubmed, Embase, CINAHL and PsychINFO for peer-reviewed articles published between 2000-2021 that studied interventions linking SUD patients from ED or inpatient hospital settings to community-based SUD services. Eligible articles measured at least one post-discharge treatment outcome and included a description of the strategy used to promote linkage to community care. Detailed information was extracted on the components of the transition strategies and a thematic coding process was used to categorize strategies into a typology based on shared characteristics. Facilitators and barriers to transitions of care were synthesized using the Consolidated Framework for Implementation Research. Results Forty-five articles met inclusion criteria. 62% included ED interventions and 44% inpatient interventions. The majority focused on patients with opioid (71%) followed by alcohol (31%) use disorder. The transition strategies reported across studies were heterogeneous and often not well described. An initial typology of ten transition strategies, including five pre- and five post-discharge transition strategies is proposed. The most common strategy was scheduling an appointment with a community-based treatment provider prior to discharge. A range of facilitators and barriers were described, which can inform efforts to improve hospital-to-community transitions of care. Conclusions Strategies to support transitions from acute-care to community-based SUD services, although critical for ensuring continuity of care, vary greatly across interventions and are inconsistently measured and described. More research is needed to classify SUD care transition strategies, understand their components, and explore which lead to the best patient outcomes.
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Affiliation(s)
- Noa Krawczyk
- Department of Population Health, NYU Grossman School of Medicine, New York NY 10065
| | - Bianca D. Rivera
- Department of Population Health, NYU Grossman School of Medicine, New York NY 10065
| | - Ji E. Chang
- Department of Public Health Policy and Management, NYU School of Global Public Health, New York NY 10003
| | - Margaux Grivel
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, New York NY 10003
| | - Yu-Heng Chen
- Department of Criminal Justice, Temple University, Philadelphia, PA 19102
| | | | - Honora Englander
- Department of Medicine, Oregon Health & Science University, Portland, OR 97239
| | - Jennifer McNeely
- Department of Population Health, NYU Grossman School of Medicine, New York NY 10065
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Adeniran E, Quinn M, Wallace R, Walden RR, Labisi T, Olaniyan A, Brooks B, Pack R. A scoping review of barriers and facilitators to the integration of substance use treatment services into US mainstream health care. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100152. [PMID: 37069961 PMCID: PMC10105485 DOI: 10.1016/j.dadr.2023.100152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/19/2023]
Abstract
Background Following the national implementation of the Affordable Care Act (ACA) in 2014, barriers still exist that limit the adoption of substance use treatment (SUT) services in mainstream health care (MHC) settings in the United States. This study provides an overview of current evidence on barriers and facilitators to integrating various SUT services into MHC. Methods A systematic search was conducted with the following databases: "PubMed including MEDLINE", "CINAHL", "Web of Science", "ABI/Inform", and "PsycINFO." We identified barriers and/or facilitators affecting patients, providers, and programs/systems. Results Of the 540 identified citations, 36 were included. Main barriers were identified for patients (socio-demographics, finances, confidentiality, legal impact, and disinterest), providers (limited training, lack of time, patient satisfaction concerns, legal implications, lack of access to resources or evidence-based information, and lack of legal/regulatory clarity), and programs/systems (lack of leadership support, lack of staff, limited financial resources, lack of referral networks, lack of space, and lack of state-level support). Also, we recognized key facilitators pertaining to patients (trust for providers, education, and shared decision making), providers (expert supervision, use of support team, training with programs like Extension for Community Health Outcomes (ECHO), and receptivity), and programs/systems (leadership support, collaboration with external agencies, and policies e.g., those expanding the addiction workforce, improving insurance access and treatment access). Conclusions This study identified several factors influencing the integration of SUT services in MHC. Strategies for improving SUT integration in MHC should address barriers and leverage facilitators related to patients, providers, and programs/systems.
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Affiliation(s)
- Esther Adeniran
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
- Corresponding author at: Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.
| | - Megan Quinn
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
| | - Richard Wallace
- Quillen College of Medicine Library, East Tennessee State University, Johnson City, TN 37614, United States
| | - Rachel R. Walden
- Quillen College of Medicine Library, East Tennessee State University, Johnson City, TN 37614, United States
| | - Titilola Labisi
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Afolakemi Olaniyan
- Department of Health Promotion and Education, School of Human Sciences, University of Cincinnati, Cincinnati, OH 45221, United States
| | - Billy Brooks
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
| | - Robert Pack
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States
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10
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Collins AB, Baird J, Nimaja E, Ashenafi Y, Clark MA, Beaudoin FL. Experiences of patients at high risk of opioid overdose accessing emergency department and behavioral health interventions: a qualitative analysis in an urban emergency department. BMC Health Serv Res 2023; 23:370. [PMID: 37069593 PMCID: PMC10110343 DOI: 10.1186/s12913-023-09387-7] [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: 10/14/2022] [Accepted: 04/11/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Emergency Departments (EDs) have become critical 'touchpoints' for the identification and early engagement of patients at risk of overdose or who have an opioid use disorder (OUD). Our objectives were to examine patients' ED experiences, identify barriers and facilitators of service uptake in ED settings, and explore patients' experiences with ED staff. METHODS This qualitative study was part of a randomized controlled trial that evaluated the effectiveness of clinical social workers and certified peer recovery specialists in increasing treatment uptake and reducing opioid overdose rates for people with OUD. Between September 2019 and March 2020, semi-structured interviews were conducted 19 participants from the trial. Interviews sought to assess participants' ED care experiences across intervention type (i.e., clinical social worker or peer recovery specialist). Participants were purposively sampled across intervention arm (social work, n = 11; peer recovery specialist, n = 7; control, n = 1). Data were analyzed thematically with a focus on participant experiences in the ED and social and structural factors shaping care experiences and service utilization. RESULTS Participants reported varied ED experiences, including instances of discrimination and stigma due to their substance use. However, participants underscored the need for increased engagement of people with lived experience in ED settings, including the use of peer recovery specialists. Participants highlighted that ED provider interactions were critical drivers of shaping care and service utilization and needed to be improved across EDs to improve post-overdose care. CONCLUSIONS While the ED provides an opportunity to reach patients at risk of overdose, our results demonstrate how ED-based interactions and service provision can impact ED care engagement and service utilization. Modifications to care delivery may improve experiences for patients with OUD or at high risk for overdose. TRIAL REGISTRATION Clinical trial registration: NCT03684681.
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Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, 121 S Main Street, Providence, RI, USA
| | - Janette Baird
- Department of Emergency Medicine, Warrant Alpert Medical School of Brown University, 55 Claverick Street 2Nd Floor, Providence, RI, 02903, USA
| | - Evelyn Nimaja
- Department of Emergency Medicine, Warrant Alpert Medical School of Brown University, 55 Claverick Street 2Nd Floor, Providence, RI, 02903, USA
| | - Yokabed Ashenafi
- Department of Epidemiology, Brown University School of Public Health, 121 S Main Street, Providence, RI, USA
| | - Melissa A Clark
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University School of Public Health, 121 S Main Street, Providence, RI, USA.
- Department of Emergency Medicine, Warrant Alpert Medical School of Brown University, 55 Claverick Street 2Nd Floor, Providence, RI, 02903, USA.
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11
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Doran KM, Welch AE, Jeffers A, Kepler KL, Chambless D, Cowan E, Wittman I, Regina A, Chang TE, Parraga S, Tapia J, Diaz C, Gwadz M, Cleland CM, McNeely J. Study protocol for a multisite randomized controlled trial of a peer navigator intervention for emergency department patients with nonfatal opioid overdose. Contemp Clin Trials 2023; 126:107111. [PMID: 36746325 PMCID: PMC10718173 DOI: 10.1016/j.cct.2023.107111] [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: 12/08/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients presenting to emergency departments (EDs) after a nonfatal opioid-involved overdose are at high risk for future overdose and death. Responding to this risk, the New York City (NYC) Department of Health and Mental Hygiene operates the Relay initiative, which dispatches trained peer "Wellness Advocates" to meet patients in the ED after a suspected opioid-involved overdose and follow them for up to 90 days to provide support, education, referrals to treatment, and other resources using a harm reduction framework. METHODS In this article, we describe the protocol for a multisite randomized controlled trial of Relay. Study participants are recruited from four NYC EDs and are randomized to receive the Relay intervention or site-directed care (the control arm). Outcomes are assessed through survey questionnaires conducted at 1-, 3-, and 6-months after the baseline visit, as well as through administrative health data. The primary outcome is the number of opioid-related adverse events, including any opioid-involved overdose or any other substance use-related ED visit, in the 12 months post-baseline. Secondary and exploratory outcomes will also be analyzed, as well as hypothesized mediators and moderators of Relay program effectiveness. CONCLUSION We present the protocol for a multisite randomized controlled trial of a peer-delivered OD prevention intervention in EDs. We describe how the study was designed to minimize disruption to routine ED operations, and how the study was implemented and adapted during the COVID-19 pandemic. This trial is registered with ClinicalTrials.gov [NCT04317053].
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Affiliation(s)
- Kelly M Doran
- Department of Emergency Medicine, NYU School of Medicine, 227 East 30(th) Street, New York, NY 10016, United States; Department of Population Health, NYU School of Medicine, 180 Madison Avenue, New York, NY 10016, United States.
| | - Alice E Welch
- Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, Division of Mental Hygiene, New York City Department of Health and Mental Hygiene, 42-09 28(th) Street, Queens, Long Island City, NY 11101, United States
| | - Angela Jeffers
- Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, Division of Mental Hygiene, New York City Department of Health and Mental Hygiene, 42-09 28(th) Street, Queens, Long Island City, NY 11101, United States
| | - Kelsey L Kepler
- Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, Division of Mental Hygiene, New York City Department of Health and Mental Hygiene, 42-09 28(th) Street, Queens, Long Island City, NY 11101, United States
| | - Dominique Chambless
- Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, Division of Mental Hygiene, New York City Department of Health and Mental Hygiene, 42-09 28(th) Street, Queens, Long Island City, NY 11101, United States
| | - Ethan Cowan
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 281 1(st) Avenue, New York, NY 10003, United States
| | - Ian Wittman
- Department of Emergency Medicine, NYU School of Medicine, 227 East 30(th) Street, New York, NY 10016, United States
| | - Angela Regina
- Department of Emergency Medicine, Saint Barnabas Hospital Health System, 4422 3(rd) Avenue, Bronx, NY 10457, United States
| | - Tingyee E Chang
- Department of Emergency Medicine, NYU School of Medicine, 227 East 30(th) Street, New York, NY 10016, United States
| | - Susan Parraga
- Department of Emergency Medicine, NYU School of Medicine, 227 East 30(th) Street, New York, NY 10016, United States
| | - Jade Tapia
- Department of Emergency Medicine, NYU School of Medicine, 227 East 30(th) Street, New York, NY 10016, United States
| | - Cesar Diaz
- Department of Emergency Medicine, NYU School of Medicine, 227 East 30(th) Street, New York, NY 10016, United States
| | - Marya Gwadz
- NYU Silver School of Social Work, 1 Washington Square North, New York, NY 10003, United States
| | - Charles M Cleland
- Department of Population Health, NYU School of Medicine, 180 Madison Avenue, New York, NY 10016, United States
| | - Jennifer McNeely
- Department of Population Health, NYU School of Medicine, 180 Madison Avenue, New York, NY 10016, United States
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12
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Bond C, Challen K, Milne WK. Hot off the press: Medications for opioid use disorder In the emergency department. Acad Emerg Med 2022; 29:1503-1505. [PMID: 36197068 DOI: 10.1111/acem.14602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022]
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13
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Distinguishing clinical factors associated with unintentional overdose, suicidal ideation, and attempted suicide among opioid use disorder in-patients. J Psychiatr Res 2022; 153:245-253. [PMID: 35841821 DOI: 10.1016/j.jpsychires.2022.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/15/2022] [Accepted: 06/24/2022] [Indexed: 01/11/2023]
Abstract
Opioid and other drug-related overdoses and suicides are leading causes of injury death and represent a significant public health threat in the United States (U.S.). This study examined clinical factors of three patient groups from two inpatient addiction treatment facilities in Appalachian West Virginia (n = 66). Patients were classified as having: 1) unintentional overdose(s) (OD), 2) suicidal ideation or suicide attempt(s) (SI/SA), and 3) suicidal ideation or suicide attempt, and unintentional overdose (SI/SA/OD). Multinomial logistic regression models were used to determine whether adverse childhood experiences, self-injurious behaviors, substance use history, overdose history, and past year stressful life events were differentially associated with history of SI/SA/OD. Participants in the OD group were more likely to have used heroin in the 24-h preceding their most recent overdose compared to either the SI/SA or SI/SA/OD groups. The multivariable model found participants with history of SI/SA had higher adverse childhood experience scores and more participants with history of SI/SA endorsed childhood physical abuse and teen dating violence. Overall, there are characteristics that distinguish unintentional overdose from suicidal ideation and attempt. Patients with SI/SA/OD appear to have greater clinical severity. More thorough evaluation of drugs involved in overdose and history of self-injury may help distinguish future risk and inform treatment planning.
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14
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Schoenfeld EM, Westafer LM, Beck SA, Potee BG, Vysetty S, Simon C, Tozloski JM, Girardin AL, Soares WE. "Just give them a choice": Patients' perspectives on starting medications for opioid use disorder in the ED. Acad Emerg Med 2022; 29:928-943. [PMID: 35426962 PMCID: PMC9378535 DOI: 10.1111/acem.14507] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Medications for opioid use disorder (MOUD) prescribed in the emergency department (ED) have the potential to save lives and help people start and maintain recovery. We sought to explore patient perspectives regarding the initiation of buprenorphine and methadone in the ED with the goal of improving interactions and fostering shared decision making (SDM) around these important treatment options. METHODS We conducted semistructured interviews with a purposeful sample of people with opioid use disorder (OUD) regarding ED visits and their experiences with MOUD. The interview guide was based on the Ottawa Decision Support Framework, a framework for examining decisional needs and tailoring decisional support, and the research team's experience with MOUD and SDM. Interviews were recorded, transcribed, and analyzed in an iterative process using both the Ottawa Framework and a social-ecological framework. Themes were identified and organized and implications for clinical care were noted and discussed. RESULTS Twenty-six participants were interviewed, seven in person in the ED and 19 via video conferencing software. The majority had tried both buprenorphine and methadone, and almost all had been in an ED for an issue related to opioid use. Participants reported social, pharmacological, and emotional factors that played into their decision making. Regarding buprenorphine, they noted advantages such as its efficacy and logistical ease and disadvantages such as the need to wait to start it (risk of precipitated withdrawal) and that one could not use other opioids while taking it. Additionally, participants felt that: (1) both buprenorphine and methadone should be offered; (2) because "one person's pro is another person's con," clinicians will need to understand the facets of the options; (3) clinicians will need to have these conversations without appearing judgmental; and (4) many patients may not be "ready" for MOUD, but it should still be offered. CONCLUSIONS Although participants were supportive of offering buprenorphine in the ED, many felt that methadone should also be offered. They felt that treatment should be tailored to an individual's needs and circumstances and clarified what factors might be important considerations for people with OUD.
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Affiliation(s)
- Elizabeth M. Schoenfeld
- Department of Emergency Medicine UMASS Chan Medical School–Baystate Springfield Massachusetts USA
- Department for Healthcare Delivery and Population Science UMASS Chan Medical School–Baystate Springfield Massachusetts USA
| | - Lauren M. Westafer
- Department of Emergency Medicine UMASS Chan Medical School–Baystate Springfield Massachusetts USA
- Department for Healthcare Delivery and Population Science UMASS Chan Medical School–Baystate Springfield Massachusetts USA
| | | | | | - Sravanthi Vysetty
- Lincoln Memorial University DeBusk College of Osteopathic Medicine Harrogate Tennessee USA
| | - Caty Simon
- Urban Survivors Union Greensboro North Carolina USA
- Whose Corner Is It Anyway Holyoke Massachusetts USA
| | - Jillian M. Tozloski
- Department of Emergency Medicine UMASS Chan Medical School–Baystate Springfield Massachusetts USA
| | - Abigail L. Girardin
- Department of Emergency Medicine UMASS Chan Medical School–Baystate Springfield Massachusetts USA
| | - William E. Soares
- Department of Emergency Medicine UMASS Chan Medical School–Baystate Springfield Massachusetts USA
- Department for Healthcare Delivery and Population Science UMASS Chan Medical School–Baystate Springfield Massachusetts USA
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15
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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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