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Jordan AE, Jette G, Graham JK, Burke C, Cunningham CO. Drug Overdose Death Following Substance Use Disorder Treatment Termination in New York City: A Retrospective Longitudinal Cohort Study. J Urban Health 2024:10.1007/s11524-024-00893-5. [PMID: 39095494 DOI: 10.1007/s11524-024-00893-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 08/04/2024]
Abstract
Drug overdose death rates are the highest recorded in New York City (NYC). Substance use disorder (SUD) treatment termination can confer increased risk of drug overdose death. Our objective was to determine the probability of, and factors associated with, drug overdose death following SUD treatment termination. Using a retrospective longitudinal cohort design, we identified those who had NYC-based SUD treatment terminated (01/2016-06/2019) using Chief Medical Examiner and SUD treatment data. Using survival analyses, we examined drug overdose deaths ≤ 14 and ≤ 90 days following SUD treatment termination, respectively. Of 51,171 patients with SUD treatment termination, 140 and 342 had a drug overdose death < 14 and ≤ 90 days, respectively. The crude drug overdose death rate was 26.7 per 1000 person-years at-risk in the ≤ 90-day period and was 71.6 per 1000 person-years at-risk in the ≤ 14-day period. In adjusted Cox proportional hazard model examining death ≤ 14 days, those unemployed (compared to employed) and those terminated from residential treatment (compared to medically supervised withdrawal, opioid treatment programs, and outpatient treatment) were more likely to have had a drug overdose death (all p-values < 0.01). In adjusted Cox proportional hazard model examining death ≤ 90 days, non-Hispanic White people (compared to non-Hispanic Black people), those not stably housed (compared to stably housed), those unemployed and those terminated from residential treatment were more likely to have had a drug overdose death (all p-values < 0.01). Strategies to improve retention including the reassessment of program treatment termination criteria along with strategies to promote ongoing OUD treatment, engagement in harm reduction, and distribution of naloxone are needed.
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Affiliation(s)
- Ashly E Jordan
- New York State Office of Addiction Services and Supports, New York City and Albany, NY, USA.
| | - Gail Jette
- New York State Office of Addiction Services and Supports, New York City and Albany, NY, USA
| | - Jason K Graham
- New York City Office of Chief Medical Examiner, New York, NY, USA
| | - Constance Burke
- New York State Office of Addiction Services and Supports, New York City and Albany, NY, USA
| | - Chinazo O Cunningham
- New York State Office of Addiction Services and Supports, New York City and Albany, NY, USA
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Pappalardo FS, Krieger M, Park C, Beaudoin FL, Wightman RS. Patients presenting to the ED with nonfatal drug overdose: Self-reported history of overdose and naloxone use. Am J Emerg Med 2024; 82:21-25. [PMID: 38759250 PMCID: PMC11254540 DOI: 10.1016/j.ajem.2024.05.007] [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: 10/25/2023] [Revised: 03/04/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND In the context of polysubstance use and fentanyl detection in non-opioid drugs supplies (e.g., cocaine, methamphetamine), it is important to re-evaluate and expand our understanding of which populations are at high risk for fatal drug overdoses. The primary objective of this pilot study was to gather data from the ED to characterize the population presenting with drug overdose, including demographics, drug use patterns and comorbidities, to inform upstream overdose prevention efforts. METHODS A consecutive sample of ED patients undergoing treatment for non-fatal overdose were prospectively recruited for study participation at the time of ED visit. Participants reported history of substance use over the past six months, recent and lifetime overdose, and naloxone receipt and administration history. RESULTS A total of 76 eligible participants were enrolled over the course of seven months. Participants reported high rates of opioid (56%), stimulant (56%), and cannabis use (59%). Self-reported polysubstance use, defined as self-reported use of more than one substance, was 83%. Of enrolled participants, 64% reported at least one overdose and 39% reported three or more lifetime overdoses prior to their index overdose ED visit. Participants with no self-reported intentional opioid use (n = 32) in the past six months had fentanyl positive urine drug screen 84% of the time versus 89% in the overall study population (n = 74). Participants who did not report opioid use in the past six months were less likely to possess (34% vs. 55%) or to know how to acquire (50% vs. 74%) naloxone compared to participants with self-reported history of opioid use. CONCLUSION This study demonstrated high rates of fentanyl exposure on toxicology testing at time of overdose across all participants including study participants without self-reported intentional opioid use. Data gathered in the ED at time of overdose can be used to inform upstream naloxone distribution and public health initiatives.
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Affiliation(s)
- Francesco S Pappalardo
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick St, Providence, RI 02906, USA.
| | - Maxwell Krieger
- Department of Epidemiology, School of Public Health of Brown University, Providence, RI, USA
| | - Carolyn Park
- Department of Epidemiology, School of Public Health of Brown University, Providence, RI, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, School of Public Health of Brown University, Providence, RI, USA
| | - Rachel S Wightman
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick St, Providence, RI 02906, USA; Department of Epidemiology, School of Public Health of Brown University, Providence, RI, USA
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Marshall KD, Derse AR, Weiner SG, Joseph JW. Navigating Care Refusal and Noncompliance in Patients with Opioid Use Disorder. J Emerg Med 2024; 67:e233-e242. [PMID: 38849254 DOI: 10.1016/j.jemermed.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/09/2024] [Accepted: 03/06/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND For many emergency physicians (EPs), deciding whether or not to allow a patient suffering the ill effects of opioid use to refuse care is the most frequent and fraught situation in which they encounter issues of decision-making capacity, informed refusal, and autonomy. Despite the frequency of this issue and the well-known impacts of opioid use disorder on decision-making, the medical ethics community has offered little targeted analysis or guidance regarding these situations. DISCUSSION As a result, EPs demonstrate significant variability in how they evaluate and respond to them, with highly divergent understandings and application of concepts such as decision-making capacity, informed consent, autonomy, legal repercussions, and strategies to resolve the clinical dilemma. In this paper, we seek to provide more clarity to this issue for the EPs. CONCLUSIONS Successfully navigating this issue requires that EPs understand the specific effects that opioid use disorder has on decision-making, and how that in turn bears on the ethical concepts of autonomy, capacity, and informed refusal. Understanding these concepts can lead to helpful strategies to resolve these commonly-encountered dilemmas.
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Affiliation(s)
- Kenneth D Marshall
- Department of Emergency Medicine and History and Philosophy of Medicine, University of Kansas Medical Center, Kansas City, Kansas.
| | - Arthur R Derse
- Department of Emergency Medicine, Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Scott G Weiner
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua W Joseph
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Dahlem CH, Dwan M, Dobbs B, Rich R, Jaffe K, Shuman CJ. Using RE-AIM Framework to Evaluate Recovery Opioid Overdose Team Plus: A Peer-Led Post-overdose Quick Response Team. Community Ment Health J 2024:10.1007/s10597-024-01319-x. [PMID: 39044057 DOI: 10.1007/s10597-024-01319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/06/2024] [Indexed: 07/25/2024]
Abstract
Peer recovery coaches utilize their lived experiences to support overdose survivors, a role gaining prominence across communities. A convergent mixed methods design, informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, was used to evaluate the Recovery Opioid Overdose Team Plus (ROOT +), through an iterative evaluation using web-based surveys and qualitative interviews. Reach: Over 27 months, ROOT + responded to 83% of suspected overdose referrals (n = 607) and engaged with 41% of survivors (n = 217) and 7% of survivors' family/friends (n = 38). Effectiveness: Among those initially engaged with ROOT +, 36% of survivors remained engaged, entered treatment, or were in recovery at 90 days post-overdose (n = 77). Adoption: First responders completed 77% of ROOT + referrals (n = 468). Implementation: Barriers included lack of awareness of ROOT + , working phones, and access to treatment from community partner interviews (n = 15). Maintenance: Adaptations to ROOT + were made to facilitate implementation. Peer-led teams are promising models to engage with overdose survivors.
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Affiliation(s)
- Chin Hwa Dahlem
- School of Nursing, University of Michigan, 400 N. Ingalls Rm 3174, Ann Arbor, MI, USA.
- Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan, Ann Arbor, MI, USA.
| | - Mary Dwan
- School of Nursing, University of Michigan, 400 N. Ingalls Rm 3174, Ann Arbor, MI, USA
| | | | | | - Kaitlyn Jaffe
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
- School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Clayton J Shuman
- School of Nursing, University of Michigan, 400 N. Ingalls Rm 3174, Ann Arbor, MI, USA
- Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Sindhwani MK, Friedman A, O'Donnell M, Stader D, Weiner SG. Naloxone distribution programs in the emergency department: A scoping review of the literature. J Am Coll Emerg Physicians Open 2024; 5:e13180. [PMID: 38726467 PMCID: PMC11079430 DOI: 10.1002/emp2.13180] [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: 12/15/2023] [Revised: 03/28/2024] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
This scoping review summarized the literature regarding naloxone distribution from emergency departments (EDs) without a prescription. Our intention was to examine various naloxone distribution programs, their methodologies, and the level of effectiveness of each. Understanding these key aspects of naloxone distribution could lead to improved standardized protocols, saving countless additional lives from opioid overdose. This review evaluated studies reporting naloxone distribution from EDs in the United States. The included studies were written in English and published between January 1, 2017, and December 31, 2022. Searches were performed using PubMed and Embase. A total of 129 studies were reviewed, with only 12 meeting the necessary criteria for analysis. Heterogeneity was found across naloxone distribution programs, including how patients were identified, how naloxone was dispensed to patients, and the specific naloxone products made available. The protocols included various methods, such as patient screening, where information used for this screening was sometimes obtained from health records or patient interviews. Some programs detailed only the distribution of naloxone, while others included additional interventions such as behavior counseling, peer support, and education. In four studies, patients received buprenorphine with naloxone kits. The various programs differed in their implementation but were generally successful in improving naloxone distribution. However, among the studies reviewed, the percentage of ED patients receiving naloxone varied from ∼30% to 70%, suggesting that certain program elements may be more impactful. Further research is needed to identify key elements of the most impactful programs in order to improve naloxone distribution and improve patient odds of surviving an opioid overdose.
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Affiliation(s)
| | | | | | | | - Scott G. Weiner
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
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Sandelich S, Hooley G, Hsu G, Rose E, Ruttan T, Schwarz ES, Simon E, Sulton C, Wall J, Dietrich AM. Acute opioid overdose in pediatric patients. J Am Coll Emerg Physicians Open 2024; 5:e13134. [PMID: 38464332 PMCID: PMC10920943 DOI: 10.1002/emp2.13134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Recent increases in pediatric and adolescent opioid fatalities mandate an urgent need for early consideration of possible opioid exposure and specific diagnostic and management strategies and interventions tailored to these unique populations. In contrast to adults, pediatric methods of exposure include accidental ingestions, prescription misuse, and household exposure. Early recognition, appropriate diagnostic evaluation, along with specialized treatment for opioid toxicity in this demographic are discussed. A key focus is on Naloxone, an essential medication for opioid intoxication, addressing its unique challenges in pediatric use. Unique pediatric considerations include recognition of accidental ingestions in our youngest population, critical social aspects including home safety and intentional exposure, and harm reduction strategies, mainly through Naloxone distribution and education on safe medication practices. It calls for a multifaceted approach, including creating pediatric-specific guidelines, to combat the opioid crisis among children and to work to lower morbidity and mortality from opioid overdoses.
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Affiliation(s)
- Stephen Sandelich
- Department of Emergency MedicinePenn State College of MedicinePenn State Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Gwen Hooley
- Department of Emergency MedicineChildren's Hospital of Los AngelesLos AngelesCaliforniaUSA
| | - George Hsu
- Department of Emergency MedicineAugusta University‐Medical College of GeorgiaAugustaGeorgiaUSA
| | - Emily Rose
- Department of Emergency MedicineKeck School of Medicine of the University of Southern CaliforniaLos Angeles General Medical CenterLos AngelesCaliforniaUSA
| | - Tim Ruttan
- Department of PediatricsDell Medical SchoolThe University of Texas at AustinUS Acute Care SolutionsCantonOhioUSA
| | - Evan S. Schwarz
- Division of Medical ToxicologyDepartment of Emergency MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Erin Simon
- Department of Emergency MedicineCleveland ClinicAkronOhioUSA
| | - Carmen Sulton
- Departments of Pediatrics and Emergency MedicineEmory University School of MedicineChildren's Healthcare of Atlanta, EglestonAtlantaGeorgiaUSA
| | - Jessica Wall
- Departments of Pediatrics and Emergency MedicineSeattle Children's HospitalHarborview Medical CenterSeattleWashingtonUSA
| | - Ann M Dietrich
- Department of Emergency MedicinePrisma HealthGreenvilleSouth CarolinaUSA
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Freibott CE, McCann NC, Biondi BE, Lipson SK. Interventions to increase naloxone access for undergraduate students: A systematic review of the literature. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-9. [PMID: 38227912 PMCID: PMC11250916 DOI: 10.1080/07448481.2023.2299404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/26/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To identify and describe interventions that increase access to naloxone for undergraduate students. METHODS A systematic review across 4 databases identified interventions that expand access to naloxone at colleges in the United States from 2015-2023. Three reviewers extracted the following data to create a narrative synthesis and summary of program elements: setting, rationale for intervention, timeline, intervention components, study size, collaboration, sustainability, outcomes and results. RESULTS Seven articles met inclusion criteria. Institutions' implemented naloxone interventions due to concerns for student safety and/or student overdose fatalities. Three universities collaborated with their School of Pharmacy for program design and/or dissemination, while two partnered with state-based naloxone distribution programs. Most programs combined opioid-overdose/naloxone training; four distributed naloxone kits. Three studies included pre/post-outcomes, and all reported increases in participant knowledge, attitudes, and/or ability to respond to an overdose. CONCLUSIONS Our results indicates an opportunity for wide-scale implementation of undergraduate naloxone programs within US colleges. However, more rigorous implementation research is needed to identify barriers and facilitators to program feasibility, acceptability, and participation.
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Affiliation(s)
- Christina E Freibott
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Nicole C McCann
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Breanne E Biondi
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sarah Ketchen Lipson
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Hood JE, Aleshin-Guendel S, Poel A, Liu J, Collins HN, Sadinle M, Avoundjian T, Sayre MR, Rea TD. Overdose and mortality risk following a non-fatal opioid overdose treated by Emergency Medical Services in King County, Washington. Drug Alcohol Depend 2023; 253:111009. [PMID: 37984033 PMCID: PMC10842336 DOI: 10.1016/j.drugalcdep.2023.111009] [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: 08/18/2023] [Revised: 10/05/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Emergency Medical Services (EMS) agencies respond to hundreds of thousands of acute overdose events each year. We conducted a retrospective cohort study of EMS patients who survived a prior opioid overdose in 2019-2021 in King County, Washington. METHODS A novel record linkage algorithm was applied to EMS electronic health records and the state vital statistics registry to identify repeat overdoses and deaths that occurred up to 3 years following the index opioid overdose. We measured overdose incidence rates and applied survival analysis techniques to assess all-cause and overdose-specific mortality risks. RESULTS In the year following the index opioid overdose, the overdose (fatal or non-fatal) incidence rate was 23.3 per 100 person-year, overdose mortality rate was 2.7 per 100 person-year, and all-cause mortality rate was 5.2 per 100 person-year in this cohort of overdose survivors (n=4234). Overdose incidence was highest in the first 30 days following the index overdose (43 opioid overdoses and 4 fatal overdoses per 1000 person-months), declined precipitously, and then plateaued from the third month onwards (10-15 opioid overdoses and 1-2 fatal overdoses per 1000 person-months). Overdose incidence rates, measured at 30 days, were highest among overdose survivors who were young, male, and experienced a low severity index opioid overdose, but these differences diminished when measured at 12 months. CONCLUSIONS Among EMS patients who survived an opioid overdose, the risk of subsequent overdose is high, especially in the weeks following the index opioid overdose. Non-fatal overdose may represent a pivotal time to connect patients with harm-reduction, treatment, and other support services.
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Affiliation(s)
- Julia E Hood
- Public Health - Seattle & King County, 401 Fifth Avenue, Suite 1250, Seattle, WA, USA; University of Washington, School of Public Health , 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Serge Aleshin-Guendel
- University of Washington, School of Public Health , 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Amy Poel
- Public Health - Seattle & King County, 401 Fifth Avenue, Suite 1250, Seattle, WA, USA
| | - Jennifer Liu
- Public Health - Seattle & King County, 401 Fifth Avenue, Suite 1250, Seattle, WA, USA
| | - Hannah N Collins
- Public Health - Seattle & King County, 401 Fifth Avenue, Suite 1250, Seattle, WA, USA
| | - Mauricio Sadinle
- University of Washington, School of Public Health , 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Tigran Avoundjian
- Public Health - Seattle & King County, 401 Fifth Avenue, Suite 1250, Seattle, WA, USA
| | - Michael R Sayre
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Thomas D Rea
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
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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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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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Kohan L, Potru S, Barreveld A, Sprintz M, Lane O, Aryal A, Emerick T, Dopp A, Chhay S, Viscusi E. Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel. Reg Anesth Pain Med 2021; 46:840-859. [PMID: 34385292 DOI: 10.1136/rapm-2021-103007] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/20/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The past two decades have witnessed an epidemic of opioid use disorder (OUD) in the USA, resulting in catastrophic loss of life secondary to opioid overdoses. Medication treatment of opioid use disorder (MOUD) is effective, yet barriers to care continue to result in a large proportion of untreated individuals. Optimal analgesia can be obtained in patients with MOUD within the perioperative period. Anesthesiologists and pain physicians can recommend and consider initiating MOUD in patients with suspected OUD at the point of care; this can serve as a bridge to comprehensive treatment and ultimately save lives. METHODS The Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, American Society of Anesthesiologists, American Academy of Pain Medicine, American Society of Addiction Medicine and American Society of Health System Pharmacists approved the creation of a Multisociety Working Group on Opioid Use Disorder, representing the fields of pain medicine, addiction, and pharmacy health sciences. An extensive literature search was performed by members of the working group. Multiple study types were included and reviewed for quality. A modified Delphi process was used to assess the literature and expert opinion for each topic, with 100% consensus being achieved on the statements and each recommendation. The consensus statements were then graded by the committee members using the United States Preventive Services Task Force grading of evidence guidelines. In addition to the consensus recommendations, a narrative overview of buprenorphine, including pharmacology and legal statutes, was performed. RESULTS Two core topics were identified for the development of recommendations with >75% consensus as the goal for consensus; however, the working group achieved 100% consensus on both topics. Specific topics included (1) providing recommendations to aid physicians in the management of patients receiving buprenorphine for MOUD in the perioperative setting and (2) providing recommendations to aid physicians in the initiation of buprenorphine in patients with suspected OUD in the perioperative setting. CONCLUSIONS To decrease the risk of OUD recurrence, buprenorphine should not be routinely discontinued in the perioperative setting. Buprenorphine can be initiated in untreated patients with OUD and acute pain in the perioperative setting to decrease the risk of opioid recurrence and death from overdose.
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Affiliation(s)
- Lynn Kohan
- Division of Pain Medicine/Department of Anesthesia, University of Virginia, Charlottesville, Virginia, USA
| | - Sudheer Potru
- Atlanta VA Medical Center, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Antje Barreveld
- Tufts University School of Medicine-and Newton Wesley Hospital, Boston and Newton, Massachusetts, USA
| | - Michael Sprintz
- Division of Geriatrics and Palliative Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Olabisi Lane
- Division of Pain Medicine, Department of Anestheisology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anuj Aryal
- Cedar Recovery and Deparment of Anesthesiolgy and Pain Medicine, VA Tennessee Valley Healthcare System Nashville Campus, Nashville, Tennessee, USA
| | - Trent Emerick
- Department of Anesthesiolgoy and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Anna Dopp
- American Society Health System Pharmacists, Bethesda, Maryland, USA
| | - Sophia Chhay
- American Society Health System Pharmacists, Bethesda, Maryland, USA
| | - Eugene Viscusi
- Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
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Hallvik SE, Dameshghi N, El Ibrahimi S, Hendricks MA, Hildebran C, Bishop CJ, Weiner SG. Linkage of public health and all payer claims data for population-level opioid research. Pharmacoepidemiol Drug Saf 2021; 30:927-933. [PMID: 33913205 DOI: 10.1002/pds.5259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Our objective is to describe how we combine, at an individual level, multiple administrative datasets to create a Comprehensive Opioid Risk Registry (CORR). The CORR will characterize the role that individual characteristics, household characteristics, and community characteristics have on an individual's risk of opioid use disorder or opioid overdose. DATA SOURCES Study data sources include the voluntary Oregon All Payer Claims Database (APCD), American Community Survey Census Data, Oregon Death Certificate data, Oregon Hospital Discharge Data (HDD), and Oregon Prescription Drug Monitoring (PDMP) Data in 2013-2018. STUDY DESIGN To create the CORR we first prepared the APCD data set by cleaning and geocoding addresses, creating a community grouper and adding census indices, creating household grouper, and imputing patient race. Then we deployed a probabilistic linkage methodology to incorporate other data sources maintaining compliance with strict data governance regulations. DATA COLLECTION/EXTRACTION METHODS Administrative datasets were obtained through an executed data use agreement with each data owner. The APCD served as the population universe to which all other data sources were linked. PRINCIPAL FINDINGS There were 3 628 992 unique people in the APCD over the entire study period. We identified 968 767 unique households in 2013 and 1 209 236 in 2018, and geocoded patient addresses representing all census tracts in Oregon. Census, death certificate, HDD, and PDMP datasets were successfully linked to this population universe. CONCLUSIONS This methodology can be replicated in other states and may also apply to a broad array of health services research topics.
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Affiliation(s)
- Sara E Hallvik
- Department of Research & Evaluation, Comagine Health, Portland, Oregon, USA
| | - Nazanin Dameshghi
- Department of Research & Evaluation, Comagine Health, Portland, Oregon, USA
| | - Sanae El Ibrahimi
- Department of Research & Evaluation, Comagine Health, Portland, Oregon, USA.,School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | | | - Christi Hildebran
- Department of Research & Evaluation, Comagine Health, Portland, Oregon, USA
| | - Carissa J Bishop
- Department of Research & Evaluation, Comagine Health, Portland, Oregon, USA
| | - Scott G Weiner
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Collins AB, Beaudoin FL, Samuels EA, Wightman R, Baird J. Facilitators and barriers to post-overdose service delivery in Rhode Island emergency departments: A qualitative evaluation. J Subst Abuse Treat 2021; 130:108411. [PMID: 34118703 DOI: 10.1016/j.jsat.2021.108411] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Emergency departments (EDs) in the US have increasingly incorporated interventions that seek to reduce opioid-related morbidity and mortality. However, many of these interventions are underutilized. This study examined ED provider-identified barriers and facilitators to policy-prescribed service provision for patients treated for an opioid overdose in Rhode Island EDs, and opportunities to improve care delivery. METHODS Semi-structured qualitative interviews were conducted with 55 ED providers (management and clinical staff) across Rhode Island EDs from November 2019 to July 2020. Thematic analysis of interviews focused on gaps and best practices in post-overdose care delivery, including social and structural factors driving access to, and uptake of, services. RESULTS Participants highlighted how automatic service delivery (opt out vs. opt in) and the integration of peer-based services enhanced post-overdose service provision. However, social and structural factors (e.g. insurance barriers, limited outpatient treatment resources) and gaps in provider knowledge of medications for opioid use disorder created barriers to care. Addressing long ED wait times and establishing dedicated care teams for patients following an overdose were seen as critical to improving ED service delivery. CONCLUSION Our findings suggest that post-overdose service delivery within EDs is a useful approach for connecting patients to services, particularly when peer support specialists are involved. However, standardizing service delivery approaches and improving provider education of harm reduction services must be prioritized alongside state-level policy changes to improve access to care for ED patients.
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Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States.
| | - Francesca L Beaudoin
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States; Department of Emergency Medicine, Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI 02903, United States; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States
| | - Elizabeth A Samuels
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI 02903, United States
| | - Rachel Wightman
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI 02903, United States
| | - Janette Baird
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States
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McLeod KE, Slaunwhite AK, Zhao B, Moe J, Purssell R, Gan W, Xavier C, Kuo M, Mill C, Buxton JA, Scheuermeyer FX. Comparing mortality and healthcare utilization in the year following a paramedic-attended non-fatal overdose among people who were and were not transported to hospital: A prospective cohort study using linked administrative health data. Drug Alcohol Depend 2021; 218:108381. [PMID: 33158663 DOI: 10.1016/j.drugalcdep.2020.108381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND As the overdose emergency continues in British Columbia (BC), paramedic-attended overdoses are increasing, as is the proportion of people not transported to hospital following an overdose. This study investigated risk of death and subsequent healthcare utilization for people who were and were not transported to hospital after a paramedic-attended non-fatal overdose. METHODS Using a linked administrative health data set which includes all overdoses that come into contact with health services in BC, we conducted a prospective cohort study of people who experienced a paramedic-attended non-fatal overdose between 2015 and 2016. People were followed for 365 days after the index event. The primary outcomes assessed were all-cause mortality and overdose-related death. Additionally, we examined healthcare utilization after the index event. RESULTS In this study, 8659 (84%) people were transported and 1644 (16%) were not transported to hospital at the index overdose event. There were 279 overdose deaths (2.7% of people, 59.4% of deaths) during follow-up. There was no significant difference in risk of overdose-related death, though people not transported had higher odds of a subsequent non-fatal overdose event captured in emergency department and outpatient records within 90 days. People transported to hospital had higher odds of using hospital and outpatient services for any reason within 365 days. CONCLUSIONS Transport to hospital after a non-fatal overdose is an opportunity to provide care for underlying and chronic conditions. There is a need to better understand factors that contribute to non-transport, particularly among people aged 20-59 and people without chronic conditions.
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Affiliation(s)
- Katherine E McLeod
- Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Amanda K Slaunwhite
- Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada; BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada
| | - Bin Zhao
- Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jessica Moe
- Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada; BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada; Vancouver General Hospital, 899 W 12th Ave, Vancouver, BC, V5Z 1M9, Canada
| | - Roy Purssell
- Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada; BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada
| | - Wenqi Gan
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada
| | - Chloé Xavier
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada
| | - Margot Kuo
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada
| | - Chris Mill
- Public Health Agency of Canada, 130 Colonnade Road A.L. 6501H, Ottawa, Ontario, K1A 0K9, Canada
| | - Jane A Buxton
- Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada; BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada
| | - Frank X Scheuermeyer
- Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada; Providence Health Care, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
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