A newly published review of programs seeking to engage individuals in appropriate care after an opioid overdose identified only three programs evaluated in peer-reviewed research, suggesting that many questions remain about what types of interventions could be most effective.
Published online last month in Preventive Medicine, the review identified 27 programs in all, with the vast majority coming from descriptions on websites or in newspaper articles. Lead author Sarah M. Bagley, MD, addiction specialist at Boston Medical Center's Grayken Center for Addiction, tells Addiction Professional that the research team decided to pursue a broader “scoping review” of post-overdose intervention programs because it realized many existing efforts have not yet been evaluated.
In fact, Bagley says, “There probably will be some that never go through a formal evaluation,” although she adds there has been evidence since the review was completed that more programs are being subject to rigorous research. This review searched articles that had been published through January of this year.
Authors of the review summarized the impact of the identified programs by writing, “These programs represent inventive tertiary prevention approaches with an unproven promise to reduce opioid-related mortality by engaging overdose survivors, the single highest-risk population of all people who use opioids.”
Nine of the 27 identified programs were based exclusively in hospital emergency departments, where individuals were approached either while still in the emergency department or within a week after discharge. Ten of the 27 programs were community-based, with follow-up occurring in overdose victims' homes or in the location where the overdose had occurred. The community-based programs often relied on collaborations that involved law enforcement or other public safety officers.
The question of a post-overdose intervention's timing is an important one that will require considerably more study, says Bagley. While there is much interest in trying to engage individuals immedately after an overdose, “For some people, right away in the emergency department might not be the right time,” she says.
One way in which several of these programs have attempted to engage individuals more successfully at an earlier stage is through use of peer specialists, the researchers reported. Bagley, who works with young patients in her role as medical director of the Center for Addiction Treatment for Adolescents/Young Adults Who Use Substances clinic, says she has found that “talking with someone with lived experience means so much to patients.” This might even be more critical when working with the highest-risk populations, she says.
But again, questions remain as to how best to maximize peers' potential effectiveness, in terms of what constitutes a peer and what training this group should receive before they begin working with patients.
These were the three post-overdose intervention programs that were identified from the peer-reviewed literature:
The AnchorED program in Rhode Island, in which on-call peer recovery specialists are available to all hospital emergency departments in the state to work with patients with an overdose or other substance use-related issue. In a one-year period from mid-2016 to mid-2017, 87% of the nearly 1,400 individuals that the program reached agreed to see a peer recovery specialist, and 51% agreed to a referral for services.
The Lifespan Opioid Overdose Prevention (LOOP) program, also in Rhode Island, in which overdose patients received naloxone and consultation with a peer recovery coach. A review of 151 hospital patient charts found that 29% initiated medication for opioid use disorder within a year of being in the emergency department, while 20% were treated for a new overdose episode.
The Tailored Telephone Interview Delivered by Peers to Prevent Recurring Opioid Overdoses program, an effort to provide up to three follow-up phone calls to individuals who had been treated for an overdose at the University of Cincinnati Medical Center. No firm conclusions could be drawn about the program's impact, the researchers reported, because a scant percentage of the patients were successfully contacted by the intervention team.
Other important details
How best to take advantage of peers' ability to reach individuals who have experienced an overdose remains just one of several questions regarding how best to structure post-overdose interventions.
For example, “What does the right initial encounter look like?” says Bagley. Is it simply a basic attempt to build an initial rapport with the individual, or does something more need to happen in that first encounter?
Another important topic involves the privacy of the individuals being targeted, given that many of these programs rely on cooperation among different parties that include law enforcement. “In order to target these programs towards high-risk individuals, the overdose survivors often need to be identified and their information may be shared. But this loss of privacy may erode trust in the outreach process,” authors of the review wrote.