ObjectiveThe United States is amidst an opioid epidemic, including synthetic opioids that may result in rapid death, leaving minimal opportunity for bystander rescue. We pilot tested a behavioral intervention to reduce the occurrence of opioid overdose among opioid dependent persons at high-risk for subsequent overdose.Materials and methodsWe conducted a single-blinded randomized-controlled trial of a repeated dose motivational interviewing intervention (REBOOT) to reduce overdose versus treatment as usual, defined as information and referrals, over 16 months at the San Francisco Department of Public Health from 2014–2016. Participants were 18–65 years of age, had opioid use disorder by Structured Clinical Interview, active opioid use, opioid overdose within 5 years, and prior receipt of naloxone kits. The intervention was administered at months 0, 4, 8, and 12, preceded by the assessment which was also administered at month 16. Dual primary outcomes were any overdose event and number of events, collected by computer-assisted personal interview, as well as any fatal overdose events per vital records.ResultsA total of 78 persons were screened and 63 enrolled. Mean age was 43 years, 67% were born male, 65% White, 17% African-American, and 14% Latino. Ninety-two percent of visits and 93% of counseling sessions were completed. At baseline, 33.3% of participants had experienced an overdose in the past four months, with a similar mean number of overdoses in both arms (p = 0.95); 29% overdosed during follow-up. By intention-to-treat, participants assigned to REBOOT were less likely to experience any overdose (incidence rate ratio [IRR] 0.62 [95%CI 0.41–0.92, p = 0.019) and experienced fewer overdose events (IRR 0.46, 95%CI 0.24–0.90, p = 0.023), findings that were robust to sensitivity analyses. There were no differences between arms in days of opioid use, substance use treatment, or naloxone carriage.ConclusionsREBOOT reduced the occurrence of any opioid overdose and the number of overdoses.Trial registrationclinicaltrials.gov NCT02093559

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ObjectiveTo utilize an established syndromic reporting system for surveillance of potentially preventable emergency department (ED) oral health visits (OHV) in New York City (NYC). IntroductionNYC Department of Health and Mental Hygiene recently reoriented its oral health care strategy to focus on health promotion and expanded surveillance. One surveillance challenge is the lack of timely OHV data; few dental providers are in our electronic health record project, and statewide utilization data are subject to delays. Prior research has examined OHV using ICD-9-CM from ED records, and has suggested that diagnostic specificity may be limited by ED providers' lack of training in dental diagnoses (1-3). We considered our existing ED syndromic system as a complement to periodic population-based surveys. This system captures approximately 95% of all ED visits citywide; 98% of records have a completed chief complaint text field whereas only 52% contain an ICD-9-CM diagnosis.