Adoption and Utilization of an Emergency Department Naloxone Distribution and Peer Recovery Coach Consultation Program

Samuels, Elizabeth A.; Baird, Janette; Yang, Eunice S.; Mello, Michael J.

doi:10.1111/acem.13545

Cited by 76 publications

(75 citation statements)

References 39 publications

(38 reference statements)

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“…Peers were able to build rapport based on commonalities and promote harm reduction efforts in the community. Studies conducted in emergency departments and clinical settings in the US and in other contexts globally have similarly reflected the acceptability and potential for peers in harm reduction and recovery support services, including for reduction of use, decreased risk behaviors, and improved quality of life [26,[60][61][62][63][64][65][66][67]. Particularly considering some stigmatizing interactions with health care workers, as one client noted above, individuals may be better able to share experiences and address underlying factors contributing to problematic substance use when working with a PRC.…”

Section: Discussionmentioning

confidence: 99%

Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City

et al. 2020

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Low-income, racial/ethnic minority groups have disproportionately high rates of problematic substance use yet face barriers in accessing evidence-based interventions (EBIs). Peer recovery coaches (PRCs), individuals with lived experience with problematic substance use, may provide an effective approach to reaching these individuals. Traditionally PRCs have focused on bridging to other types of care rather than delivering EBIs themselves. The aim of this study was to assess perceptions of the appropriateness of a PRC-delivered adapted behavioral activation (BA) intervention to reduce problematic substance use for individuals not engaged in care. This study was conducted at a community resource center in Baltimore, Maryland serving low-income and homeless clients who have high rates of problematic substance use yet also face barriers to accessing care. Guided by the ADAPT-ITT framework, we conducted semi-structured key informant interviews with clients (n = 30) with past or present problematic substance use, and a focus group with community providers, including staff at the community resource center (n = 5) and PRCs (n = 6) from the community. Thirty percent (n = 9) of clients interviewed reported past problematic substance use and 70% (n = 21) met criteria for current use, most commonly cocaine and opioids. Clients, center staff, and PRCs shared that PRC-delivered BA could be acceptable and appropriate with suggested adaptations, including adding peer-delivered case-management and linkage to care alongside BA, and tailoring BA to include activities that are accessible and feasible in the community. These findings will inform the adaptation of PRC-delivered BA to address problematic substance use in this setting.

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Section: Discussionmentioning

confidence: 99%

Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City

et al. 2020

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“…MROTs are comprised of behavioral health professionals (e.g., licensed/certified substance abuse counselors) and people with lived experience of opioid use who are in recovery (i.e., "peers"), who provide recovery support, coaching, and linkage to services for opioid overdose patients (Reif et al, 2014). This type of post-overdose outreach program has garnered enthusiasm in recent years as a promising response to the growing epidemic of overdoses (Formica et al, 2018;Powell, Treitler, Peterson, Borys, & Hallcom, 2019;Samuels, Baird, Yang, & Mello, 2019;Waye et al, 2019), though precedent for such programs has existed for decades (Davidson, 1999).…”

Section: Introductionmentioning

confidence: 99%

“Another tool for the tool box? I'll take it!”: Feasibility and acceptability of mobile recovery outreach teams (MROT) for opioid overdose patients in the emergency room

Wagner

Oman

Smith

et al. 2020

Journal of Substance Abuse Treatment

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A B S T R A C TDrug poisoning deaths involving opioids have increased exponentially in the United States. Post-overdose outreach to patients in the emergency room (ER) is a promising strategy for increasing uptake of medication assisted treatment and reducing subsequent overdose. We conducted a mixed methods study to investigate the feasibility and acceptability of a mobile recovery outreach team (MROT) program for opioid overdose patients presenting in Nevada's ERs, which was funded by the SAMHSA Opioid State Targeted Response (STR) grant. We interviewed 25 ER staff using quantitative questions informed by Diffusion of Innovation (DOI) theory and qualitative questions regarding their experiences caring for overdose patients, perceived benefits, and concerns about the MROT program. Respondents expressed strong support and enthusiasm for the program, identified advantages of the program relative to standard of care, highlighted logistical issues that must be addressed prior to implementation, and illustrated how the MROT program is compatible with their personal and professional values. Our results suggest that the STR-funded MROT program could reduce burden and stress among ER staff and improve patient outcomes, but must be informed by formative research that addresses issues of logistical complexity and cultural compatibility.

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“…5,7,9 Furthermore, the rate of naloxone prescription upon ED discharge following nonfatal overdose remains low even as an evidence-based practice known to decrease mortality and risk of future overdose. 11,14 Just as the ED is a unique setting to increase rates of BUP initiation, it is also an opportunity to implement other harm reduction strategies such as naloxone prescribing. 15 Numerous patient-side barriers currently limit the adoption of BUP initiation, including confusion and cultural stigma surrounding medication therapy for OUD and patient perceptions that such treatment is harmful, inferior to detoxification, and even incompatible with being truly "drug-free."…”

mentioning

confidence: 99%

Interrupted Time Series of User‐centered Clinical Decision Support Implementation for Emergency Department–initiated Buprenorphine for Opioid Use Disorder

Holland

Nath

Li³

et al. 2020

Academic Emergency Medicine

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Objectives Adoption of emergency department (ED) initiation of buprenorphine (BUP) for opioid use disorder (OUD) into routine emergency care has been slow, partly due to clinicians’ unfamiliarity with this practice and perceptions that it is complicated and time‐consuming. To address these barriers and guide emergency clinicians through the process of BUP initiation, we implemented a user‐centered computerized clinical decision support system (CDS). This study was conducted to assess the feasibility of implementation and to evaluate the preliminary efficacy of the intervention to increase the rate of ED‐initiated BUP. Methods An interrupted time series study was conducted in an urban, academic ED from April 2018 to February 2019 (preimplementation phase), March 2019 to August 2019 (implementation phase), and September 2019 to December 2019 (maintenance phase) to study the effect of the intervention on adult ED patients identified by a validated electronic health record (EHR)‐based computable phenotype consisting of structured data consistent with potential cases of OUD who would benefit from BUP treatment. The intervention offers flexible CDS for identification of OUD, assessment of opioid withdrawal, and motivation of readiness to start treatment and automates EHR activities related to ED initiation of BUP (including documentation, orders, prescribing, and referral). The primary outcome was the rate of ED‐initiated BUP. Secondary outcomes were launch of the intervention, prescription for naloxone at ED discharge, and referral for ongoing addiction treatment. Results Of the 141,041 unique patients presenting to the ED over the preimplementation and implementation phases (i.e., the phases used in primary analysis), 906 (574 preimplementation and 332 implementation) met OUD phenotype and inclusion criteria. The rate of BUP initiation increased from 3.5% (20/574) in the preimplementation phase to 6.6% (22/332) in the implementation phase (p = 0.03). After the temporal trend of the number of physician's with X‐waiver training and other covariates were adjusted for, the relative risk of BUP initiation rate was 2.73 (95% confidence interval [CI] = 0.62 to 12.0, p = 0.18). Similarly, the number of unique attendings who initiated BUP increased modestly 7/53 (13.0%) to 13/57 (22.8%, p = 0.10) after offering just‐in‐time training during the implementation period. The rate of naloxone prescribed at discharge also increased (6.5% preimplementation and 11.5% implementation; p < 0.01). The intervention received a system usability scale score of 82.0 (95% CI = 76.7 to 87.2). Conclusion Implementation of user‐centered CDS at a single ED was feasible, acceptable, and associated with increased rates of ED‐initiated BUP and naloxone prescribing in patients with OUD and a doubling of the number of unique physicians adopting the practice. We have implemented this intervention across several health systems in an ongoing trial to assess its effectiveness, scalability, and generalizability.

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Adoption and Utilization of an Emergency Department Naloxone Distribution and Peer Recovery Coach Consultation Program

Abstract: ED naloxone distribution and consultation of a community-based peer recovery coach are feasible and acceptable and can be maintained over time.

Cited by 76 publications

References 39 publications

Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City

Adapting a peer recovery coach-delivered behavioral activation intervention for problematic substance use in a medically underserved community in Baltimore City

“Another tool for the tool box? I'll take it!”: Feasibility and acceptability of mobile recovery outreach teams (MROT) for opioid overdose patients in the emergency room

Interrupted Time Series of User‐centered Clinical Decision Support Implementation for Emergency Department–initiated Buprenorphine for Opioid Use Disorder

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