“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

Abstract

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.

Implementing hospital-based peer recovery support services for substance use disorder

“…Post-overdose interventions in the emergency department (ED) are critical for mitigating the high risk of short-term all-cause mortality for patients who visit the ED for opioid and other drug overdose (8)(9)(10)(11). Peer recovery support programs for patients who visit the ED for opioid overdose or other substance userelated reasons are funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) in several states, including Indiana, Nevada, New Jersey, and Rhode Island (12)(13)(14)(15). In Rhode Island, the vast majority of ED providers surveyed utilized peer recovery support consultations for patients at risk of opioid overdose, and consultation utilization was consistent over time (16).…”

Findings from the recovery initiation and management after overdose (RIMO) pilot study experiment

“…This approach is consistent with recent innovative approaches to intervene with individuals within several days after an overdose (Bowman et al, 2014;Garza & Dyer, 2016) and to build collaborative partnerships with emergency services providers (Samuels, 2014). The study findings contribute to the growing literature on the use of interventions for treatment linkage and recovery support that target individuals who have had an opioid overdose, which have focused on making initial contacts with individuals within hospital EDs (McGuire et al, 2019;Powell et al, 2019;Wagner et al, 2019;Waye et al, 2019). The unique aspect of the RIMO intervention is the combined use of assertive outreach with a well-established treatment linkage intervention for out-of-treatment individuals who are initially contacted outside of the ED, which expands the range of potential access points to the opioid treatment service cascade (Williams, Nunes, Bisaga, Levin, & Olfson, 2019).…”

“…Furthermore, spurred by state-level funding, including the STR projects, several innovative models have been developed that use peer recovery specialists to intervene with patients in the ED following an overdose (Powell, Treitler, Peterson, Borys, & Hallcom, 2019), and to provide overdose prevention education and naloxone training, continuing outreach and peer support, and referrals to services (McGuire, Powell, Treitler, et al, 2019;Wagner et al, 2019;Waye, Goyer, Dettor, & Marshall, 2019). Yet, even though standard protocols usually require EMS to transport individuals to the ED following naloxone administration, many such individuals refuse to go into an ED or, if they do, leave as soon as they are capable, without having received a treatment referral (Wampler, Molina, McManus, Laws, & Manifold, 2011).…”

The mobile emergency recovery intervention trial (MERIT): Protocol for a 3-year mixed methods observational study of mobile recovery outreach teams in Nevada’s emergency departments

“…The MROT intervention model was designed by the STR/SOR stakeholders and the MROT staff members, and the intervention is independent from the funded evaluation research. However, the STR/SOR program development, funding requirements, and oversight were heavily informed by the feasibility and acceptability research findings from the R21 phase of the MERIT study, and the research team and STR/SOR stakeholders met regularly to collaborate regarding optimizing the implementation of the intervention [ 4 ]. As part of the STR/SOR-funded intervention, participating EDs are provided with the phone number for the MROTs, which is triaged through a call-taking application that forwards the call to the mobile phones of all MROT team members’ individual phones.…”