Emergency medical services targeting opioid user disorder: An exploration of current out‐of‐hospital post‐overdose interventions

Champagne‐Langabeer, Tiffany; Bakos-Block, Christine; Yatsco, Andrea; Langabeer, James R.

doi:10.1002/emp2.12208

Cited by 19 publications

(6 citation statements)

References 44 publications

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“…Importantly, this study examined only nonfatal drug overdoses treated in health care settings, yet research shows that some drug overdoses occurring in the community and those responded to by emergency medical services do not lead to transport to an ED . Therefore, emergency medical services and other community-based strategies can play a vital role in broader postoverdose support, including follow-up, outreach, education, and linkage to care …”

Section: Discussionmentioning

confidence: 99%

Overdose, Behavioral Health Services, and Medications for Opioid Use Disorder After a Nonfatal Overdose

Jones,

Shoff,

Blanco

et al. 2024

JAMA Intern Med

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ImportanceRecognizing and providing services to individuals at highest risk for drug overdose are paramount to addressing the drug overdose crisis.ObjectiveTo examine receipt of medications for opioid use disorder (MOUD), naloxone, and behavioral health services in the 12 months after an index nonfatal drug overdose and the association between receipt of these interventions and fatal drug overdose.Design, Setting, and ParticipantsThis cohort study was conducted in the US from January 2020 to December 2021 using claims, demographic, mortality, and other data from the Centers for Medicare &amp; Medicaid Services, the Centers for Disease Control and Prevention, and other sources. The cohort comprised Medicare fee-for-service beneficiaries aged 18 years or older with International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes for a nonfatal drug overdose. Data analysis was performed from February to November 2023.ExposuresDemographic and clinical characteristics, substance use disorder, and psychiatric comorbidities.Main Outcomes and MeasuresReceipt of MOUD, naloxone, and behavioral health services as well as subsequent nonfatal and fatal drug overdoses.ResultsThe cohort consisted of 136 762 Medicare beneficiaries (80 140 females [58.6%]; mean (SD) age of 68.2 [15.0] years) who experienced an index nonfatal drug overdose in 2020. The majority of individuals had Hispanic (5.8%), non-Hispanic Black (10.9%), and non-Hispanic White (78.8%) race and ethnicity and lived in metropolitan areas (78.9%). In the 12 months after their index nonfatal drug overdose, 23 815 beneficiaries (17.4%) experienced at least 1 subsequent nonfatal drug overdose and 1323 (1.0%) died of a fatal drug overdose. Opioids were involved in 72.2% of fatal drug overdoses. Among the cohort, 5556 (4.1%) received any MOUD and 8530 (6.2%) filled a naloxone prescription in the 12 months after the index nonfatal drug overdose. Filling a naloxone prescription (adjusted odds ratio [AOR], 0.70; 95% CI, 0.56-0.89), each percentage of days receiving methadone (AOR, 0.98; 95% CI, 0.98-0.99) or buprenorphine (AOR, 0.99; 95% CI, 0.98-0.99), and receiving behavioral health assessment or crisis services (AOR, 0.25; 95% CI, 0.22-0.28) were all associated with reduced adjusted odds of fatal drug overdose in the 12 months after the index nonfatal drug overdose.Conclusions and RelevanceThis cohort study found that, despite their known association with reduced risk of a fatal drug overdose, only a small percentage of Medicare beneficiaries received MOUD or filled a naloxone prescription in the 12 months after a nonfatal drug overdose. Efforts to improve access to behavioral health services; MOUD; and overdose-prevention strategies, such as prescribing naloxone and linking individuals to community-based health care settings for ongoing care, are needed.

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Section: Discussionmentioning

confidence: 99%

Overdose, Behavioral Health Services, and Medications for Opioid Use Disorder After a Nonfatal Overdose

Jones,

Shoff,

Blanco

et al. 2024

JAMA Intern Med

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“…However, there are few examples of implementing these evidence-based interventions in first responder systems with one narrative review finding only 27 programs out of nearly 22,000 EMS agencies nationally described in the literature, with many providing naloxone distribution and community referrals while few facilitated linkage to medications for OUD. 41 …”

Section: Discussionmentioning

confidence: 99%

Harm Reduction in the Field: First Responders’ Perceptions of Opioid Overdose Interventions

Fockele,

Frohe,

McBride

et al. 2024

Western Journal of Emergency Medicine

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Introduction: Recent policy changes in Washington State presented a unique opportunity to pair evidence-based interventions with ﬁrst responder services to combat increasing opioid overdoses. However, little is known about how these interventions should be implemented. In partnership with the Research with Expert Advisors on Drug Use team, a group of academically trained and community-trained researchers with lived and living experience of substance use, we examined facilitators and barriers to adopting leave-behind naloxone, ﬁeld-based buprenorphine initiation, and HIV and hepatitis C virus (HCV) testing for ﬁrst responder programs. Methods: Our team completed semi-structured, qualitative interviews with 32 ﬁrst responders, mobile integrated health staff, and emergency medical services (EMS) leaders in King County, Washington, from February–May 2022. Semi-structured interviews were recorded, transcribed, and coded using an integrated deductive and inductive thematic analysis approach grounded in community-engaged research principles. We collected data until saturation was achieved. Data collection and analysis were informed by the Consolidated Framework for Implementation Research. Two investigators coded independently until 100% consensus was reached. Results: Our thematic analysis revealed several perceived facilitators (ie, tension for change, relative advantage, and compatibility) and barriers (ie, limited adaptability, lack of evidence strength and quality, and prohibitive cost) to the adoption of these evidence-based clinical interventions for ﬁrst responder systems. There was widespread support for the distribution of leave-behind naloxone, although funding was identiﬁed as a barrier. Many believed ﬁeld-based initiation of buprenorphine treatment could provide a more effective response to overdose management, but there were signiﬁcant concerns that this intervention could run counter to the rapid care model. Lastly, participants worried that HIV and HCV testing was inappropriate for ﬁrst responders to conduct but recommended that this service be provided by mobile integrated health staff. Conclusion: These results have informed local EMS strategic planning, which will inform roll out of process improvements in King County, Washington. Future work should evaluate the impact of these interventions on the health of overdose survivors.

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“…Bagley et al ( 2019 ) synthesized what is known about post opioid-overdose interventions in community ( n = 16) and hospital settings ( n = 11). Champagne-Langabeer et al ( 2020 ) further explored 27 “out-of-hospital” post-overdose interventions with a focus on EMS-led interventions. Both reviews found post-overdose interventions addressed a gap in healthcare service and were led by multidisciplinary teams but noted variability in intervention design and limited monitoring of outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Notably, few of the interventions in prior scoping reviews included programs that engaged law enforcement partners in program operation (Bagley et al, 2019 ; Champagne-Langabeer et al, 2020 ). Law enforcement are potential key partners in public health initiatives that aim to reduce harms of the opioid epidemic (Becker, 2021 ; Goulka, Del Pozo, & Beletsky, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

A scoping review of community-based post-opioid overdose intervention programs: implications of program structure and outcomes

2023

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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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Emergency medical services targeting opioid user disorder: An exploration of current out‐of‐hospital post‐overdose interventions

Cited by 19 publications

References 44 publications

Overdose, Behavioral Health Services, and Medications for Opioid Use Disorder After a Nonfatal Overdose

Overdose, Behavioral Health Services, and Medications for Opioid Use Disorder After a Nonfatal Overdose

Harm Reduction in the Field: First Responders’ Perceptions of Opioid Overdose Interventions

A scoping review of community-based post-opioid overdose intervention programs: implications of program structure and outcomes

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