Life after opioid‐involved overdose: survivor narratives and their implications for ER/ED interventions

Abstract

Background and AimsNumerous states in the United States are working to stem opioid‐involved overdose (OD) by engaging OD survivors before discharge from emergency departments (EDs). This analysis examines interactions between survivors and medical care providers that may influence opioid risk behaviors post‐OD.DesignQualitative stakeholder analysis involving in‐depth interviews with samples from three groups.SettingTwo hospitals in high OD‐mortality neighborhoods in New York City (NYC), USA.ParticipantsTotal N = 35: emergency medical services personnel (EMS; n = 9) and ED medical staff (EDS; n = 6) both working in high OD‐mortality neighborhoods in NYC; recent opioid‐involved OD survivors who had been administered naloxone and transported to a hospital ED (n = 20).MeasurementsEMS and EDS interviews examined content of verbal interactions with survivors and attitudes related to people who use opioids. Survivor interviews addressed healthcare experiences, OD‐related behavioral impacts and barriers to risk‐reduction post‐OD.FindingsBoth EMS and EDS stakeholders described frequent efforts to influence survivors’ subsequent behavior, but some acknowledged a loss of empathy, and most described burnout related to perceived ingratitude or failure to influence patients. Survivors reported being motivated to reduce opioid risk following a non‐fatal OD and many described successful risk‐reduction efforts post‐OD. Intentions to cease opioid use or reduce risk were complicated by unmanaged, naloxone‐related withdrawal, lack of social support and perceived disrespect from EMS and/or EDS.ConclusionsEmergency department interventions with opioid‐involved overdose (OD) survivors may benefit from training emergency medical staff to assure a continuity of non‐judgmental, socially supportive remediation attempts throughout contacts with different care‐givers. Brief interventions to educate emergency medical staff about current theories of addiction and evidence‐based treatment may achieve this goal while reducing care‐giver burnout and improving the uptake and efficacy of post‐OD interventions delivered in emergency departments.

“They’re not doing enough.”: women’s experiences with opioids and naloxone in Toronto

“…The findings also revealed what women felt was an unmet need for appropriate naloxone-induced withdrawal aftercare and reduction in wait times for opioid treatment services. Only a few recent studies with majority-male samples have examined naloxone-induced opioid withdrawal, but the findings are also consistent with those of our study [ 73 – 76 ]. Participants in these studies often felt unable to provide appropriate care for someone experiencing acute opioid withdrawal symptoms.…”

“…However, regional variabilities in naloxone uptake by pharmacies and local populations [ 69 , 70 ], along with American research indicating naloxone awareness, use, or carrying of a kit is not always commensurate with increased availability [ 71 ], point to a need to understand whether or how women in Ontario are learning about, accessing, and using naloxone. This is especially necessary in light of the 2017 Toronto Overdose Action Plan stressing the city’s need for expanded naloxone access [ 72 ], as well as international research, mostly involving men, pointing to issues or difficulties people may have surrounding its usage, such as strained peer relationships, precipitated opioid withdrawal, and a lack of overdose aftercare [ 73 – 76 ]. Naloxone is a safe drug, but any unacknowledged gaps in naloxone access, knowledge, and use in Canada may affect overdose outcomes.…”

Take-Home Naloxone for the Emergency Interim Management of Opioid Overdose: The Public Health Application of an Emergency Medicine

“…Experiencing withdrawal is feared among people who use opioids. Qualitative interviews in Scottish and US cohorts of PWUO identified negative views on naloxone administration in the emergency room and the harm caused, such as acute withdrawal, aggression, self-discharge and further drug seeking activity [134, 135]. These attitudes were missed by ordinary observational studies.…”

A qualitative study of emergency department patients who survived an opioid overdose: Perspectives on treatment and unmet needs

“…Closing this knowledge gap is critical, because ED clinicians often report patients seeking care after an overdose as uniquely challenging to engage in treatment discussions and often interpret patient behaviors as disinterest in ED-based intervention. 24,37 Qualitative studies are best suited to generate in-depth understanding of the complex factors that may impact patients' choice to accept referral for treatment or other services or to initiate MOUD treatment in the ED. 25 As the first step to inform development of an ED-based intervention, the current study sought to explore how ED patients' personal goals and perceived resource needs may shape patient priorities and decisions to engage with treatment and other patient support services.…”