Relay: A Peer-Delivered Emergency Department–Based Response to Nonfatal Opioid Overdose

Welch, Alice; Jeffers, Angela; Allen, Bennett; Paone, Denise; Kunins, Hillary V.

doi:10.2105/ajph.2019.305202

Cited by 41 publications

(34 citation statements)

References 5 publications

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“…A study of 1329 emergency department peer coaching contacts in Rhode Island demonstrated high rates of patients receiving naloxone training by peer recovery coaches (88.7%) and agreeing to continue contact with a peer recovery coach (86.8%) [ 110 •]. Welch et al demonstrated a 74% enrollment rate ( N =876) in a program linking peer recovery support to overdose survivors for 90 days [ 111 ]. A retrospective study analyzing 555 patients admitted to an ED for overdose or who the ED provider documented as having opioid misuse/opioid use disorder reported high rates of peer recovery coach consultation (85.5%) and distribution of take-home naloxone (95.2%) [ 112 ].…”

Section: Opportunities For Interventionmentioning

confidence: 99%

New and Emerging Opioid Overdose Risk Factors

2021

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Purpose of Review The purpose of this review is to provide a review of the current literature surrounding opioid overdose risk factors, focusing on relatively new factors in the opioid crisis. Recent Findings Both a market supply driving force and a subpopulation of people who use opioids actively seeking out fentanyl are contributing to its recent proliferation in the opioid market. Harm reduction techniques such as fentanyl testing strips, naloxone education and distribution, drug sampling behaviors, and supervised injection facilities are all seeing expanded use with increasing amounts of research being published regarding their effectiveness. Availability and use of interventions such as medication for opioid use disorder and peer recovery coaching programs are also on the rise to prevent opioid overdose. Summary The opioid epidemic is an evolving crisis, necessitating continuing research to identify novel overdose risk factors and the development of new interventions targeting at-risk populations.

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Section: Opportunities For Interventionmentioning

confidence: 99%

New and Emerging Opioid Overdose Risk Factors

2021

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“…Pilot study participants expressed feeling positively about peer workers, both for the substance use intervention received at baseline and when asked about a hypothetical housing peer navigator intervention. There is increasing interest in use of professional peer‐based interventions in EDs 37–39 and other health care settings, 40,41 though effectiveness research is still limited. Peer‐delivered interventions may hold particular promise for highly stigmatized conditions such as substance use and homelessness and should be studied in future research.…”

Section: Discussionmentioning

confidence: 99%

ED‐Home: Pilot feasibility study of a targeted homelessness prevention intervention for emergency department patients with drug or unhealthy alcohol use

Fazio

Zuiderveen²,

Guyet³

et al. 2022

Academic Emergency Medicine

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Background: Housing insecurity is prevalent among emergency department (ED) patients. Despite a surge of interest in screening for patients' social needs including housing insecurity, little research has examined ED social needs interventions. We worked together with government and community partners to develop and pilot test a homelessness prevention intervention targeted to ED patients with drug or unhealthy alcohol use. Methods: We approached randomly sampled patients at an urban public hospital ED, May to August 2019. Adult patients were eligible if they were medically stable, not incarcerated, spoke English, had unhealthy alcohol or any drug use, and were not currently homeless but screened positive for risk of future homelessness using a previously developed risk screening tool. Participants received a three-part intervention: (1) brief counseling and referral to treatment for substance use delivered through a preexisting ED program; (2) referral to Homebase, an evidence-based community homelessness prevention program; and (3) up to three troubleshooting phone calls by study staff. Participants completed surveys at baseline and 6 months. Results: Of 2183 patients screened, 51 were eligible and 40 (78.4%) participated; one later withdrew, leaving 39 participants. Participants were diverse in age, gender, race, and ethnicity. Of the 32 participants reached at 6 months, most said it was very or extremely helpful to talk to someone about their housing situation (n = 23, 71.9%) at the baseline ED visit. Thirteen (40.6%) said their housing situation had improved in the past 6 months and 16 (50.0%) said it had not changed. Twenty participants (62.5%) had made contact with a Homebase office. Participants shared ideas of how to improve the intervention.

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“…For example, if a patient is prescribed an opioid, the electronic health system could trigger a reflex order for naloxone to the patient’s preferred pharmacy. As another example, the Mount Sinai emergency department started a collaboration in early 2020 that connects participants who have had a near fatal overdose to peer “wellness advocates” who are deployed to the ED to offer overdose education, ( Welch et al, 2019 ), naloxone, linkage to care (including to the REACH Program) and supportive follow-up up for 90 days.…”

Section: Discussionmentioning

confidence: 99%

Community Case Study of Naloxone Distribution by Hospital-Based Harm Reduction Program for People Who Use Drugs in New York City

et al. 2021

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Background: In 2017, The Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program at Mount Sinai Hospital became a registered Opioid Overdose Prevention Program (OOPP) and received funding from the New York City Department of Health and Mental Hygiene to develop a program to provide overdose education and naloxone distribution (OEND) training to at risk population and bystanders. We report on the programmatic quality improvement initiatives conducted.Methods: From April 2017 to December 2020, the REACH OOPP conducted 290 opioid overdose reversal trainings, throughout the Mount Sinai Health System and in multiple other community settings. OEND training was at times offered alone and in other settings alongside Hepatitis C Virus point of care testing. Additionally, a “train the trainer” model was implemented whereby medical students and nurses at outpatient clinics were trained to train others.Results: There were 4235 naloxone kits distributed to 3,906 participants. The training venues included hospital settings (patients and medical staff), public events, substance use programs, educational facilities, homeless prevention programs, faith-based organizations, alternative to incarceration programs, and community-based organizations. We implemented two types of training. During outreach sessions, we utilized one-on-one personalized sessions to train bystanders. When training clinic staff in the “train the trainer” model we utilized a standardized didactic presentation with slides. The two top reasons participants reported for being trained were “Just in case I see someone overdose” (59.3%) and “I'm worried that someone I know will overdose OR that I will overdose” (20.2%).Conclusion: The REACH program at Mount Sinai Hospital developed an effective model to train community bystanders and health care staff by leveraging administrative support and building on broader programmatic initiatives to promote drug user health and stigma-free care for people who use drugs. Hospitals do not currently mandate staff training or keeping naloxone stocked at inpatient units or outpatients clinics posing a challenge when implementing an OEND program in this setting. A recommended policy change needed to decrease overdose deaths is for hospitals to be required to implement systematic naloxone education and access for all health care personal and at risk patients.

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Relay: A Peer-Delivered Emergency Department–Based Response to Nonfatal Opioid Overdose

Cited by 41 publications

References 5 publications

New and Emerging Opioid Overdose Risk Factors

New and Emerging Opioid Overdose Risk Factors

ED‐Home: Pilot feasibility study of a targeted homelessness prevention intervention for emergency department patients with drug or unhealthy alcohol use

Community Case Study of Naloxone Distribution by Hospital-Based Harm Reduction Program for People Who Use Drugs in New York City

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