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

Abstract

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.

“Wanna cry this out real quick?”: an examination of secondary traumatic stress risk and resilience among post-overdose outreach staff in Massachusetts

“…Post-overdose outreach programs, which engage overdose survivors and/or their social networks in the days after an overdose event, are an emerging response to opioid overdose [ 1 – 5 ]. Many such programs in the Commonwealth of Massachusetts are collaborations between public safety (i.e., police officers or fire fighters) and public health professionals (i.e., behavioral health personnel, recovery coaches, peer workers, or harm reduction outreach workers) [ 4 ].…”

“…In 2019, post-overdose outreach programs that conduct home-based outreach were operating in 44% (156/351) of municipalities in Massachusetts [ 4 ]. These programs provide a range of services including referral to and navigation of addiction treatment systems, recovery support, overdose prevention education and naloxone distribution, and support for families and social networks of overdose survivors [ 5 ]. Implementation of these programs has been associated with lower rates of fatal opioid overdose at the municipal level [ 6 ], but the operational pathways through which they operate is not well understood [ 7 ] – including critical questions concerning whether incorporating law enforcement officers into outreach activities increases overdose survivors’ risk of arrest and other adverse outcomes [ 8 – 12 ].…”

Implementation and evaluation of interprofessional overdose review team recommendations following intentional or accidental overdose events

“…1 Most existing literature focuses on interventions to lower the rate of future accidental opioid overdose related events. 2 , 3 Whereas intentional overdose deaths are significantly less common, data suggests there may be specific health care–related opportunities to minimize this risk. 4 …”

“…Whereas overdose fatality review teams take a public health approach to identify areas for improvement in community-specific policy, processes, and programs, postoverdose intervention programs aim to provide patient-specific interventions. 2 , 3 , 5–7 There is an increasing number of hospital- and community-based postoverdose intervention programs, but there is little evidence regarding related outcomes and large variability in program design. 2 , 3 These teams are essential considering that patients who have survived an overdose are at significantly higher risk for future fatal and nonfatal overdose.…”

“… 2 , 3 , 5–7 There is an increasing number of hospital- and community-based postoverdose intervention programs, but there is little evidence regarding related outcomes and large variability in program design. 2 , 3 These teams are essential considering that patients who have survived an overdose are at significantly higher risk for future fatal and nonfatal overdose. 2 …”