Outreach to people who survive opioid overdose: Linkage and retention in treatment

Abstract

Cognitive motivation theories contend that individuals have greater readiness for behavioral change during critical periods or life events, and a non-fatal overdose could represent such an event. The objective of this study was to examine if the use of a specialized mobile response team (assertive outreach) could help identify, engage, and retain people who have survived an overdose into a comprehensive treatment program. We developed an intervention, consisting of mobile outreach followed by medication and behavioral treatment, in Houston Texas between April and December 2018. Our primary outcome variables were the level of willingness to engage in treatment, and percent who retained in treatment after 30 and 90 day endpoints. We screened 103 individuals for eligibility, and 34 (33%) elected to engage in the treatment program, while two-thirds chose not to engage in treatment, primarily due to low readiness levels. The average age was 38.2 ± 12 years, 56% were male, 79% had no health insurance, and the majority (77%) reported being homeless or in temporary housing. There were 30 (88%) participants still active in the treatment program after 30 days, and 19 (56%) after 90 days. Given the high rates of relapse using conventional models, which wait for patients to present to treatment, our preliminary results suggest that assertive outreach could be a promising strategy to motivate people to enter and remain in long-term treatment.

Real-world changes in US health system hospital-based services following treatment with a prescription digital therapeutic for opioid use disorder

“…However, it was observed that patients were experienced with buprenorphine treatment and had high levels of adherence prior to initiating reSET-O, which increases confidence in the value of providing neurobehavioral treatment in addition to buprenorphine treatment. Furthermore, this approach of having each patient act as his or her own control avoids the potential bias involved with comparing to potentially dissimilar populations which may be at a different readiness for change state [38].…”

The opioid crisis: a contextual, social-ecological framework

“…A wide range of other psychological and temperamental factors can also play a role in the opioid epidemic; these include factors such as impulsivity [ 36 ], self-stigma [ 37 ] and self-determination [ 38 ]. Readiness for change is also another factor that is associated with entry into treatment [ 39 ] and the change process during the treatment [ 40 ], although limited data suggest this may not be related to OUD treatment outcome [ 41 ]. Overall, there is an essential need for more research on the role of these and other similar psychosocial factors.…”

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

“…A paramedic and a peer recovery coach are part of an assertive outreach team who locate and engage opioid overdose survivors into treatment. The program is also staffed with a DATA‐waivered nurse practitioner who provides buprenorphine, a licensed chemical dependency counselor who provides substance abuse counseling, and peer recovery coaches who provide support groups and regular check‐ins on participants of the program, and preliminary results suggest that 88% of people are retained in treatment at 30 days 45,46 . Programs such as EPICC (Engaging Patients in Care Coordination) in St. Louis, the RIMO (Recovery Initiation and Management After Overdose) intervention in Chicago, Project POINT (Planned Outreach, Intervention, Naloxone, and Treatment) in Indiana, and AnchorED (Anchor Recovery Center and Emergency Department) in Rhode Island also leverage the lived experience of peer recovery coaches within their programs, because coaches relate to the common challenges and barriers to sustaining treatment 47–50 …”