Theme: Models of Care Year: 2022
Background:
Surviving an overdose is a strong risk factor for subsequent fatal overdose. In the midst of surging
overdoses from a fentanyl-contaminated drug supply, many United States communities have
deployed post-overdose outreach programs. Programs, staffed as public safety-public health
partnerships, offer survivors overdose prevention and treatment.
Description of model of care/intervention:
We used mixed methods to: (1) describe characteristics of emerging programs via a program survey
across the state of Massachusetts; (2) qualitatively explore best practices, unintended
consequences, and implementation barriers and facilitators via 52 interviews with staff, survivors,
and social network members; (3) examine impact on overdose deaths via an interrupted time-series
analysis; and (4) generate best practice guidance via a modified Delphi expert panel.
Effectiveness:
Forty-four percent (156/351) of Massachusetts municipalities reported programs in 2019. Most
(86%, 118/138) included police during outreach and deployed coercive tools, including pre-visit
arrest warrant queries (57 %, 79/138). Many programs (81 %, 112/138) assisted families with
involuntary commitment to treatment – although typically as an option of last resort. Many (66 %,
90/136) provided naloxone at the outreach visit. In interrupted time series analyses, we detected a
6% annual decrease in the opioid fatality rate time trend, (adjusted beta = -0.015, 1.5% reduction
per quarter, p <0.01), compared to before program implementation. Among active programs,
referring survivors to housing, education, food, and transportation services was associated with
improved overdose fatality. The Delphi guidance calls for staffing, training, services, visit procedures,
and privacy protections, that focus on the public health goals of overdose prevention and
engagement, and minimize coercion.
Conclusion and next steps:
Implementation of post-overdose outreach programs was associated with a relative decrease in
municipal opioid overdose rates. There was substantial variability in program structure and
operations. Law enforcement facilitated the emergence of these programs, yet coercive practices
likely limit engagement of high-risk populations. Ongoing research is needed to develop evidence for
post-overdose outreach.
Disclosure of Interest Statement:
No pharmaceutical grants were received in the development of this study. This work was supported
by a grant from the USA Centers for Disease Control and Prevention R01 CE003052-01 (Walley,
Principal Investigator).