Luther Elliott1,2, Alex S Bennett1,2, Brett Wolfson-Stofko1,2. 1. National Development and Research Institutes, Center on Community and Health Disparities Research, New York, NY, USA. 2. New York University College of Global Public Health, Center for Drug Use and HIV/HCV Research, New York, NY, USA.
Abstract
BACKGROUND AND AIMS: Numerous 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. DESIGN: Qualitative stakeholder analysis involving in-depth interviews with samples from three groups. SETTING: Two hospitals in high OD-mortality neighborhoods in New York City (NYC), USA. PARTICIPANTS: Total 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). MEASUREMENTS: EMS 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. FINDINGS: Both 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. CONCLUSIONS: Emergency 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.
BACKGROUND AND AIMS: Numerous 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. DESIGN: Qualitative stakeholder analysis involving in-depth interviews with samples from three groups. SETTING: Two hospitals in high OD-mortality neighborhoods in New York City (NYC), USA. PARTICIPANTS: Total 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). MEASUREMENTS: EMS 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. FINDINGS: Both 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. CONCLUSIONS: Emergency 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.
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