Public Safety-Led Post-Overdose Outreach Programs
How can public safety-led post-overdose outreach programs work to reduce drug overdose?
People who have experienced a nonfatal drug overdose are at higher risk of fatal overdose than those who have not.1 Public safety-led post-overdose outreach has the ability to identify people who are at higher risk, link them to care, and engage them in evidence-based overdose prevention interventions, such as overdose education, naloxone distribution, syringe service programs (SSPs), and medications for opioid use disorder (MOUDa).
Public safety officials (emergency medical services [EMS], fire services, and law enforcement) are often the first to arrive at the scene of a 911 overdose call; therefore, their data systems provide information about people who experience nonfatal overdoses, allowing for outreach after an overdose event.
Public safety-led post-overdose outreach often includes:
- Identifying program participants via EMS, fire, and/or law enforcement data. Privacy is ensured through data use agreements between partners and by contacting participants before conducting outreach to address privacy concerns.2,3
- A multidisciplinary team consisting of:4
- A health provider (e.g., case manager, peer recovery coach, social worker, counselor) who leads the outreach encounter
- EMS personnel who assist the health provider in offering information and leave behind naloxone
- Law enforcement who also assist the health provider (This may involve outreach visits by police being conducted using an unmarked vehicle and the officer wearing plain clothes.3)
- Outreach occurring within a few days of an overdose event.3
- An outreach encounter at the person’s residence or virtually that consists of:2,4,5
- Assessment of needs and risks
- Use of motivational interviewing5 to encourage and empower the person to set goals
- Messages about harm reduction strategies (e.g., overdose prevention, naloxone distribution and administration, and Good Samaritan Laws)
- Information about local services (e.g., SSPs, MOUD, social services)
- Connection with a peer support specialist for long-term linkage to care and recovery support
- Leaving behind naloxone and information about local services (e.g., SSPs, MOUD, social services)
- Providing transportation to services
- Outreach to family and social networks, particularly when the person who experienced overdose is not available
- Follow-up, conducted either in-person or virtually (e.g., via text or phone call), based on participant consent.
Evaluations of public safety-led post-overdose outreach programs show that implementing these activities reduced overdose risk for participants through their engagement with health providers, including linkage to treatment with MOUD.2,5
Case Study Snapshots
- With the support of federal funding, quick response teams (QRTs) are intended to enhance post-overdose linkages to care and increase participation in treatment for opioid use disorder (OUD) with a goal of reducing overdoses.
- The West Virginia Department of Health and Human Resources (WVDHHR) coordinates and provides administrative support to QRTs implemented by local health departments (LHDs) and other agencies in 33 counties. WVDHHR coordination efforts ensure alignment with their strategic plan,6 facilitate response expansion based on readiness and need, and reduce duplication of efforts.
- LHDs, EMS agencies and behavioral health centers lead QRT implementation, allowing for customization based on resources and needs at the local level. Each QRT includes a peer recovery specialist. Other key partners may include health care workers, law enforcement, emergency responders, faith leaders, and community members.
- After first responders respond to a nonfatal overdose, the QRT initiates contact within 24-72 hours to discuss treatment options. Contact continues through repeated house visits, phone calls, text messages, and other communication routes.
- The Rapid Response Emergency Addiction Crisis Teams (RREACT) program engages individuals who recently experienced a nonfatal overdose to provide access to treatment and offer harm reduction and other social service supports (e.g., housing, transportation, food assistance) with the primary goal of overdose prevention.
- The RREACT program is led by the Columbus Fire Department who also owns the data used to identify program participants.
- Key partners include the agencies representing the multidisciplinary RREACT program: a substance use disorder (SUD) clinician, a paramedic, and a law enforcement officer.
- The team reaches out to individuals who experienced a nonfatal overdose within 72 hours of the event. They typically present at individuals’ homes without prior notice to improve the likelihood of making a successful initial contact.
- During the home visit, the team conducts a physical health check, reviews withdrawal management and SUD treatment options, discusses harm reduction techniques to prevent the risk of OD, and leaves behind naloxone. They also leave behind an information packet for the family or friends.
For more information about West Virginia’s Quick Response Teams Program and Franklin County, Ohio’s Rapid Response Emergency Addiction Crisis Teams Program, check out the full case study here [PDF – 17 pages].
- Krawczyk, N., Eisenberg, M., Schneider, K. E., Richards, T. M., Lyons, B. C., Jackson, K., Ferris, L., Weiner, J. P., & Saloner, B. (2020). Predictors of overdose death among high-risk emergency department patients with substance-related encounters: a data linkage cohort study. Annals of Emergency Medicine, 75(1), 1-12. https://doi.org/10.1016/j.annemergmed.2019.07.014
- Scott, C. K., Dennis, M. L., Grella, C. E., Nicholson, L., Sumpter, J., Kurz, R., & Funk, R. (2020). Findings from the recovery initiation and management after overdose (RIMO) pilot study experiment. Journal of Substance Abuse Treatment, 108, 65-74. https://doi.org/10.1016/j.jsat.2019.08.004
- Formica, S. W., Waye, K. M., Benintendi, A. O., Yan, S., Bagley, S. M., Beletsky, L., Carroll, J. J., Xuan, Z., Rosenbloom, D., Apsler, R., Green, T. C., Hunter, A., & Walley, A. Y. (2020). Characteristics of post-overdose public health-public safety outreach in Massachusetts. Drug and Alcohol Dependence, 219, 1-8. https://doi.org/10.1016/j.drugalcdep.2020.108499
- Formica, S. W., Apsler, R., Wilkins, L., Ruiz, S., Reilly, B., & Walley, A. Y. (2018). Post opioid overdose outreach by public health and public safety agencies: Exploration of emerging programs in Massachusetts. The International Journal of Drug Policy, 54, 43-50. https://doi.org/10.1016/j.drugpo.2018.01.001
- Langabeer, J. R., Persse, D., Yatsco, A., O’Neal, M. M. & Champagne-Langabeer T. A. (2020). A framework for EMS outreach for drug overdose survivors: a case report of the Houston Emergency Opioid Engagement System. Prehospital Emergency Care, 25(3), 441-448. https://doi.org/10.1080/10903127.2020.1755755
- State of West Virginia Department of Health and Human Resources, Office of Drug Control Policy. (2020, January 20). West Virginia 2020–2022 substance use response plan. https://dhhr.wv.gov/office-of-drug-control-policy/news/Documents/FINAL%20-%20West%20Virginia%202020_2022%20Council%20Substance%20Use%20Plan_January%2020%2c%202020%20%28as%20filed%29.pdf]
- MOUDs include, but are not limited to, methadone, naltrexone, and buprenorphine