Life after opioid-involved overdose: survivor narratives and their implications for ER/ED interventions

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.

Keywords: Emergency departments; emergency medical services; naloxone; opioids; overdose; stakeholder analysis.