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Fatal opioid overdose is a national epidemic in the United States. Like many states, the prevalence of opioid use disorder is a critical problem confronting New Jersey’s addiction treatment system. While use and distribution of naloxone has expanded, linkage to treatment after reversal has not increased at the same rate.
The New Jersey Single State Authority on Substance Abuse implemented an innovative pilot program, the Opioid Overdose Recovery Program (OORP), in November 2015. New Jersey developed the OORP to address the epidemic and more specifically, the issue of low treatment admissions following a non-fatal overdose. The OORP utilizes an intervention model with peer recovery specialists and clinical patient navigators to engage individuals within emergency departments (ED’s) immediately following a reversal from an opioid overdose. These personnel provide assistance, recovery supports, and referrals for assessment and substance use disorder (SUD) treatment while maintaining follow-up for eight weeks following the reversal. OORP services are initiated within ED’s in counties with the highest need.
The purpose of this study was to examine the process through which the OORP was implemented in its pilot year and explore the processes, facilitators and barriers.
Methods: Qualitative, case study methods were used in this study. Three in-depth, semi-structured focus groups were conducted with 23 participants, and ten in-depth, structured telephone interviews were conducted with key OORP staff and stakeholders. Participants were selected through purposeful, non-random sampling. Interview questions examined challenges, successes, and implementation processes during the pilot year. Data were collected between June and September 2016. Focus group sessions averaged one hour and 30 minutes while interview averaged one hour. Interviews were transcribed verbatim and data were uploaded into Atlas.ti software. Analysis included the common process of several iterations of coding, and organzing coding into overall themes and the patterns and divergent views within those. Multiple trained qualitative researchers conducted analysis triangulation to corroborate findings.
Findings: Data revealed a successful launch of the OORP pilot year in multiple hospitals within funded counties. Collaboration among OORP staff and ED staff was developed in its first year and this relationship was critical within the hectic ED environment. Many strategies were implemented to build partnerships. Findings revealed a positive shift in attitudes within ED’s in the treatment of people with SUD’s. The model with peer recovery specialists as first respondents to OORP clients appeared to have a positive impact on services as their experiences with addiction enabled them to more successfully engage with clients. Study participants reported substantial progress in achieving the overall goal of linking patients to treatment as a follow-up to the overdose reversal.
Conclusions/Implications: Results underscore the effort needed to integrate this important model within ED’s. If this model is expanded, more individuals suffering with opioid disorders may be linked to peer support, which could lead to more SUD treatment and decrease the number of opioid-related deaths. This model may also have a positive impact on de-stigmatizing drug addiction in hospital settings, a critical social work value and needed step to improve the wellbeing of communities.