Proactive Response to Overdose and Appropriate Connections to Treatment (PROACT) Implementation in Two Counties

Background and Purpose: Traditional first response and emergency department protocols struggle to connect opioid overdose survivors with post-overdose services (D’Onofrio et al., 2015), while this population is 24 times more likely to die than the general public (Olfson et al., 2018). Beginning January 2020, researchers facilitated the implementation of a Proactive Response to Overdose and Appropriate Connections to Treatment (PROACT) program in two midwestern counties. Through PROACT, first responders notify treatment providers, whose recovery coaches follow up with survivors at their respective stages of change. Our research questions are: What are the barriers to implementing a post-overdose response model to connect patients who overdose with recovery coaches? What are the preliminary outcomes of the model?

Methods: Researchers adapted PROACT programs to the local county’s population density, resource availability, and emergency medical services (EMS) support. Treatment agencies reviewed patient information sent by first responders, and recovery coaches attempted weekly reach-outs at incident addresses, resident addresses, or by phone. If direct contact was made, patient engagement was measured as either “low” (i.e., received information and/or naloxone), “medium” (i.e., interest in syringe services), or “high” (i.e., interest in substance use disorder services). Fifteen months of program data and EMS naloxone administration data from a statewide EMS database were assessed, representing N=1,280 naloxone administrations; bivariate analyses were used to assess variation in outcomes by demographics.

Findings: An initial implementation barrier was EMS hesitancy to share identifiable patient information with treatment providers, particularly without collecting consent on the overdose scene. In the first six months, only the sheriff’s office referred patients to the PROACT team, accounting for only 11% (n=13) of the county’s naloxone patients. Once EMS legal counsel declared referrals allowable under continuity of care, 81% (n=157) were referred. In the other county, the sole referring EMS agency referred 47% (n=162) of naloxone patients in its catchment area (20% of the county total). Across both counties, 53%, (n=157) of referrals had usable contact information, of which 42% (n=66) were directly contacted. Given direct contact, 83% (n=55) engaged with treatment providers to a “low” (n=30) or “high” (n=25) level. Across both counties, non-white patients were more likely to refuse all services (35%, n=6) than were white patients (4%, n=5), χ²(1, N=150)=22.058, p<.001. In one county, while women and men were referred and successfully contacted at similar rates, contacted women were more likely to show interest in “high” level services (58%, n=7) than were contacted men (23%, n=6), χ²(1, N=38)=4.535, p<.05.

Conclusions and Implications: EMS overdose data identifies a high-risk population primed for post-overdose response interventions. The legal sharing of EMS patient information without consent forges a viable pathway to care; overdose patient referral policies should be adopted by EMS agencies and encouraged through state law to ease confidentiality concerns. Administrative referral of EMS overdose data was logistically quick and simple. The recovery coach follow-up was inexpensive, and direct contact resulted in relatively high levels of engagement. Further study is needed to assess longer-term outcomes and address racial and gender disparities.