Objective: Emergency department (ED)-initiated buprenorphine has proven efficacy, but many patients are reluctant to begin this treatment. This study evaluated SafetyNet, a program using a 2-person, recovery coach and paramedic (RCP) intervention postoverdose to reduce subsequent opioid overdose, engage patients in medications for opioid use disorder (MOUD), and reduce illicit drug use.
Methods: We conducted a prospective nonrandomized study in individuals who experienced opioid overdoses, received naloxone, but subsequently declined buprenorphine initiation in the ED. Each participant was followed by an RCP team that performed a brief negotiation interview (BNI) to motivate engagement in treatment, peer-recovery coaching to encourage recovery-related activities, and health education around medical concerns by trained paramedics. Participants were followed-up at 30 and 180 days. The primary hypothesized outcome was reduction in overdose events; the secondary hypothesized outcomes were engagement in MOUD and reduction in opioid positive urine tests.
Results: Eighty-one patients were enrolled and received BNIs; 45 (56%; 95% CI: 44-67) had at least 1 follow-up encounter. Twenty participants (25%; 95% CI: 16-36) had at least 1 overdose during follow-up. Fifty-five participants (68%; 95% CI: 57-78) were confirmed to have engaged in some form of medication treatment. Differences in subsequent overdose events (P = .95), engagement in MOUD (P = .49), and rates of opioid-positive urine toxicology rates within 30 days (P = .44) and between 31 and 180 days (P = .46) were not significantly different when comparing those who did and did not follow-up.
Conclusion: There were no differences in rates of subsequent overdose, MOUD engagement, or positive urine toxicology screens in our intervention. However, 68% of participants engaged in outpatient MOUD, a treatment associated with fewer overdose events, particularly fatal ones. Substantial limitations occurred due to the COVID pandemic, and sample size estimates were not met. Further research is needed to investigate potential benefits of the SafetyNet program.
Keywords: emergency medical services; medications for opioid use disorder; paramedics; prehospital.