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Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose.
Treitler, Peter; Crystal, Stephen; Cantor, Joel; Chakravarty, Sujoy; Kline, Anna; Morton, Cory; Powell, Kristen Gilmore; Borys, Suzanne; Cooperman, Nina A.
Affiliation
  • Treitler P; Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey.
  • Crystal S; Boston University School of Social Work, Boston, Massachusetts.
  • Cantor J; Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey.
  • Chakravarty S; School of Social Work, Rutgers University, New Brunswick, New Jersey.
  • Kline A; School of Public Health, Rutgers University, Piscataway, New Jersey.
  • Morton C; Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey.
  • Powell KG; Department of Health Sciences, Rutgers University, Camden, New Jersey.
  • Borys S; Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey.
  • Cooperman NA; School of Social Work, Rutgers University, New Brunswick, New Jersey.
JAMA Netw Open ; 7(3): e243614, 2024 Mar 04.
Article in En | MEDLINE | ID: mdl-38526490
ABSTRACT
Importance Patients treated in emergency departments (EDs) for opioid overdose often need drug treatment yet are rarely linked to services after discharge. Emergency department-based peer support is a promising approach for promoting treatment linkage, but evidence of its effectiveness is lacking.

Objective:

To examine the association of the Opioid Overdose Recovery Program (OORP), an ED peer recovery support service, with postdischarge addiction treatment initiation, repeat overdose, and acute care utilization. Design, Setting, and

Participants:

This intention-to-treat retrospective cohort study used 2014 to 2020 New Jersey Medicaid data for Medicaid enrollees aged 18 to 64 years who were treated for nonfatal opioid overdose from January 2015 to June 2020 at 70 New Jersey acute care hospitals. Data were analyzed from August 2022 to November 2023. Exposure Hospital OORP implementation. Main Outcomes and

Measures:

The primary outcome was medication for opioid use disorder (MOUD) initiation within 60 days of discharge. Secondary outcomes included psychosocial treatment initiation, medically treated drug overdoses, and all-cause acute care visits after discharge. An event study design was used to compare 180-day outcomes between patients treated in OORP hospitals and those treated in non-OORP hospitals. Analyses adjusted for patient demographics, comorbidities, and prior service use and for community-level sociodemographics and drug treatment access.

Results:

A total of 12 046 individuals were included in the study (62.0% male). Preimplementation outcome trends were similar for patients treated in OORP and non-OORP hospitals. Implementation of the OORP was associated with an increase of 0.034 (95% CI, 0.004-0.064) in the probability of 60-day MOUD initiation in the half-year after implementation, representing a 45% increase above the preimplementation mean probability of 0.075 (95% CI, 0.066-0.084). Program implementation was associated with fewer repeat medically treated overdoses 4 half-years (-0.086; 95% CI, -0.154 to -0.018) and 5 half-years (-0.106; 95% CI, -0.184 to -0.028) after implementation. Results differed slightly depending on the reference period used, and hospital-specific models showed substantial heterogeneity in program outcomes across facilities. Conclusions and Relevance In this cohort study of patients treated for opioid overdose, OORP implementation was associated with an increase in MOUD initiation and a decrease in repeat medically treated overdoses. The large variation in outcomes across hospitals suggests that treatment effects were heterogeneous and may depend on factors such as implementation success, program embeddedness, and availability of other hospital- and community-based OUD services.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Drug Overdose / Opiate Overdose / Opioid-Related Disorders Limits: Female / Humans / Male Country/Region as subject: America do norte Language: En Journal: JAMA Netw Open Year: 2024 Document type: Article Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Drug Overdose / Opiate Overdose / Opioid-Related Disorders Limits: Female / Humans / Male Country/Region as subject: America do norte Language: En Journal: JAMA Netw Open Year: 2024 Document type: Article Country of publication: United States