Experiences of patients at high risk of opioid overdose accessing emergency department and behavioral health interventions: a qualitative analysis in an urban emergency department

• Published in: BMC health services research 2023-04, Vol.23 (1), p.370-370, Article 370
• Main Authors: Collins, Alexandra B, Baird, Janette, Nimaja, Evelyn, Ashenafi, Yokabed, Clark, Melissa A, Beaudoin, Francesca L
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - therapeutic use; Analysis; Clinical social workers; Clinical trials; Coronaviruses; COVID-19; Data collection; Discrimination; Drug overdose; Drug Overdose - prevention & control; Drug use; Drugs; Emergency department; Emergency medical care; Emergency medicine; Emergency Service, Hospital; Emergency services; Harm reduction; Health behavior; Health services; Humans; Intervention; Interviews; Methods; Narcotics; Opiate Overdose - drug therapy; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - therapy; Opioids; Overdose; Pandemics; Patients; Peer worker; Qualitative Research; Registration; Risk; Services; Social work; Social worker; Social workers; Specialists; Substance abuse
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-023-09387-7

Emergency Departments (EDs) have become critical 'touchpoints' for the identification and early engagement of patients at risk of overdose or who have an opioid use disorder (OUD). Our objectives were to examine patients' ED experiences, identify barriers and facilitators of service uptake in ED settings, and explore patients' experiences with ED staff. This qualitative study was part of a randomized controlled trial that evaluated the effectiveness of clinical social workers and certified peer recovery specialists in increasing treatment uptake and reducing opioid overdose rates for people with OUD. Between September 2019 and March 2020, semi-structured interviews were conducted 19 participants from the trial. Interviews sought to assess participants' ED care experiences across intervention type (i.e., clinical social worker or peer recovery specialist). Participants were purposively sampled across intervention arm (social work, n = 11; peer recovery specialist, n = 7; control, n = 1). Data were analyzed thematically with a focus on participant experiences in the ED and social and structural factors shaping care experiences and service utilization. Participants reported varied ED experiences, including instances of discrimination and stigma due to their substance use. However, participants underscored the need for increased engagement of people with lived experience in ED settings, including the use of peer recovery specialists. Participants highlighted that ED provider interactions were critical drivers of shaping care and service utilization and needed to be improved across EDs to improve post-overdose care. While the ED provides an opportunity to reach patients at risk of overdose, our results demonstrate how ED-based interactions and service provision can impact ED care engagement and service utilization. Modifications to care delivery may improve experiences for patients with OUD or at high risk for overdose. Clinical trial registration: NCT03684681.