Every day in the U.S, nearly 200 people die from opioid-related overdoses. Even more widespread than fatal overdoses are non-fatal overdoses. People who survive one overdose are twice as likely to die from a future one.
To address this risk factor, Prevention Solutions@EDC (PS@EDC) is providing training and consultation to nine post-overdose support teams (POST) funded by the Massachusetts Department of Public Health to prevent opioid overdose. These teams of community-based professionals—consisting of a public safety representative (police/fire) and harm reduction specialist—visit overdose survivors and their families in the days or weeks following the overdose event.
“These visits offer an important bridge between the crisis and a safer future,” says PS@EDC Coordinator Rachel Pascale. “Teams provide access to [the overdose reversal medication] Naloxone, referrals to mental health counseling, and information about treatment and recovery services.”
While each community implements a POST model that fits the needs of its population, all nine programs share common elements—as well as common challenges. PS@EDC has been working with the project since September to help teams find practical solutions to these challenges.
Integrating Harm Reduction Practices
Harm reduction is a term used to describe a set of practical strategies, policies, and programs to reduce the negative consequences associated with the misuse of drugs. Rather than promoting abstinence, harm reduction focuses on the harms caused by drug use and identifies steps to reduce them. Among the first responders on the support teams, understanding and embracing harm reduction in the context of opioid use and overdose required a shift in perspective.
“Using illicit substances like heroin and fentanyl is illegal in Massachusetts. And law enforcement is, by definition, responsible for upholding the law. So it was important for the teams to spend time reconciling harm reduction practices with the existing first responder framework,” says Pascale.
Part of this reconciliation was accepting that some survivors would not be interested in, or ready to, enter treatment.
“The priority is keeping people safe,” says Pascale. “For some survivors, this may mean talking about treatment. For others, it may be more appropriate to focus on other ways to reduce risk—for example, by avoiding mixing opioids with other substances and/or understanding the changes in tolerance to opioids, may be a more immediate objective.”
Accessing Quality Post-Overdose Data
To do their work, support teams need to know who in their communities have overdosed and where they live. Obtaining this information can be difficult. Incident reports often lack apartment numbers or include wrong phone numbers. Also, there are few systems in place for sharing reports across precincts, making it difficult to identify individuals who overdosed outside the towns or counties where they live.
“We needed to find ways for teams to access sensitive information without unnecessarily exposing the victim’s privacy,” says Pascale. This meant building relationships with the systems that collect these data, such as hospitals and emergency medical services, and with neighboring police and fire departments. PS@EDC also worked with the support teams to find creative ways to “clean” their data—that is, more efficiently cull through existing data sources to find the information they need.
Enhancing the Quality of Outreach Conversations
Post-overdose visits offer a unique opportunity for building connections—with the individual who has survived the overdose and with their family members. They provide a space for sharing resources and giving support. But they also are a starting point for building the kinds of relationships that make it more likely that survivors, and their families, will contact professionals in the future.
Establishing the trust needed as the foundation for these relationships can be challenging. Survivors may be reluctant to engage with law enforcement for fear of being arrested. Family members may be angry or ashamed or grief-stricken. Committed to making the visit about more than “just sharing resources”, teams were eager to develop the skills needed to forge a deeper connection.
To build these skills, PS@EDC has been exploring with team members the range of family dynamics that influence substance misuse. Teams have been practicing motivational interviewing techniques, a short-term process that focuses on listening with empathy and empowering individuals to move toward change. And they’ve been learning strategies for supporting people who are grieving, as it is not uncommon to visit households where the identified survivor has since died from a subsequent overdose.
“Teams are beginning to acknowledge their own trauma in doing this work, and are working to get the supports they need,” says Pascale.
Building Connections across Communities
Though PS@EDC just came on board in September, several of the support teams have been doing this work for three or more years, garnering significant experience during that time. To facilitate cross-team learning, PS@EDC has been convening regular peer-sharing calls where teams can collectively problem-solve and share lessons learned. They are also producing a monthly newsletter (The POST Post) and will be developing a set of resources to support the implementation of POST programs in new communities.
According to Pascale: “No one wants to reinvent wheel, so we’re continually looking for ways for teams to connect, mentor one another, and make the most of limited resources.”
To learn more about this project, contact Rachel Pascale at rpascale@edc.org.