Post Opioid Overdose Outreach and Follow-up Services By Public Health and Public Safety Partnerships: An Examination of Home Visit and Referral Programs in Massachusetts

Introduction: Opioid-related overdose deaths have increased three-fold in the U.S. over the past 15 years. Federal and state governments have addressed the opioid overdose epidemic through a patchwork of prevention, education, enforcement, harm reduction, and treatment approaches. In many instances, these efforts have resulted in informal and formal partnerships and collaborations among public health and public safety. Partnerships among organizations with diverse social service missions has been well documented in response to a wide variety of complex social issues such as substance use prevention and suicide prevention. The response of prevention partnerships to increases in opioid overdoses has been less well documented.

In 2015, the Massachusetts Department of Public Health identified several community organizations and first responder agencies that were delivering post-overdose follow-up services as part of collaborative efforts among public health and public safety providers in the community. The archetypal approach involved first responders and a public health representative returning to the site of a non-fatal opioid overdose to provide follow-up services to overdose victims and their personal and social networks. As reports of these novel post-overdose collaborations increased, MDPH recognized the importance of assessing the extent of the programs and gathering information about their operations.

Methods: The study consisted of two phases. First, we distributed a brief online screening survey to police and fire chiefs across all 351 towns and cities in Massachusetts during December 2015. We identified 60 municipalities with some type of outreach and/or referral program being delivered as part of informal or formal collaborative efforts among public health and public safety agencies. In phase two, we conducted interviews with representatives from 20 municipalities with the most well-established programs to obtain information on the development, structure, type, and operation of the programs.

Results/Implications: Police and/or fire personnel in 110 municipalities (31%) responded. Responding municipalities represented 13 of the 14 counties in MA. Out of the 110 responding municipalities, 64 identified the presence of a post overdose outreach and follow-up program – 60 of which were delivered through public health and public safety partnerships. Four program types were identified: (1) Public Health-Public Safety Home Visit, (2) Public Safety Home Visit with Referrals, (3) Embedded Clinician Follow-Up, and (4) Public Safety Drop-In.

These programs include several attractive features. First, they proactively intervene at the most common locus for overdose – the home. Second, they capitalize on first responders’ knowledge of when and where overdoses occur, thereby providing public health providers access to overdose victims, their associates, and families shortly after the non-fatal overdose event. Third, they facilitate intervening with those at high risk of experiencing a future overdose. Fourth, they enable first responders to maintain involvement beyond administering naloxone. Findings and implications from the study on these innovative approaches will be shared.