AEM Early Access 49: A Qualitative Study of Emergency Department Patients Who Survived an Opioid Overdose: Perspectives on Treatment and Unmet Needs

Welcome to the forty ninth episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to a recent AEM Article or Article in Press, with an author interview podcast.

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DISCUSSING (OPEN ACCESS THROUGH January 31, 2021; CLICK ON TITLE TO ACCESS)

A qualitative study of emergency department patients who survived an opioid overdose: Perspectives on treatment and unmet needs. Kathryn Hawk, Lauretta E Grau, David A Fiellin, Marek Chawarski, Patrick G O’Connor, Nikolas Cirillo, Chris Breen, Gail D’Onofrio

LISTEN NOW: INTERVIEW with first author Dr kathryn hawk

Kathryn Hawk, MD, MHS

Assistant Professor of Emergency Medicine

Yale University Department of Emergency Medicine

@kathryn_hawk

Abstract

Objective: Emergency medicine clinicians are uniquely positioned to deliver interventions to enhance linkage to evidence-based treatment for opioid use disorder (OUD) in the acute overdose period, yet little is known about patient perspectives to effectively engage patients immediately following opioid overdose. Our objective was to explore patients' perspectives on substance use treatment, perceived needs, and contextual factors that shape the choice of patients seen in the emergency department (ED) to engage with treatment and other patient support services in the acute post-opioid overdose period.

Methods: We administered a brief quantitative survey and conducted semistructured interviews with 24 adult ED patients receiving care after an acute opioid overdose between June 2016 and August 2017 in an urban, academic ED. We used constant comparison method and thematic analysis to identify themes across four levels of a modified social ecologic model (individual, interpersonal, organizational, and structural).

Results: The mean (±SD) age of the sample was 33.5 (±9.33) years; 83% were White and 12% were Black; 67% were male; and 83% were diagnosed with OUD, with a mean (±SD) of 3.25 (±2.64) self-reported lifetime opioid overdoses. Eight themes were identified as influencing participants' consideration of OUD treatment and other services: (1) perceptions about control of drug use, (2) personal experience with substance use treatment, (3) role of interpersonal relationships, (4) provider communication skills, (5) stigma, (6) availability of ED resources, (7) impact of treatment policies, and (8) support for unmet basic needs.

Conclusions: Patients receiving ED care following overdose in our ED are willing to discuss their opioid use and its treatment in the ED and report a variety of unmet needs. This work supports a role for ED-based research evaluating a patient-oriented approach to engage patients after opioid overdose.