“It’s Gonna be a Lifeline”: Findings From Focus Group Research to Investigate What People Who Use Opioids Want From Peer-Based Postoverdose Interventions in the Emergency Department

• Published in: Annals of emergency medicine Vol. 76; no. 6; pp. 717 - 727
• Main Authors: Wagner, Karla D., Mittal, Maria L., Harding, Robert W., Smith, Krysti P., Dawkins, Ashley D., Wei, Xing, Woodard, Stephanie, Roget, Nancy A., Oman, Roy F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2020
• Subjects: Adult; Aged; Analgesics, Opioid - adverse effects; Counseling - methods; Emergency Service, Hospital - statistics & numerical data; Feasibility Studies; Female; Focus Groups - methods; Humans; Insurance Coverage - standards; Male; Middle Aged; Nevada - epidemiology; Opiate Overdose - epidemiology; Opiate Overdose - mortality; Opiate Overdose - therapy; Patient-Centered Care; Program Evaluation; Psychosocial Intervention - methods; Qualitative Research; Substance Withdrawal Syndrome - epidemiology; Nevada
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2020.06.003

Postoverdose interventions that deploy peer recovery support specialists to emergency departments (EDs) are a promising response to opioid overdoses among patients presenting in EDs. The objective of this study was to elicit patients’ perspectives regarding the feasibility and acceptability of such an intervention and to ensure that their perspectives are represented in intervention design, implementation, and evaluation. In 2019 the study investigators conducted focus groups with people who use opioids to elicit perspectives about a postoverdose intervention delivered in the ED by using a semistructured interview guide that asked about feasibility, acceptability, perceived benefits, and concerns. Focus groups were digitally recorded, transcribed, and analyzed for emerging themes. Nine focus groups with 30 people who use opioids were conducted. Key findings that could improve feasibility and acceptability of the intervention include the following: the importance of balancing the urgency of seeing patients quickly with a need to accommodate the experience of precipitated withdrawal symptoms; the need to address privacy concerns; and the need to address concerns related to cost, insurance coverage, and sustainability. Perceived benefits of the intervention included the ability of the peer recovery support specialist to provide advocacy and support, serve as a model of hope and encouragement for behavior change, and fill key service gaps. Postoverdose interventions in the ED provide the opportunity to integrate harm reduction–based interventions into traditional biomedical care facilities. These interventions can fill gaps in services and provide additional care and comfort for people who use opioids, but design, implementation, and evaluation should be informed by a patient-centered care perspective.