Recovery opioid overdose team (ROOT) pilot program evaluation: A community-wide post-overdose response strategy

Abstract

Background: Effective interventions for overdose survivors are needed in the emergency departments (EDs). One promising model is the use of peer recovery coaches to engage with survivors in EDs, followed by partnering with community case management navigators to connect survivors to recovery support and treatment services. This paper describes the evaluation of a pilot program, the Recovery Opioid Overdose Team (ROOT), a warm hand-off system that links survivors to treatment services post-ED discharge. Methods: The ROOT program is composed of a peer recovery coach who is in long-term recovery, and a case management navigator who specializes in mental health care and provides guidance for accessing community services. After an overdose reversal, law enforcement contacts a county 24/7 Crisis Team, who then notifies ROOT. The peer recovery coach engages with the survivor in the ED, and then follow up continues with the case management navigator and the peer recovery coach for up to 90 days post-ED discharge. Retrospective chart reviews were conducted to evaluate ROOT in two Midwest EDs from September 2017 through March 2019. Results: Of the 122 referrals, 77.0% (n = 94) of the survivors initially engaged with ROOT in the ED or in the community. The remaining 23.0% (n = 28) left the ED against medical advice or were unengaged. The majority of overdose survivors were male (63.9%; n = 78), White (43.4%; n = 53), had housing (80.2%; n = 48), and access to transportation (48.4%; n = 59). From the 122 referrals, 33.6% (n = 41) received ongoing treatment services (n = 20 outpatient, n = 17 residential, n = 2 detoxification facility, n = 1 recovery housing, n = 1 medication treatment for opioid use disorder), 2.5% (n = 3) were incarcerated, 2.5% (n = 3) died, and 61.5% (n = 75) declined services. Conclusions: The ROOT, a community-wide coordinated program in the EDs, shows promise in linking overdose survivors to recovery support and treatment services post-overdose.

Keywords:

• Peer recovery
• opioid overdose
• law enforcement
• emergency department
• naloxone
• case management
• mental illness

Acknowledgments

The authors thank the peer recovery coaches and case management navigators, Shad Jordan, Tami Lewis, Robert Johnson, Christina Mersereau, Dathan Sanchez, and Brent Steenbergh for their passion and commitment to caring for overdose survivors. In addition, the authors wish to acknowledge Kathryn Lundquist and Kate Leary for their reviews of the manuscript.

Disclosure statement

None of the authors report a conflict of interest.

Additional information

Funding

Funding for Recovery Opioid Overdose Team was provided by Michigan Department of Health and Human Services, Office of Recovery Oriented Systems of Care through the Substance Abuse Prevention and Treatment Block Grant. Funding for the sixth author (Dr. McCabe) was provided by the National Institute on Drug Abuse, National Institutes of Health [R01DA031160]. The funding sources were not involved in the manuscript process and submission.