Identifying and Testing Post-Overdose Outreach Adaptations to Enhance Survivor Engagement During the COVID-19 Pandemic

PROJECT SUMMARY / ABSTRACT As the leading cause of accidental injury death, overdose remains a critical public health challenge that has worsened in the midst of the COVID-19 pandemic. Engaging overdose survivors in OEND and MOUD presents a key opportunity to reduce subsequent fatal overdose. In response to the opioid overdose epidemic, community post-overdose outreach programs, which typically include partner public health and public safety professionals to follow-up with overdose survivors in-person, have emerged to engage overdose survivors in OEND and MOUD. With the onset of the COVID-19 pandemic, most post-overdose programs suspended or initially reduced their contact with overdose survivors and, then, adapted their outreach activities to continue their engagement with high-risk overdose survivors. These innovations included telephone and texting contact, distributing phones to those without, drop-off distribution of OEND kits and masks, and telemedicine partnerships for low barrier MOUD initiation. Identifying, describing, and testing these innovations is crucial to understand how to best engage overdose survivors in the midst of the COVID pandemic and beyond. In this R21, we propose a two-year plan to identify and describe innovative post-overdose engagement strategies developed during the COVID-19 pandemic, and to pilot test a toolkit of the most promising adaptations. The specific aims are to identify innovative adaptions in response to the COVID-19 pandemic through a statewide survey (Aim 1), describe mechanisms of action that promote or impede successful COVID-19 related adaptations through 30 qualitative interviews of overdose survivors and post-overdose outreach staff (Aim 2), and pilot test a toolkit of the most promising COVID-19 adaptive strategies within one post-overdose outreach program to increase the number of overdose survivor contacts, naloxone rescue kits provided, and referrals to MOUD (Aim 3). Guided by the PARiHS framework, our mixed-method approach will provide critical insight on what has promoted or impeded success of COVID-19 related adaptations and enable successful and sustained change during the COVID-19 pandemic and beyond. Our ultimate goal is to develop an effective, community-level post-overdose outreach intervention toolkit that reduces opioid overdose fatalities via engaging overdose survivors in OEND and MOUD that is resilient to the COVID-19 pandemic's social and economic challenges.