Follow-Up Care After Drug Overdose

Connecting people who experience a nonfatal drug overdose with treatment is crucial to preventing additional nonfatal or fatal overdoses. It is estimated that about 1 in 20 people who receive medical treatment in an emergency department for an overdose and are discharged die within a year. About two thirds of those deaths can be linked to an opioid overdose.¹

Transition of Care

People who receive medical treatment for a nonfatal drug overdose from a hospital or other emergency medical services benefit from a smooth transition of care. A transition of care is any movement between two systems. For example, from detox to treatment in a hospital, or from the hospital back to a primary care clinic. A recent study in the Annals of Internal Medicine reveals four alarming statistics about the lack of transition of care for patients with chemical health needs, especially when it comes to after-care following a nonfatal overdose.²

• Even after a nonfatal opioid overdose, 90% of patients continue to receive prescription opioids
• Of the patients who received an opioid prescription following a nonfatal overdose, 70% of the time the opioid prescription came from the same prescriber who prescribed opioids before the overdose
• Of the patients who received an opioid prescription following a nonfatal overdose, 46% of them had a previous diagnosis of substance use disorder
• Of the patients included in the study sample, 7% of the patients suffered an additional nonfatal opioid overdose during the study period of a year

Emergency departments are an important point of contact between people using drugs and treatment providers. People who survive a nonfatal overdose will only be in the emergency room (if they are treated there) for a short period of time and do not always need follow-up medical care, but there are other healthcare needs that can be addressed to prevent future overdoses including mental health support, medication assisted-treatment (MAT), naloxone, access to culturally specific recovery supports, and securing stable housing.

Mental Health Support/Warm Handoff

People who survive an overdose can be traumatized by the experience and benefit from a quick connection to mental health services in their community. With a warm handoff,  a nurse or first responder engage with a patient to build trust. This relationship is used to connect that patient to mental health services so they can develop a treatment plan to continue receiving care.

Medication-Assisted Treatment (MAT)

 MAT provides an option for patients to stop using opioids without experiencing these symptoms that can make maintaining recovery very difficult. Patients that begin MAT in the hospital have lower rates of illicit opioid use and are more likely to maintain substance use recovery than patients who have to wait to begin MAT after a nonfatal overdose.²

Many times, there are waiting lists for substance use treatment programs and to see providers that can prescribe MAT. A promising approach to reduce future overdoses is to bring patients on MAT in the emergency department instead of requiring patients to find an MAT provider in their community and wait to be seen.³

Naloxone

Naloxone (also called Narcan) is a life-saving medication that can be used to reverse the effects of opioids during an opioid overdose. Naloxone is available from many different sources, some of which are listed on the Naloxone webpage. People that experience a nonfatal overdose, as well as their friends and family can benefit from having access to naloxone. Physicians can prescribe naloxone to patients, who can then fill their prescription at a pharmacy that is authorized to dispense naloxone.

Recovery and Social Supports

Connection to a social support network and culturally-specific recovery supports are both very important to preventing opioid overdoses and maintaining substance use recovery. The Minnesota FastTracker has the option to search for culturally-specific substance use treatment options across the state.

Recovery support services include continuing care with a medical team, mutual support groups such as twelve-step programs, and peer recovery services that connect a person with others with lived experience of substance use and recovery. The Minnesota FastTracker can be used to search for outpatient, peer recovery, and recovery support groups. Culturally-specific recovery supports are services that respect and acknowledge each client’s unique cultural attitudes and values about substance use. Recovery supports that have providers with diverse racial, ethnic, and gender identities is important for patients to feel recognized and have any experiences of discrimination and racism validated.  Groups of people that can benefit from culturally-specific recovery supports include people of color, Indigenous people, foreign-born people, and people who speak a language other than English.

Housing

Substance misuse, overdose, and follow-up care are influenced by many factors that impact a person’s health and access to treatment. A major risk factor for experiencing a second overdose is a lack of stable housing and homelessness. ^4,5 Having a safe, secure place to live can reduce stress in a person’s life. Housing options for people who experience an overdose and want to abstain from substances can be difficult to find in the community. The development of sober housing, expansion of in-patient treatment services, and improved access to housing in general can all support a person maintain their recovery from substance use following an overdose.

References:

1. Tobin, S.C. (2020, April 2). Many people treated for opioid overdose in emergency departments die within 1 year. National Institute on Drug Abuse. https://www.drugabuse.gov/news-events/nida-notes/2020/04/many-people-treated-opioid-overdose-in-emergency-departments-die-within-1-year
2. Larochelle, M.R., Liebschutz, J.M., Zhang, F., Ross-Degnan, D., & Wharam, J.F. (2016). Opioid prescribing after nonfatal overdose and associated with repeated overdose: A cohort study. Annals of Internal Medicine, 164(1), 1-9. https://doi.org/10.7326/M15-0038
3. Carroll, J.J., Green, T.C., & Noonan, R.K. (2018). Evidence-based strategies for preventing opioid overdose: What’s working in the United States. Centers for Disease Control and Prevention National Center for Injury Prevention and Control. https://www.cdc.gov/drugoverdose/pdf/pubs/2018-evidence-based-strategies.pdf
4. Mericle, A.A., & Grella, C.E. (2016). Integrating housing and recovery support services: Introduction to the special section. Journal of Dual Diagnosis, 12(2), 150-152. https://doi.org/10.1080/15504263.2016.1176408
5. Johnson, T.P., & Fendrich, M. (2007). Homelessness and drug use: Evidence from a community sample. American Journal of Preventive Medicine, 32(6S), S211-S218. https://doi.org/10.1016/j.amepre.2007.02.015

Please visit the Opioid Dashboard for more information on opioid overdose death, nonfatal overdose, use, misuse, substance use disorder, prescribing practices, supply, diversion, harm reduction, co-occurring conditions, and social determinants of health.