Post-opioid overdose response team intervention barriers and facilitators to substance use treatment: Perspectives of patients and team members

Emergency medical services (EMS) frequently respond to patients with opioid-related overdoses but often lack the infrastructure and capacity to provide resources and support to individuals who decline transportation to the emergency department. Post-overdose response teams pair EMS clinicians with other first responders or substance use treatment professionals to provide outreach, harm reduction materials, and recovery resources. We aimed to explore the experiences of post-overdose patients and team members to better inform a prehospital care intervention and outcomes for patients with opioid use disorder. This exploratory case study was part of a larger program evaluation of the Rapid Response Emergency and Addiction Crisis Team (RREACT) and describes the barriers and facilitators to accessing substance use recovery resources from the perspective of former patients (n = 8, called program alumni) and RREACT team members (n = 19) in Columbus, OH, USA. Semi-structured interviews were conducted between October 2019 and August 2020. We used inductive thematic analysis to identify key themes by participant group. Themes were compared for similarities and differences. Member checking with team members, peer debriefing, and triangulation of data were used to increase the trustworthiness of the findings. Four overall themes were identified: fear, relationships, resources, and stigma. For program alumni, the fear of withdrawal symptoms was categorized as a barrier to treatment, while the fear of death was a facilitator. Positive relationships between alumni and RREACT team members, among team members, and between RREACT and the community facilitated treatment entry. Additional facilitators of the RREACT intervention were resources in terms of their immediate response and ability to navigate systems. Barriers to RREACT's work included substance use stigma, a lack of appropriate and available treatment services, services only accepting particular insurers, and treatment services for special populations. An EMS-led post-overdose response team provided recovery resources and linkage to treatment by meeting patients in times of desperation, employing non-judgmental personnel, and removing complex barriers. These findings are important to leveraging EMS in expanded roles as part of the larger public health response to opioid overdose.