The Massachusetts Department of Public Health Post Overdose Support Team Initiative: A Public Health–Centered Co-Response Model for Post–Overdose Outreach
Consideration should be given to embedding post–overdose outreach within existing public health infrastructure as a medical and behavioral health support service.
Drug overdose events, both fatal and non-fatal, continue to impact municipalities across the United States. Given that non-fatal drug overdose is associated with increased risk for subsequent overdose, there has been increased interest in developing and implementing post–overdose interventions. In late 2015, members of our study team were among the first to describe the emergence of collaborative efforts between public health and public safety agencies in Massachusetts to conduct home-based outreach with overdose survivors and their personal networks soon after an overdose event. One of the findings from this and subsequent work was that post-overdose outreach programs are largely initiated by and centered within police departments rather than health and human services agencies.
In our new practice full report, the authors describe the design, early implementation, and evolution of the Post Overdose Support Team (POST) initiative in Massachusetts. Conceptualized by representatives within the Massachusetts Department of Public Health (MDPH) with grant support from the Substance Abuse and Mental Health Services Administration (SAMHSA), this demonstration project directs funding to health and human services agencies to implement locally designed harm reduction–oriented outreach following an overdose event. Funded agencies layered post-overdose follow-up services upon a foundation of harm reduction programming, including access to safer consumption supplies, testing and linkage to care for HIV/Viral Hepatitis/STIs, overdose education and naloxone distribution, and addiction treatment navigation. Drawing on the wisdom of practice, MDPH established broad guidelines for the initiative and convened grantees into a learning collaborative to jointly establish processes, protocols, and principles of practice for implementation.
Our goals in writing this paper were to describe the context and circumstances within which the POST initiative was formed, present an alternative funding and organizational model to the dominant paradigm, explore the feasibility of this approach, and document practitioner-derived practice-based lessons learned from the cross-site evaluation of the first four years of the initiative. It is our combined hope that the increased interest in public health and public safety partnerships to reduce drug overdoses described in this and other articles in the journal’s November/December 2022 supplement will inspire others to continue researching and documenting this emerging area.
What We Found
Drawing on data from grants management records, a database of all outreach attempts and visits, monthly peer-sharing calls, and annual site visit interview data from each of the 11 funded programs, we offer lessons for practice for those currently implementing or planning to implement similar models. Specifically, we learned:
- Post–overdose outreach programs bring services to individuals who may not already be connected to health and human services agencies. During its first 4 years of implementation, POST initiative grantees conducted more than 10,000 post–overdose outreach visits and engaged more than 3,000 overdose survivors either directly or indirectly through a social network member. These contacts represent opportunities that might not otherwise occur to bring the offer of supports and services to individuals who are not already aware of, connected to, or comfortable accessing these services on their own. Staff reported that most individuals they conducted outreach with were not already engaged with their harm reduction services.
- The use of harm reduction specialists expands the range of available services. Although programs made referrals to a wide range of treatment and recovery supports, the most common services requested/provided were overdose prevention education, overdose risk reduction planning, and naloxone distribution. As an assertive outreach approach, services should be person-centered, non-judgmental, and respectful of individuals at different levels of readiness to change. The inclusion of harm reduction specialists in post-overdose outreach programs expands these brief interventions beyond a narrow focus on abstinence-, treatment-, and recovery-based services, which may not always be warranted or desired.
- It is feasible to embed post–overdose outreach within existing public health infrastructure. Post-overdose outreach programs are heavily reliant on strong collaboration between public health and public safety agencies. Overdoses are medical emergencies rather than criminal legal events, and there are benefits to integrating post-overdose outreach programs within health and human services agencies. Law enforcement present on teams may discourage individuals and communities who have been disproportionately impacted by the war on drugs from engagement in services.
As post–overdose outreach models continue to expand and grow, it is imperative that lessons learned from early adopters help inform the design of new programs and modification of existing programs. The POST initiative represents an alternative organizational and operational approach that departs in important ways from the dominant model for these programs in the United States. Further evaluation is needed to identify best practices and to corroborate or call into question the way existing post–overdose outreach programs operate. What can be done?
- Re-consider resource allocation. Support for post-overdose outreach interventions has largely been directed to municipal first responder agencies (police, fire, EMS). While there is often encouragement to partner with public health agencies, this approach places primary responsibility for structuring, organizing, and coordinating these services outside of the public health sphere. This is a missed opportunity to leverage and enhance local public health infrastructure and develop sustainable systems of care.
- Support and facilitate data sharing between agencies. The primary source of information on overdose events and survivors in our study came from emergency call data accessed through police records. Although emergency call data from police are convenient because they are not considered protected health information in the United States, communities should consider and collectively work toward identifying alternative or supplemental data from other sources. This might include the use of HIPPA release forms, partnering with EMS and emergency departments, or other cross-agency data sharing agreements that protect personal information but facilitate the expedient delivery of potentially life-saving outreach services. State and local health departments and regulatory staff are well-positioned to creatively identify ways to reduce these barriers.
We invite you to read our full paper here:
- The Massachusetts Department of Public Health Post Overdose Support Team Initiative: A Public Health–Centered Co-Response Model for Post–Overdose Outreach.
- First Responder Assertive Linkage Programs: A Scoping Review of Interventions to Improve Linkage to Care for People Who Use Drugs
- Warrant checking practices by post-overdose outreach programs in Massachusetts: A mixed-methods study Marco E Tori et al., International Journal of Drug Policy, 2022
- Moving Beyond Narcan: A Police, Social Service, and Researcher Collaborative Response to the Opioid Crisis Michael D. White et al., American Journal of Criminal Justice, 2021
- Post-Overdose Response Team (PORT) Toolkit North Carolina Department of Health and Human Services, 2020
- Position Paper on Community Strategies for Post-Opioid Overdose Interventions New York Department of Health, 2021
- Characteristics of post-overdose public health-public safety outreach in Massachusetts Scott W Formica et al., Drug and Alcohol Dependence, 2020
- Implementing peer recovery services for overdose prevention in Rhode Island: An examination of two outreach-based approaches Katherine M Waye et al., Addictive Behaviors, 2019
- Examining the implementation of police-assisted referral programs for substance use disorder services in Massachusetts Melissa Davoust et al., International Journal of Drug Policy, 2021
- A scoping review of post opioid-overdose interventions Sarah M Bagley et al., Preventive Medicine, 2019
- Post opioid overdose outreach by public health and public safety agencies: Exploration of emerging programs in Massachusetts Scott W Formica et al., International Journal of Drug Policy, 2018
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Scott W. Formica, PhD, is a Senior Research Scientist at Social Science Research and Evaluation, Inc. He has over 20 years of applied research and evaluation experience on health and behavioral health initiatives with a focus on substance misuse prevention and intervention.
Brittni Reilly, MSW, is the Harm Reduction Lead Program Coordinator at the Massachusetts Department of Public Health, Bureau of Substance Addiction Services. She has over 10 years of experience working on harm reduction, overdose prevention, housing, and homelessness issues in Massachusetts.