Project POINT: Effectiveness and Scalability of an Overdose Survivor Intervention

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Opioid misuse and addiction are at historic heights in the United States, and deaths due to opioid overdose have quadrupled over the past 16 years. Despite significant need, substantial treatment and design barriers prevent many opioid users from accessing medication assisted treatment (MAT), the gold standard treatment for opioid use disorder (OUD). Planned Outreach, Intervention, Naloxone, and Treatment (POINT) is an emergency department (ED)-based outreach program for engaging opioid overdose survivors into MAT. POINT builds on the strengths and addresses weaknesses of previous ED-based opioid use disorder (OUD) interventions. POINT is essentially a critical time intervention in that it seeks to quickly mobilize support for members of a highly vulnerable population at a juncture in their lives when they are likely to be receptive to assistance (i.e., after an overdose). It accomplishes this through use of recovery coaches (i.e., individuals with lived experience of recovery who are trained to assist those struggling with addiction) who assist patients to navigate barriers to MAT access after ED discharge. The use of recovery coaches in substance abuse services is based in the premise that patients will be more receptive to sharing their personal struggles with someone who has had similar experiences. The primary goal of this project is the establishment of POINT as an effective and scalable intervention for engaging patients in MAT. This study employs a Hybrid Type 1 effectiveness implementation design to take full advantage of current POINT expansion efforts currently happening in Indiana. Aim 1 of this project is to replicate POINT in a new hospital, which will prepare the intervention for subsequent feasibility testing through (a) assessment of the chosen implementation strategy and (b) the piloting of research protocols and secondary data collection procedures to inform our transition to the next stage of our study. Aim 2 is to conduct a multi-site, pragmatic randomized cluster trial to (a) establish POINT’s effectiveness compared to standard care and (b) enhance our understanding of POINT’s effect on the recovery process through longitudinal interviews conducted with a subset of POINT patients. Aim 3 will determine POINT’s potential scalability to other hospitals and systems through (a) a cost benefit analysis and (b) structured interviews with potential adopters of POINT who can assist us in identifying potential barriers and facilitators to inform future scaling activities. This project is strongly aligned with Indiana’s 21st Century Cures Act funding, as Goal 4 of the state’s Cures Act application seeks to develop the Indiana Recovery and Peer Support Initiative (IRPSI), which will implement ED-based peer supports in various hospitals across the state. Indeed, the IRPSI is based on POINT’s preliminary work. Indiana’s Division of Mental Health and Addiction, which manages the Indiana’s Cures Act funding, has partnered with us to leverage their activities to implement the IRPSI as a means of expanding and studying POINT. Therefore, we have a unique opportunity to study an intervention that is being scaled in its nascent phases. Successful completion of the above aims will poise us to further test POINT’s effectiveness and implementation outcomes in a larger study and/or compare effectiveness with similar interventions (e.g., provision of buprenorphine prescriptions in the ED setting).