National Development and Research Institutes, Center on Community and Health Disparities Research, New York, NY, USA.
New York University College of Global Public Health, Center for Drug Use and HIV/HCV Research, New York, NY, USA.
Addiction. 2019 Aug;114(8):1379-1386. doi: 10.1111/add.14608. Epub 2019 Apr 11.
Numerous states in the United States are working to stem opioid-involved overdose (OD) by engaging OD survivors before discharge from emergency departments (EDs). This analysis examines interactions between survivors and medical care providers that may influence opioid risk behaviors post-OD.
Qualitative stakeholder analysis involving in-depth interviews with samples from three groups.
Two hospitals in high OD-mortality neighborhoods in New York City (NYC), USA.
Total N = 35: emergency medical services personnel (EMS; n = 9) and ED medical staff (EDS; n = 6) both working in high OD-mortality neighborhoods in NYC; recent opioid-involved OD survivors who had been administered naloxone and transported to a hospital ED (n = 20).
EMS and EDS interviews examined content of verbal interactions with survivors and attitudes related to people who use opioids. Survivor interviews addressed healthcare experiences, OD-related behavioral impacts and barriers to risk-reduction post-OD.
Both EMS and EDS stakeholders described frequent efforts to influence survivors' subsequent behavior, but some acknowledged a loss of empathy, and most described burnout related to perceived ingratitude or failure to influence patients. Survivors reported being motivated to reduce opioid risk following a non-fatal OD and many described successful risk-reduction efforts post-OD. Intentions to cease opioid use or reduce risk were complicated by unmanaged, naloxone-related withdrawal, lack of social support and perceived disrespect from EMS and/or EDS.
Emergency department interventions with opioid-involved overdose (OD) survivors may benefit from training emergency medical staff to assure a continuity of non-judgmental, socially supportive remediation attempts throughout contacts with different care-givers. Brief interventions to educate emergency medical staff about current theories of addiction and evidence-based treatment may achieve this goal while reducing care-giver burnout and improving the uptake and efficacy of post-OD interventions delivered in emergency departments.
美国许多州正在努力通过在急诊科（ED）出院前让阿片类药物过量（OD）幸存者参与进来，以阻止阿片类药物相关的 OD。本分析研究了幸存者与医疗保健提供者之间的相互作用，这些相互作用可能会影响 OD 后的阿片类药物风险行为。
涉及三组样本的定性利益相关者分析，包括深入访谈。
美国纽约市（NYC）两个高 OD 死亡率社区的两家医院。
总共 35 名：在 NYC 高 OD 死亡率社区工作的紧急医疗服务人员（EMS；n = 9）和 ED 医务人员（EDS；n = 6）；接受过纳洛酮治疗并被送往医院 ED 的最近一次阿片类药物相关 OD 幸存者（n = 20）。
EMS 和 EDS 的访谈内容包括与幸存者的口头交流内容以及与使用阿片类药物的人的态度相关的内容。幸存者访谈内容涉及医疗保健经验、OD 相关行为影响以及 OD 后减少风险的障碍。
EMS 和 EDS 利益相关者都描述了经常努力影响幸存者随后的行为，但有些人承认失去了同理心，大多数人描述了与感知到的不感激或未能影响患者有关的倦怠。幸存者报告说，在经历非致命性 OD 后，他们有动力降低阿片类药物的风险，并且许多人在 OD 后描述了成功的风险降低努力。由于纳洛酮相关戒断、缺乏社会支持以及来自 EMS 和/或 EDS 的感知不尊重，停止使用阿片类药物或降低风险的意图变得复杂。
急诊科对阿片类药物过量（OD）幸存者的干预措施可能受益于对紧急医疗人员进行培训，以确保在与不同照顾者的接触中始终保持非评判性、社会支持性的补救尝试。对紧急医疗人员进行关于当前成瘾理论和循证治疗的简短干预可能会实现这一目标，同时减少照顾者的倦怠，并提高在急诊科提供的 OD 后干预措施的接受度和效果。
