Table 1 Community-based post-overdose interventions documented in empirical literature, 2001–2021

Scott et al., 2020

Recovery Initiation and Management after Overdose (RIMO), Chicago, IL, Not Reported

Chicago FD EMS, Lighthouse Institute, research personnel, linkage managers. SAMHSA funding.

EMS data released to study team after naloxone administration and patient authorization. Participants not in treatment, use opioids, at least 18 years old. Linkage managers call participant. Second contact peer outreach workers to residence. Individual is transported to study site, screened, enrolled.

Intervention group: treatment referral (MOUD, detox, other), linkage managers check-in weekly and refer to social services. Control group: treatment options flyer.

N = 33 27.3% females; 66.7% Black, 15% Latinx, 9.1% White

Participants randomized into intervention (n = 17) or control (16). Mixed-methods: baseline survey, follow-up survey and focus group. Intervention group was significantly more likely to initiate treatment (81% vs. 35%), especially MOUD (81% vs. 18%), and to stay engaged in MOUD after 30-day period (44% vs. 6%). Intervention focus group (n = 9 from intervention) reported persistent and motivational follow-up aided engagement.

Langabeer et al., 2021

Houston Emergency Response Opioid Engagement System (HEROES), Houston, TX, 2018

University of Texas Health Science Center, Memorial Hermann Hospital, Houston FD, Houston Recovery Center. Health and Human Services Commission of Texas and SAMHSA funding.

EMS and ED data released to program after naloxone administration. Participants not in treatment, use opioids, at least 18 years old, valid address. Within 168-hours of event, peer recovery coach and paramedic conduct residential outreach to screen and enroll participant. Patient navigator schedules treatment appointments.

MOUD induction (buprenorphine) within 24-hours, referral to outpatient, weekly check-in and counseling. Referral to social services.

N = 70 Socio-demographic not reported.

Quantitative administrative case data. 1000 cases and 212 were available at first contact. Of those contacted, 70 enrolled in treatment (33%). Authors challenges to program success: cost of outreach and establishing health data agreement. Facilitators: outreach team share personal experience of substance use and risks.

Langabeer et al., 2020

Houston Emergency Response Opioid Engagement System (HEROES), Houston, TX, 2018

University of Texas Health Science Center, Memorial Hermann Hospital, Houston FD, Houston Recovery Center. SAMHSA funding.

EMS and ED data released to program after naloxone administration. Participants not currently in treatment, use opioids, at least 18 years old. Within 168-hours of event, peer recovery coach and paramedic conduct residential outreach to screen and enroll participant. Patient navigator schedules treatment appointments.

MOUD induction (buprenorphine) within 24-hours, referral to outpatient, weekly check-in and counseling. Referral to social services.

N = 34 55.9% male; 38.2 mean age; 61.8% White, 23.5% Black, 8.8% Latinx; 76.5% homeless; 75% unemployed; 79.4% no health insurance

Quantitative administrative case data. 251 cases, 103 contacted, and 34 (33%) were enrolled in study. Retention at 30-days was 88% (1 lost contact; 3 chose to stop); at 90-days retention was 56% (6, 9). No reported overdoses or deaths. Authors challenges to program success: inability to reach individuals and to access public health insurance. Facilitators: providing treatment and services to vulnerable population and strong agency relationships.

Yatsco et al., 2020

Houston Emergency Response Opioid Engagement System (HEROES), Houston, TX, 2018

University of Texas Health Science Center, Houston PD, psychiatric and recovery centers. Department of Justice Bureau of Justice Assistance funding.

Law enforcement data released to program after overdose or high-risk behavior. Participants able to enter treatment, use opioids, at least 18 years old. Within 168-hours of event, law enforcement conduct residential outreach to screen and enroll participant. Patient navigator schedules treatment appointment within 48-hours.

MOUD induction (buprenorphine) within 24-hours, referral to outpatient, weekly check-in and counseling. Referral to mental health and social services.

N = 24 75% male; 31.6 mean age; 87.5% White non-Latinx or Latinx

Quantitative administrative case data. Treatment engagement of 23% for those who were contacted. Authors shared challenges to program success: slow growth of program, participant distrust of law enforcement, and potential bias of which participants receive law enforcement treatment referral.

White et al., 2021

The Tempe First-Responder Opioid Recovery Project (ORP), Tempe, AZ, 2020

Tempe PD, Tempe FD, EMPACT (behavioral health), Arizona State University, California State University Long Beach. SAMHSA funding.

Police release 9–11 overdose data to program’s behavioral health counselor 24/7 hotline. Participant eligibility criteria not reported. Peer support specialist goes to individual’s location to collect contact information and discuss program. Within 24-hours, a navigator conducts follow-up to provide services for individual and family/friends.

Referrals include: naloxone, state-designated mental health treatment, substance use treatment (outpatient, residential), and social services. Navigator contact for 45 days.

N = 81 32.1 mean age; 69.8% White, 14.6% Black, 12.5% Latinx, 27% homeless

Mixed-methods: administrative data on cases and qualitative data from partner interviews. 81 individuals survived overdose. Of those contacted (63, 78%), 34 (54%) accepted navigation to services. Most often state-designated mental health (n = 16), outpatient (15), residential (7), and naloxone (67). Key partner facilitators for program success: collaboration and communication among partners, continuous meetings, understanding of agency norms, and multisectoral relationships. Anticipated benefits: officer commitment and tools to save lives.