CE25-149 - Engaging Overdose Survivors with the SafeSpot Hotline for Secondary Overdose Prevention

Boston Medical Center, Boston MA

Investigators

Abstract

Project Abstract Over 90% of people who die from opioid overdose are unwitnessed and alone. Naloxone is an effective opioid overdose antidote that decreases community-level opioid overdose death rates. Yet, naloxone works only if a bystander or responder is administers it within a few minutes of overdose onset. Thus, to reduce opioid overdose deaths in the United States, we must reduce unwitnessed drug use. Overdose prevention hotlines emerged in the United States and Canada to reduce unwitnessed drug use by connecting callers to operators who monitor callers. The caller and operator establish a safety plan to activate an emergency response if the caller becomes unresponsive. While promising, the effectiveness of hotlines is untested. Overdose survivors are at especially high risk for repeat overdose, and thus, may greatly benefit from using an overdose prevention hotline. To engage overdose survivors, we will pursue Funding Option B to iteratively develop the SafeSpot Overdose Safety Planning and Engagement (SOSPE) intervention. Likely elements of this intervention include: i) saving the SafeSpot number in survivors’ phones; ii) conducting a practice call that includes orientation, safety planning, and role-playing; and iii) sending text message safety plan reminders. The research will be conducted via a partnership between the SafeSpot founding director, a highly experienced multidisciplinary team of researchers and community outreach experts who lead a diverse group of programs experienced in engaging overdose survivors. This application proposes to develop, implement and rigorously evaluate the SOSPE intervention through the following aims: Aim 1: Develop the SOSPE intervention via i) convening community outreach experts to co-design the SOSPE intervention, ii) theater testing the SOSPE intervention via 2 focus groups (N=6 overdose survivors/group), and iii) incorporating theater testing feedback with community outreach experts. Aim 2: Implement and iteratively refine the SOSPE intervention to increase SafeSpot calls among overdose survivors via serial, proof of concept trials among overdose survivors, resulting in a finalized SOSPE intervention. Aim 3: Evaluate via a two-arm randomized controlled trial to test whether the SOSPE intervention vs. an attention control (n=100 intervention, n=100 control): i) increases SafeSpot hotline calling, ii) reduces the number of days of unwitnessed drug use, and iii) reduces non-fatal overdose events among overdose survivors assessed at 3- and 6-months follow-up. This proposal aligns with the CDC Division of Overdose Prevention’s research priority to “Develop and evaluate innovative prevention strategies designed to prevent overdose, including among those at greatest risk.” By evaluating the SOSPE intervention, this proposal will move the promising and innovative, but untested, field of overdose prevention hotlines forward and improve the ability of community outreach programs, health departments, and federal agencies to implement new low-barrier strategies to reduce overdose deaths.