In recent years, the United States has experienced a growing opioid-use epidemic accompanied by a dramatic rise in opioid-overdose (OOD). Individuals experiencing a non-fatal OOD are at heightened risk for future OODs. A recent study revealed that patients with repeated OODs accounted for 15% of all OOD ED visits, and were more likely to be hospitalized. Although naloxone can reverse an acute overdose, there is no guarantee the medication will be available in time. The only completely effective method of preventing subsequent OOD is successful treatment of the underlying opioid use disorder (OUD). Despite this, there are no published interventions to facilitate treatment entry for patient experiencing a non-fatal OOD. To fill this gap, we created the Tailored Telephone Intervention delivered by Peers to Prevent Recurring Opioid Overdoses (TTIP-PRO), a secondary prevention intervention for individuals with OUD and a recent OOD designed to: 1) encourage patients to initiate medication assisted treatment (MAT) and 2) increase knowledge about OOD risk reduction. To maximize effectiveness, TTIP-PRO was designed based on principles from the elaboration likelihood model (ELM) of persuasion. Based on the ELM, TTIP-PRO is patient-tailored, provides empirically-based information in a multimodal format, and is delivered by a Peer Interventionist - a person who has been abstinent from illicit opioids for at least a year, is enrolled in MAT, and has personal experience with OOD. To minimize cost and implementation barriers, TTIP-PRO is provided remotely and consists of: 1) a 30-minute telephone call during which the Peer Interventionist engages the individual in an open discussion about MAT and provides tailored feedback based on the individual's OOD risk factors and knowledge about OOD and MAT; 2) a mailing with materials to reinforce the patient's knowledge of his/her personal risk factors, review how to appropriately respond to an OOD, re-emphasize the benefits of MAT, and remind the participant where he/she can obtain treatment. Because the TTIP-PRO computer program generates tailored feedback and guides the Peer Interventionist through intervention delivery, TTIP-PRO training and certification can be accomplished in 4 hours. Our initial study evaluating the acceptability of TTIP-PRO revealed a high degree of satisfaction with TTIP-PRO for both Peer Interventionists and participants and a significant increase in the participants' knowledge about OOD and MAT.
The specific aims of this project are to: 1) Finalize the Peer Interventionist training materials by creating training files and evaluating the inter-rater reliability of TTIP-PRO's competence assessment (Stage IA); and 2) Conduct pilot testing in preparation for a full-scale clinical trial (Stage IB). Exploratory aims ae to: E1) Test the validity of two assessments developed for TTIP-PRO; E2) Test our conceptual model of TTIP-PRO's mechanisms of change.
Recurring opioid overdose (OOD) is a significant problem in the U.S. yet there is no evidence-based intervention for patients with OOD. This project will further develop and test a promising, low-cost, intervention to reduce recurring OOD rates.
