Replication of an emergency department-based recovery coaching intervention and pilot testing of pragmatic trial protocols within the context of Indiana's Opioid State Targeted Response plan

Solving the opioid crisis requires immediate, innovative, and sustainable solutions. A number of promising strategies are being carried out by U.S. states and territories as part of their Opioid State Targeted Response (STR) plans funded through the 21st Century Cures Act, and they provide an opport...

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Bibliographic Details
Published in:Journal of substance abuse treatment 2020-01, Vol.108, p.88-94
Main Authors: Watson, Dennis P., Brucker, Krista, McGuire, Alan, Snow-Hill, Nyssa L., Xu, Huiping, Cohen, Alex, Campbell, Mark, Robison, Lisa, Sightes, Emily, Buhner, Rebecca, O'Donnell, Daniel, Kline, Jeffrey A.
Format: Article
Language:English
Subjects:
21st century
21st century cures
Addictions
Clinical research
Coaching
Drugs
Efficacy
Emergency Service, Hospital - organization & administration
Emergency services
Generalizability
Government Programs
Health Services Accessibility - organization & administration
Hospitals
Humans
Indiana
Intervention
Medication for addiction treatment
Naloxone
Naloxone - therapeutic use
Narcotics
Opioid State Targeted Response
Opioid use disorder
Opioid-Related Disorders - drug therapy
Opioids
Outreach programs
Patient Selection
Peer Group
Peer support
Pilot Projects
Pilot study
Recovery coach
Recruitment
Social emergency medicine
State Government
Sustainability
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Summary:Solving the opioid crisis requires immediate, innovative, and sustainable solutions. A number of promising strategies are being carried out by U.S. states and territories as part of their Opioid State Targeted Response (STR) plans funded through the 21st Century Cures Act, and they provide an opportunity for researchers to assess effectiveness of these interventions using pragmatic approaches. This paper describes a pilot study of Project Planned Outreach, Intervention, Naloxone, and Treatment (POINT), the intervention that served as the basis for Indiana's STR-funded, emergency department (ED)-based peer specialist expansion that was conducted in preparation for a larger, multisite pragmatic trial. Through the pilot, we identified, documented, and corrected for challenges encountered while implementing planned study protocols. Per the project's funding mechanism, the ability to move to the larger trial was determined by the achievement of 3 milestones: (1) successful replication of the intervention; (2) demonstrated ability to obtain the necessary sample size; and (3) observe a higher level of engagement in medication for addiction treatment in the POINT group compared to standard care. Overall implementation of the study protocols was successful, with only minor refinements to proposed procedures being required in light of challenges with (1) data access, (2) recruitment, and (3) identification of the expansion hospitals. All three milestones were reached. Challenges in implementing protocols and reaching milestones resulted in refinements that improved the study design overall. The subsequent trial will add to the limited but growing evidence on ED-based peer supports. Capitalizing on STR efforts to study an already scaling and promising intervention is likely to lead to faster and more sustainable results with greater generalizability than traditional, efficacy-focused clinical research. •This project leverages Indiana's Opioid State Targeted Response efforts.•Pilot work demonstrates the necessity of flexibility in pragmatic trial design.•All three milestones were reached and implementation of protocols was successful.•Data access, recruitment, and identification of hospitals required refinements.•The subsequent pragmatic trial will help inform ED-based peer supports much faster.
ISSN:0740-5472
1873-6483
DOI:10.1016/j.jsat.2019.06.002