{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T13:33:53Z","timestamp":1783085633723,"version":"3.54.6"},"reference-count":48,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T00:00:00Z","timestamp":1637625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005217","name":"National Center for Injury Prevention and Control","doi-asserted-by":"publisher","award":["R01 CE003149"],"award-info":[{"award-number":["R01 CE003149"]}],"id":[{"id":"10.13039\/100005217","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["P20GM125507"],"award-info":[{"award-number":["P20GM125507"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["U54GM115677"],"award-info":[{"award-number":["U54GM115677"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Study Objective<\/jats:title><jats:p>Emergency department (ED)\u2010based naloxone distribution and peer\u2010based behavioral counseling have been shown to be feasible, but little is known about utilization maintenance over time and clinician, patient, and visit level factors influencing implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study of an ED overdose prevention program providing take\u2010home naloxone, behavioral counseling, and treatment linkage for patients treated for an opioid overdose at two Rhode Island EDs from 2017 to 2020: one tertiary referral center and a community hospital. Utilizing a Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE\u2010AIM) framework, we evaluated program reach, adoption, implementation modifiers, and maintenance using logistic and Poisson regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven hundred forty two patients were discharged after an opioid overdose, comprising 966 visits (median: 32 visits per month; interquartile range: 29, 41). At least one intervention was provided at most (86%, 826\/966) visits. Take\u2010home naloxone was provided at 69% of visits (637\/919). Over half (51%, 495\/966) received behavioral counseling and treatment referral (65%, 609\/932). Almost all attending physicians provided take\u2010home naloxone (97%, 105\/108), behavioral counseling (95%, 103\/108), or treatment referral (95%, 103\/108) at least once. Most residents and advanced practice practitioners (APPs) provided take home naloxone (78% residents; 72% APPs), behavioral counseling (76% residents; 67% APPs), and treatment referral (80% residents; 81% APPs) at least once. Most clinicians provided these services for over half of the opioid overdose patients they cared for. Patients were twice as likely to receive behavioral counseling when treated by an attending in combination with a resident and\/or APP (adjusted odds ratio: 2.29; 95% confidence interval, 1.68, 3.12) compared to an attending alone. There was no depreciation in use over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>ED naloxone distribution, behavioral counseling, and referral to treatment can be successfully integrated into usual emergency care and maintained over time with high reach and adoption. Further work is needed to identify low\u2010cost implementation strategies to improve services use and dissemination across clinical settings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14409","type":"journal-article","created":{"date-parts":[[2021,11,5]],"date-time":"2021-11-05T08:00:04Z","timestamp":1636099204000},"page":"294-307","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Implementation and maintenance of an emergency department naloxone distribution and peer recovery specialist program"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5910-853X","authenticated-orcid":false,"given":"Brendan P.","family":"Jacka","sequence":"first","affiliation":[{"name":"Department of Epidemiology Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3670-382X","authenticated-orcid":false,"given":"Hannah N.","family":"Ziobrowski","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Lawrence","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Alpert Medical School of Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2729-4008","authenticated-orcid":false,"given":"Janette","family":"Baird","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Alpert Medical School of Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3585-8379","authenticated-orcid":false,"given":"Anna E.","family":"Wentz","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0134-7052","authenticated-orcid":false,"given":"Brandon D. L.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6141-1776","authenticated-orcid":false,"given":"Rachel S.","family":"Wightman","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Brown University School of Public Health  Providence Rhode Island USA"},{"name":"Department of Emergency Medicine Alpert Medical School of Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Mello","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Alpert Medical School of Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca L.","family":"Beaudoin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Brown University School of Public Health  Providence Rhode Island USA"},{"name":"Department of Emergency Medicine Alpert Medical School of Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2414-110X","authenticated-orcid":false,"given":"Elizabeth A.","family":"Samuels","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Brown University School of Public Health  Providence Rhode Island USA"},{"name":"Department of Emergency Medicine Alpert Medical School of Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,11,23]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Provisional drug overdose death counts. National Center for Health Statistics. 2021. Accessed August 7 2021.https:\/\/www.cdc.gov\/nchs\/nvss\/vsrr\/drug\u2010overdose\u2010data.htm"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2021.0967"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.34878"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2020.102906"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2019.04.020"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2019.07.014"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2019.06.039"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/M17-3107"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2018.01.052"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.3474"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2018.08.439"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2015.2.24909"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2018.07.013"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12910"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1811988"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2021.05.024"},{"key":"e_1_2_8_18_1","unstructured":"E\u2010QUAL network opioid initiative.2019. Accessed June 15 2019.https:\/\/www.acep.org\/administration\/quality\/equal\/emergency\u2010quality\u2010network\u2010e\u2010qual\/e\u2010qual\u2010opioid\u2010initiative\/"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.108009"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.108595"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2016.03.018"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13545"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2020.02.013"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.4561"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.21209"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.5852"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2019.04.035"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.18511"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2018.304847"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2016.07.027"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1017\/cem.2018.368"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2014.10.021"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2021.108588"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.89.9.1322"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-013318"},{"key":"e_1_2_8_36_1","unstructured":"Drug overdose mortality by state.2021. Accessed September 5 2021.https:\/\/www.cdc.gov\/nchs\/pressroom\/sosmap\/drug_poisoning_mortality\/drug_poisoning.htm"},{"key":"e_1_2_8_37_1","unstructured":"Opioid overdose\u2010related emergency department visits.2021. Accessed September 20 2021.https:\/\/ridoh\u2010drug\u2010overdose\u2010surveillance\u2010eddashboard\u2010rihealth.hub.arcgis.com\/"},{"key":"e_1_2_8_38_1","unstructured":"HildebranG.Staying Alive on the Outside. [DVD] Rhode Island Hospital.2012."},{"key":"e_1_2_8_39_1","unstructured":"Addiction Policy Forum.AnchorED Rhode Island. Updated Mar 14 2020. Accessed September 10 2021.https:\/\/www.addictionpolicy.org\/post\/anchored\u2010rhode\u2010island"},{"issue":"97","key":"e_1_2_8_40_1","first-page":"38","article-title":"Emergency department naloxone distribution: a Rhode Island department of health, recovery community, and emergency department partnership to reduce opioid overdose deaths","volume":"2014","author":"Samuels E","year":"2013","journal-title":"R I Med J"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2018.09.027"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13545"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2021.02.004"},{"key":"e_1_2_8_44_1","unstructured":"Rhode Island Department of Health. Rules and Regulations Pertaining to Opioid Overdose Prevention and Reporting.Rhode Island Department of Health;2014."},{"key":"e_1_2_8_45_1","volume-title":"Levels of Care for Rhode Island Emergency Departments and Hospitals for Treating Overdose and Opioid Use Disorder","author":"Rhode Island Department of Behavioral Healthcare Developmental Disabilities and Hospitals, Rhode Island Department of Health","year":"2017"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-032052"},{"key":"e_1_2_8_47_1","article-title":"Emergency department crowding: the canary in the health care system","author":"Kelen G","year":"2021","journal-title":"NEJM Catal"},{"key":"e_1_2_8_48_1","unstructured":"PreventOverdoseRI.org. Race & ethnicity.2021. Accessed July 30 2021.https:\/\/preventoverdoseri.org\/race\u2010ethnicity\u2010data\/"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocz113"}],"container-title":["Academic Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.14409","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/acem.14409","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.14409","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T16:12:03Z","timestamp":1692979923000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acem.14409"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,23]]},"references-count":48,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,3]]}},"alternative-id":["10.1111\/acem.14409"],"URL":"https:\/\/doi.org\/10.1111\/acem.14409","archive":["Portico"],"relation":{},"ISSN":["1069-6563","1553-2712"],"issn-type":[{"value":"1069-6563","type":"print"},{"value":"1553-2712","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,23]]},"assertion":[{"value":"2021-07-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-11-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-11-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}