Li Li

Title: A bundled intervention for opioid overdose survivors: Engaging and retaining in treatment

Abstract

Background & Introduction: Treatment retention and engagement after hospital discharge remains low among patients with nonfatal opioid overdose. It is critical to develop models targeting this population. We conducted a prospective study using a bundled intervention to engage patients, increase treatment uptake and retention, and reduce repeat overdoses.

Methods: This prospective study began on January 1, 2025. The 12-week bundled intervention comprises three components, including buprenorphine treatment, telehealth physician visits (weeks 1, 3, 5, 9, and 12) and telehealth peer support (daily during week 1, every other day during week 2, weekly during weeks 3–12), and facilitated linkage to community resources and ongoing treatment. Adults aged 19 years or older with a diagnosis of opioid use disorder (OUD) and a documented opioid overdose within the last 12 months were recruited from emergency department and inpatient settings at the University of Alabama at Birmingham Hospital. After enrollment, buprenorphine treatment was initiated or continued, and peer support specialists began engaging and coaching patients. Upon discharge, patients received follow-up care via telehealth from both physicians and peers for up to 12 weeks. Participants completed validated surveys assessing craving levels and mental health status at baseline, 1 month, and 3 months.

Results: By October 2025, 30 patients had enrolled in the study. Most participants were male (60%) and white (72%), with a mean age of 38.6 years (SD ±8.5). Nearly one-quarter were uninsured (24%), and over half (52%) were experiencing housing insecurity. Polysubstance use was common: stimulants were most frequent (32%), followed by benzodiazepines (32%) and alcohol (20%).

Of the 30 participants, six were lost to follow-up, and 20 have completed the 12-week intervention to date. Retention was evaluated based on adherence to peer and physician contacts, buprenorphine usage, and follow-up assessments. Among enrolled participants, retention rates were high with 82% at 1 month and 81% at 3 months, and 68% of participants were linked and engaged with community-based addiction treatment programs. During the intervention, participants averaged 12 peer-support telehealth contacts and 5 physician telehealth visits. Among 20 completed participants, 90% were on buprenorphine treatment throughout the 12-weeks intervention.

Craving scores on the Opioid Craving Scale decreased from 17.2±7.9 at baseline to 7.9±7.9 at 3 months. Depression scores, measured using Patient Health Questionnaire-9, dropped from 14.1±6.4 to 2.9±4.0, and anxiety scores, measured using General Anxiety Disorder-7, declined from 13.2±6.6 to 3.5±4.6 over the same period. To date, there have been four repeat nonfatal opioid overdoses and no overdose-related deaths.

Conclusions & Discussions: Our findings suggest that this bundled, telehealth-enabled intervention is feasible and may increase treatment uptake and retention in patients at high risk for repeat overdose and death. These preliminary findings will be further evaluated in the ongoing trial, which aims to demonstrate effectiveness in an estimated sample of 190 patients in the next four years.