Lessons Learned from Implementation of a Post-Opioid Overdose Outreach Program in Rural Massachusetts

What’s the Question?

Post-overdose outreach programs aim to connect people who have recently overdosed to health and harm reduction services and to educate and link them to other resources like employment support, transportation, food, housing, and health insurance. Outreach typically takes place anywhere between 3 days to 1 month after an overdose.

Recent research suggests that post-overdose outreach programs are associated with lower opioid fatalities over time. Despite this emerging evidence of their effectiveness, however, few of these programs exist.

In 2020, SAMHSA prioritized the planning and implementation of community-based post-overdose outreach programs. Not much is known about the design of these programs, especially in rural settings, and what lessons communities have been learning through their implementation.

This report addresses that knowledge gap by looking at the experiences of a community-based post-overdose outreach program in rural Massachusetts, which received SAMHSA funding in 2020 to establish the CONNECT program in Franklin County/North Quabbin.

How Was This Report Conducted?

CONNECT, the Community, Opportunity, Network, Navigation, Exploration, and Connection Team, is the first 24/7 rapid response team for both fatal and non-fatal opioid overdoses in the only federally-designated rural county in MA. It targets overdose survivors and those at high risk of overdose, as well as families impacted by overdoses.

For this report, researchers collected data from March 2022 to July 2022, about a year after CONNECT was launched. Focus groups were held in virtual format, using semi-structured interview guides covering topics like descriptions of CONNECT client characteristics and experiences, barriers and facilitators of implementation and collaboration among involved partners, and future needs for continued program operations.

Researchers then transcribed the focus groups and identified and analyzed thematic patterns within and across responses.

What Did Researchers Find Out?

Facilitators to implementation identified by participants included:

• Serving complex, hard-to-serve and high-risk populations, including people who co-use injection opioids and stimulants, people with criminal-legal system involvement, and low-income people
• Fostering engagement, direct outreach, and providing a menu of options
• Overcoming challenges to inter-disciplinary collaboration, consulting with outside facilitators, maintaining good relationships
• Good leadership, mutual support and learning, regular meetings
• Strong culture of collaboration in the community

Barriers included:

• Need to better serve subpopulations, including unhoused individuals, people who use stimulants who are unaware of contamination of the drug supply, people who don’t call 9-1-1 after an overdose, uninsured people, people who don’t trust organizations/systems
• Competing priorities across sectors
• Need to build out referral systems and services for friends and family of overdose survivors, especially children
• Shame and blame, stigma, not enough harm reduction services in outlying towns, limited time to enter data

What Are the Implications for the Workforce?

This innovative program is one of the first community-based post-overdose interventions in a rural region and, as such, it has a lot to teach other communities around the country that are trying to do similar things. To improve the design and implementation of post-overdose programs like CONNECT, it’s important to explore what worked and what needs work, consider the integration of offering additional health and social services, such as services for people who are unhoused, and be thoughtful about ways to manage competing priorities across key partner sectors.