A medical student-led model for telephone-based opioid overdose education and naloxone distribution during the COVID-19 pandemic

Abstract

Background: The co-occurrence of the COVID-19 pandemic and opioid epidemic has increased the risk of overdose and death for patients with opioid use disorder (OUD). COVID-19 has also exacerbated already limited access to opioid overdose education and naloxone distribution (OEND). In this context, we aim to increase access to OEND for patients at risk for opioid overdose. Methods: Medical student volunteers were trained to conduct telephone-based OEND, and subsequently contacted all patients at a NYC primary care clinic for people who use drugs as well as those presenting to the hospital with OUD or a history of opioid overdose. Interested patients who completed the training received naloxone kits via mail or at hospital discharge. Results: OEND provision was converted to a remote-only model from May to June 2020. During this time, eight pre-clinical medical students called a total of 503 high-risk patients. Of these patients, 165 were reached, with 90 (55%) accepting telephone-based OEND. Comparing across populations, 51% of primary care patients versus 76% of ED/hospitalized patients accepted opioid overdose education. Eighty-four total patients received naloxone. Conclusions: We have outlined a scalable, adaptable model by which clinics and hospitals with affiliated medical schools can provide OEND by telephone. Medical student-driven, telephone-based OEND efforts can effectively reach at-risk patients and increase naloxone access.

Keywords:

• COVID-19 response
• opioid overdose
• naloxone
• patient education
• medical student education

Acknowledgements

We would like to thank the ISMMS COVID-19 Student Workforce and its leadership team from both ISMMS Student Council and the ISMMS Department of Medical Education. Without their organization and infrastructure, student volunteer recruitment would not have been possible. We would also like to thank the following seven ISMMS student volunteers, who (along with one of the authors) conducted the telephone-based OEND:

• Kelsey Auyeung

• Sewit Bereket

• Sanjana Inala

• Eliott Kim

• Shelly Teng

• Amey Vrudhula

• Stephanie Wu

Author contributions

TMH, ZHR, JJW, MH and LW jointly conceived of the intervention. TMH and ZHR oversaw medical student training and telephone calls, and WT and DLS oversaw naloxone distribution. AK analyzed all data. All authors, TMH, AK, ZHR, WT, DLS, JJW, MH, LW, contributed to the writing and editing of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s). The views expressed in this article are those of the authors.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

We would like to thank the New York City Department of Health and Mental Hygiene for program grant funding and provision of the naloxone kits that were distributed to patients. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.