Behavioral intervention to reduce opioid overdose among high-risk persons with opioid use disorder: A pilot randomized controlled trial

Phillip Oliver Coffin, Glenn-Milo Santos, Tim Matheson, Emily Behar, Chris Rowe, Talia Rubin, Janelle Silvis, Eric Vittinghoff, Phillip Oliver Coffin, Glenn-Milo Santos, Tim Matheson, Emily Behar, Chris Rowe, Talia Rubin, Janelle Silvis, Eric Vittinghoff

Abstract

Objective: The United States is amidst an opioid epidemic, including synthetic opioids that may result in rapid death, leaving minimal opportunity for bystander rescue. We pilot tested a behavioral intervention to reduce the occurrence of opioid overdose among opioid dependent persons at high-risk for subsequent overdose.

Materials and methods: We conducted a single-blinded randomized-controlled trial of a repeated dose motivational interviewing intervention (REBOOT) to reduce overdose versus treatment as usual, defined as information and referrals, over 16 months at the San Francisco Department of Public Health from 2014-2016. Participants were 18-65 years of age, had opioid use disorder by Structured Clinical Interview, active opioid use, opioid overdose within 5 years, and prior receipt of naloxone kits. The intervention was administered at months 0, 4, 8, and 12, preceded by the assessment which was also administered at month 16. Dual primary outcomes were any overdose event and number of events, collected by computer-assisted personal interview, as well as any fatal overdose events per vital records.

Results: A total of 78 persons were screened and 63 enrolled. Mean age was 43 years, 67% were born male, 65% White, 17% African-American, and 14% Latino. Ninety-two percent of visits and 93% of counseling sessions were completed. At baseline, 33.3% of participants had experienced an overdose in the past four months, with a similar mean number of overdoses in both arms (p = 0.95); 29% overdosed during follow-up. By intention-to-treat, participants assigned to REBOOT were less likely to experience any overdose (incidence rate ratio [IRR] 0.62 [95%CI 0.41-0.92, p = 0.019) and experienced fewer overdose events (IRR 0.46, 95%CI 0.24-0.90, p = 0.023), findings that were robust to sensitivity analyses. There were no differences between arms in days of opioid use, substance use treatment, or naloxone carriage.

Conclusions: REBOOT reduced the occurrence of any opioid overdose and the number of overdoses.

Trial registration: clinicaltrials.gov NCT02093559.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist. PC has previously directed National Institutes of Health-funded trials that have received donated study medications from Alkermes (2014–2015) and Gilead (2015–2017). This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Participant flow diagram for REBOOT…
Fig 1. Participant flow diagram for REBOOT study, San Francisco 2014–2016.
Fig 2
Fig 2
(a) Proportion of REBOOT and control participants with any overdose in preceding 4 months, San Francisco 2014–2016; (b) Mean number of overdoses in preceding 4 months per REBOOT and control participant, San Francisco 2014–2016.

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