Many Clinicians Feel Ill-Prepared for Drug Overdose Deaths

Pauline Anderson

December 20, 2021

Many healthcare professionals do not feel prepared to cope with a patient overdose death or to support a colleague after such a death, new research suggests.

However, results from a survey study also showed that colleagues were an important source of support in the wake of this type of event.

"A patient overdose death can change clinical decision-making for providers experiencing high levels of stress related to the overdose death," note investigators, led by Amy Yule, MD, director of adolescent addiction psychiatry, Boston Medical Center and assistant professor of psychiatry at Boston University Medical Center, Massachusetts.

The findings were presented by Yule at the American Academy of Addiction Psychiatry (AAAP) 32nd Annual Meeting.

All-Time High

As reported by Medscape Medical News, there has recently been a record number of drug overdose deaths. And these deaths affect families and communities and often providers, Yule told meeting attendees.

Previous research has looked at the impact of drug overdose deaths and the opioid epidemic on first responders and community health workers in the field of overdose prevention.

"But there's less in the literature to my knowledge that describes the experience of providers and clinicians who are working in more formalized medical settings," said Yule.

In December 2020, researchers sent an email to members of the Providers Clinical Support System (PCSS) inviting them to complete an anonymous survey. The PCSS program was created in response to the opioid overdose epidemic to train primary care clinicians in the prevention and treatment of opioid use disorders (OUD).

A total of 12,204 members received the email, 1064 opened the survey link, and 523 completed the survey.

Participants were mostly White and female, with an average age of 52 years. Respondents had been practicing for an average of about 16 years.

The largest responder group was physicians (47%), followed by counselors (29%), nurse practitioners (17%), and nurses (7%).

Among physician respondents, 41% reported having received additional formal training in addiction.

Only 24% of the respondents indicated they received training in "postvention," which refers to interventions after a suicide to support the bereaved. Such interventions "could be helpful in potentially preparing them for a drug overdose death in their practice," said Yule.

Categories of Preparedness

The survey inquired about three categories of preparedness: coping with a drug overdose death, providing support to a colleague, and talking with families who have lost a member to a drug overdose.

Overall, 59% said they felt somewhat or fairly well prepared for the first two categories and 55% for the third category.

"I think it's notable that there is a higher percentage of people who felt not at all prepared to talk with family members (20.5%) compared to those who felt not at all prepared to cope with a drug overdose death (13.8%) or prepared to support a colleague (12%)," Yule said.

More than half of respondents (55%) indicated a drug overdose death had occurred in their own practice.

The survey also looked at frequency of consultations with colleagues, critical incident debriefing sessions, and interactions with a patient's family.

Almost half (48%) of the sample said they consulted with a colleague after most patient overdose deaths. Only 24% said they had a critical incidence debriefing session after most of these events, and 20% said they interacted with the patient's family.

Asked what resources they found helpful for coping with a recent patient drug overdose death, respondents flagged their colleagues and meetings with families.

The survey also examined provider trauma after a patient drug overdose death, using the Impact of Event scale-R. "If the score is above a certain cutoff level, there is potential concern" for post-traumatic stress disorder, Yule said.

Among the 141 respondents who had a patient drug overdose death in their practice during the previous year, 121 completed this trauma scale. Of these, 18% had "a very elevated" score, Yule reported.

Sources of Support

Commenting on the survey study for Medscape Medical News, Larissa Mooney, MD, associate professor and director of the Addiction Psychiatry Division in the Department of Psychiatry and Biobehavioral Sciences at the UCAL in Los Angeles, said it is not surprising that many providers do not feel adequately prepared to cope with an overdose death, or how to support a colleague after such an event.

"This is not routinely covered in training, and patient overdose may occur without warning signs," said Mooney, who was not involved with the research.

However, these new findings suggest a range of potential sources of support for providers after a patient overdose death that may be helpful, "including colleagues, friends, therapy, supervision, and meeting with the patient's family," she said.

The study received funding from the Providers Clinical Support System (PCSS). Yule has disclosed no relevant financial relationships.

American Academy of Addiction Psychiatry (AAAP) 32nd Annual Meeting. Paper Session III. Presented December 12, 2021.

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