Many clinicians feel ill-prepared to face drug overdose deaths

Many health professionals feel unwilling to cope with a patient’s death from an overdose or to support a colleague after such a death, new research suggests.

However, the results of a survey also showed that the colleagues were an important support in the course of such an event.

“A patient’s death from overdose can transform clinical decision-making for providers who are exposed to high stress levels related to death from an overdose,” note investigators, led by Amy Yule, MD, Boston Medical Center director of adolescent psychiatry and assistant professor in Psychiatry from Boston University Medical Center, Massachusetts.

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

All time high

As reported by Medscape Medical News, there has been a record number of deaths from drug overdose recently. And those deaths affect families and communities, and often vendors as well, Yule told attendees at the meeting.

Previous research has examined the impact of drug overdose deaths and the opioid epidemic on first responders and community health workers in the area of ​​overdose prevention.

“But, to my knowledge, there is less in the literature that describes the experience of providers and clinicians working in a more formalized medical setting,” said Yule.

In December 2020, researchers sent an email to members of the Clinical Support System (PCSS) provider asking them to complete an anonymous survey. The PCSS program was launched in response to the opioid overdose epidemic to train general practitioners in the prevention and treatment of opioid use disorder (OUD).

A total of 12,204 members received the email, 1,064 opened the survey link and 523 completed the survey.

The participants were predominantly white and female with a mean age of 52 years. The respondents practice on average for about 16 years.

The largest response group were doctors (47%), followed by counselors (29%), nurses (17%) and nurses (7%).

Of the doctors surveyed, 41% stated that they had completed additional formal training in addiction disorders.

Only 24% of those questioned stated that they had received training on the subject of “postvention”, ie 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,” Yule said.

Categories of readiness

The survey looked at three categories of prevention: managing a death from drug overdose, helping a colleague, and talking to families who lost a member to an overdose.

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

“I think it’s noteworthy that there is a higher percentage of people who didn’t feel ready to talk to family members at all (20.5%) compared to those who didn’t feel at all ready to go through with a death Coping with drug overdoses (13.8%) or prepared to “support a colleague (12%),” said Yule.

More than half of respondents (55%) said one death from drug overdose occurred in their own practice.

The survey also looked at the frequency of consultations with colleagues, debriefings for critical incidents, and interactions with a patient’s family.

Almost half (48%) of the sample said they had consulted with a colleague after most of the deaths from patient overdose. Only 24% reported debriefing for critical events following most of these events, and 20% reported interacting with the patient’s family.

When asked what resources they found helpful in dealing with a recently deceased patient with a drug overdose, respondents indicated their colleagues and family meetings.

The survey also looked at a doctor’s trauma following a patient death from a drug overdose, using the Impact-of-Event Scale-R. “If the score is above a certain limit, there is a potential concern about post-traumatic stress disorder,” said Yule.

Of the 141 respondents who had a drug overdose death patient in their practice in the past year, 121 completed this trauma scale. Of these, 18% had a “very high” score, Yule reported.

Sources of support

Commenting on the survey study for Medscape Medical News, Larissa Mooney, MD, associate professor and director of the Department of Addiction Psychiatry in the Department of Psychiatry and Bio-Behavioral Sciences at UCAL’s Los Angeles, said it is not surprising that many providers feel inadequate To be prepared for an overdose death or to support a colleague after such an event.

“This is not routinely addressed in education and patient overdose can occur with no warning signs,” said Mooney, who was not involved in the research.

However, these new results suggest a number of potential sources of support for providers who may be helpful after a patient dies from overdose, “including colleagues, friends, therapy, monitoring, and meeting with the patient’s family,” she said.

The study was funded by the Providers Clinical Support System (PCSS). Yule has not disclosed any relevant financial relationships.

32nd Annual Meeting of the American Academy of Addiction Psychiatry (AAAP). Paper session III. Presented on 12/12/2021.

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