Impact of a stimulant-inclusive post-overdose outreach toolkit on engagement of overdose survivors who use stimulants: An interrupted time series analysis.

Abstract

Stimulant (cocaine or methamphetamine)-involved overdoses have increased significantly. Post-overdose outreach programs seek to reduce future overdose by engaging overdose survivors. We evaluated the change in successful outreach after the implementation of a stimulant-inclusive post-overdose outreach toolkit in March 2023. We conducted a comparative interrupted time-series analysis over a 31-month period (March 2022-September 2024) using individual-level survivor outreach and contact data collected from 11 post-overdose outreach programs in Massachusetts. The primary outcome was the monthly proportion of successful outreach contacts based on all outreach attempts each month. We also analyzed a binary outcome indicating whether individual outreach contacts were successful. The comparative ITS analysis examined differences in outreach success among outreach attempts to survivors who use stimulants compared to attempts to survivors who did not use stimulants. The proportions of successful contacts among survivors who used stimulants were 37.5% before toolkit implementation and 52.1% after implementation (Chi-squared=18.91, p < 0.001). The toolkit was associated with an immediate 15.2 %age points increase (level) of the proportion of successful contacts (marginally significant at p = 0.06) and a statistically significant 2.3 %age point (p = 0.03) monthly increase (slope) of the proportions of successful contacts after implementation, compared to non-stimulant-involved outreach contacts. Adjusted logistic regression results on the binary outcome of successful contact found positive level and slope increases. Implementation of a stimulant-inclusive outreach toolkit was associated with improved engagement among survivors who used stimulants. These findings warrant more evaluation of tailored outreach strategies engaging individuals who use stimulants.