Creating Opioid Response Specialists: A Harm Reduction Initiative

Aim: Each year, more than 100,000 Americans die from an overdose. Most of these deaths are attributed to high-potency opioids, including fentanyl. People who use drugs face multiple barriers to treatment including access, knowledge of options, and adverse medical experiences. In 2022, Worcester County, Massachusetts saw a sharp increase in overdose deaths. In response, our team, based in Central Massachusetts developed and implemented an Opioid Response Specialist (ORS) Program, under the auspices of a mobile addiction service which has been operating in our area since 2021.

Methods: The Mobile Addiction Service is composed of physicians and advanced practice providers to facilitate low-barrier access to medications for opioid use disorder (MOUD) and harm reduction resources and the ORS service includes two care givers with emergency medical services (EMS) experience, currently also working as paramedics in the area. A model curriculum for the ORS role was developed and then the pilot testing of this role within the existing mobile addiction service was performed. These specialists were trained to the paramedic level and added extensive experience with overdose reversal, phlebotomy, wound care, and additional touch points with high-risk patients to the mobile service.

Results: As a result, we saw increases in naloxone and clean syringe distribution, and hepatitis C and human immunodeficiency virus screening. The integration of these personnel within the mobile addiction service also facilitated the uptake of opioid use disorder treatment interventions by our city's EMS which resulted in further improvements to city-wide naloxone distribution and the use of buprenorphine/naloxone after overdose reversal.

Conclusions: Based on our initial work, the concept of an ORS, especially when embedded with a mobile addiction service, has the potential to improve access to harm reduction as well as form the basis of a training program to extend the skills and scope of personnel with a background in EMS practice.