Background: The American opioid epidemic is a public health emergency, with over 100,000 opioid-related overdose deaths occurring in 2021 (1). Harm reduction treatment models, formulated with the goal of reducing the negative consequences of opioid use, have been implemented as an alternative approach in minimizing opioid overdose and mortality (2). With approximately 4-11% of hospitalized patients having opioid use disorder (OUD), the benefits of implementing these models in medical settings have been widely documented in literature (3-6). However, no studies have described the implementation of a hospital-based, medical student-led harm reduction team.
Purpose: Medical students at the Icahn School of Medicine at Mount Sinai lead a harm reduction team to identify, screen, and train hospitalized patients on opioid overdose identification and naloxone administration.
Description: The Mount Sinai Health System is one of the largest hospital networks in New York City. Access to this system primes medical students to be apt harm reductionists through inpatient training. Patients are identified via (a) direct referral from providers, or (b) daily reports generated through the electronic medical record that flag hospitalized patients for a potential OUD, such as an endocarditis diagnosis or documentation of opioid use. Patients that meet the criteria for training have a diagnosis of any substance use disorder or are actively taking prescribed opioid medications. With the approval of providers, students train these patients on how to identify an opioid overdose and administer naloxone nasal spray, dispensing a kit containing naloxone at their bedside.From January 2021 to November 2022, the student group has identified 143 patients as patients of interest for training. Of these, 67 patients either declined training, were discharged from the hospital before training, or were not approved for training by the physician overseeing their care. The remaining 76 patients (54%) were successfully trained and received an Overdose Rescue Kit. Patients who received training varied in age with a mean age of 53 years (SD=13.9) at the time of training. The majority of them had a documented history of opioid use (n=60, 79%), including those with OUD and/or illicit opioid use, among which 7% (n=4) had opioid prescriptions to treat symptoms of chronic pain. The student group also utilized hospital translation services to train patients with non-English language preferences (n=3, 4%).
Conclusions: Inpatient hospitalization has been identified as an opportune moment for implementing interventional tactics to reduce opioid-related mortality (4-6). As opioid-related hospitalizations and deaths are on the rise, it is important that individuals that use drugs are both trained and supplied with resources to prevent overdose deaths. Here, we present preliminary outcomes on the feasibility and application of a student-led harm reduction group.