Warm handoff is a process of transitioning a patient with a SUD from an intercept point, such as an emergency department, to medical treatment, peer support, or other care or services.

Community paramedicine is a model of community-based healthcare, in which state-licensed emergency medical service (EMS) professionals work in expanded roles to connect people who need health care or other services to resources outside of a hospital emergency department. Community paramedics can play a key role in local mental health and SUD infrastructures.

Drug poisoning survivors have a high likelihood of future hospitalization and fatal or near-fatal medical events. Warm handoffs place drug poisoning survivors and other people with SUDs on a path to treatment and recovery, and they can decrease the risk of subsequent drug poisonings. 

A study published in March 2023 in the American Journal of Preventive Medicine, examined patterns of opioid use disorder (OUD) treatment after adult Medicare participants received inpatient or emergency treatment for nonfatal opioid poisoning. Researchers found that receiving medication for OUD (MOUD) after a nonfatal opioid poisoning was associated with a 62 percent reduction in the risk of opioid poisoning death in the following year. The finding highlights the need to initiate treatment, including MOUD, following nonfatal opioid poisonings. 

A second study published in March 2023 also highlights the importance of timely initiation of treatment and services for SUDs. Researchers found that expanded availability of telehealth services for OUD and MOUD during the COVID-19 public health emergency was associated with lower likelihood of fatal drug poisonings among Medicare beneficiaries. Persons with OUD who received MOUD from an opioid treatment program and those prescribed buprenorphine for OUD in office-based settings had reduced odds of fatal drug poisoning of nearly 60 percent and 40 percent, respectively. 

Warm handoffs are key to ensuring a seamless transition for patients from emergency medical care to specialty substance use disorder (SUD) treatment, thus improving the prospect of recovery. The effectiveness of SUD warm handoff programs is supported by credible evidence.

In 2018, a study examining patient-level predictors of initiating brief behavioral treatment (BT) and treatment with medication for opioid use disorder (MOUD) found that patients who received “collaborative care” (e.g., a warm handoff and follow-up by a care coordinator) were more than six times as likely to initiate BT than the control groups. Patients who received MOUD were more than five times as likely to initiate BT, with the majority receiving BT prior to starting MOUD. Although the temporal relationship of BT and MOUD was not analyzed, collaborative care may have helped individuals initiate BT through a warm handoff to, and follow-up by, a care coordinator, and the BT may have facilitated MOUD initiation after a thorough SUD assessment and discussion of treatment options. In this study, MOUD was limited to buprenorphine or naltrexone.

A 2020 study found that emergency department (ED)-initiated buprenorphine was linked to higher treatment retention rates. Patient navigators assessed patients’ readiness to change and motivation for treatment by conducting brief interventions. Patients with OUD who were willing to engage in SUD treatment were eligible to initiate buprenorphine in the ED. Peer recovery coaches assisted in arranging next-day follow up with a treatment provider. Once receiving buprenorphine, 78 percent (187) of patients arrived at the next-day follow-up appointment, and 59 percent (111) of those patients remained in treatment 30 days later. A 2020 review of 25 articles related to ED-initiated buprenorphine identified similar results, finding that initial visit follow-up rates ranged from 63 percent to 83 percent compared to 38 percent among control conditions.

Similarly, a study published in 2021 on treatment retention after ED-initiated buprenorphine found the rate of attendance at the first referral appointment at 77 percent for patients receiving ED-initiated buprenorphine. At 30-day follow-up, 43 percent of patients were retained in treatment. 

Through community paramedicine (CP) programs, EMS professionals can intervene and help individuals with SUDs access community resources and supportive services. Community paramedic services may include conducting screenings and interventions; offering referrals to treatment providers; supporting medication adherence, storage, and disposal; dispensing naloxone; coordinating bridge medication between an emergency incident and an appointment with a treatment provider; and connecting individuals with housing or food assistance, or mutual aid groups. In short, CP programs link emergency services with medical and social services to improve patient health and prevent repeat drug poisonings. 

In July 2022, 988 became the three-digit dialing code that routes callers to the national Suicide and Crisis Lifeline. 988 was implemented to provide immediate support to people in need of mental health crisis services. Now, individuals experiencing a suicidal, mental health, or substance use crisis have an easier-to-remember way to access a larger, stronger network of crisis call centers. 

When local 988 Lifeline infrastructures are fully established, they will provide an alternative to law enforcement responses to suicide, mental health, and substance use crises. Community paramedicine can be used to strengthen local 988 Lifeline infrastructures by providing immediate crisis support and connecting people with mental health and SUD services.