The CARE Overdose Response Team in Chicago: A multidisciplinary out-of-hospital post-opioid overdose intervention

Objectives: In 2021, the opioid overdose crisis led to 1,441 fatalities in Chicago, the highest number ever recorded. Interdisciplinary post-overdose follow-up teams provide care at a critical window to mitigate opioid-related risk and associated fatalities. Our objective was to describe a pilot follow-up program in Chicago including eligible overdose incidents, provision of response team services, and program barriers and successes.

Methods: Chicago's Crisis Assistance Response and Engagement Overdose Response Team (CARE ORT) was piloted starting February 1, 2023 across three neighborhoods that collectively responded to an average of 6-7 opioid-related Emergency Medical Services (EMS) incidents each day, among the highest in Chicago. The program involved a two-member field response team consisting of a community paramedic and a peer recovery coach that followed-up with individuals who experienced an opioid overdose in the previous 24-72 hours to offer connections to treatment, overdose education and harm reduction kits including naloxone.

Results: During its 14-month pilot, there were 2,875 eligible overdose events within the pilot area. A total of 723 (25.2%) individuals received an outreach attempt, of which 65 individuals (9.0%) were reached and accepted services. Most overdose incident locations were in public locations (78.4%), but most of the patients that CARE ORT served had overdosed in a private residence (76.9%) and reported being stably housed (71.0%). Among the 65 individuals reached and served, 31 (47.7%) had a prior overdose event in the past 12 months and 32 (49.2%) accessed naloxone in the past three months. Twenty-nine out of 65 CARE ORT patients (44.6%) were referred to outpatient, inpatient or residential treatment and 19 of those (65.5%) for medication assisted recovery with buprenorphine, methadone, or naltrexone.

Conclusions: The CARE ORT model proved successful in engaging predominantly older, non-Hispanic Black men in post-overdose outreach who were stably housed. While the number of individuals reached compared to the total eligible individuals was low, the program successfully navigated multiple barriers of limited EMS referral information, limited accuracy of data management, and urban realities of public overdose locations to reach a marginalized patient population with a high risk of mortality.