Hello. I'm excited to be presenting today a presentation focused on supporting providers after overdose death. I developed this presentation with Dr. Francis Levin, and we'll go into it. Now, before I get started, I want to note that neither Dr. Levin or I have any relevant financial relationships with ineligible companies to disclose. And to also start with this, the overarching goal of PCFs is to train healthcare professionals and evidencebased practices for the prevention and treatment of opioid disorders, particularly in prescribing medications, as well as for the prevention and treatment of substance use disorders. The goal of the talk is to really review therapeutic and legal issues to consider when working with families after an overdose death, to describe ways to care for yourselves and to support coworkers after an overdose death, and to also summarize possible quality, safety, and regulatory review procedures to follow after an overdose death. To do this, we'll briefly review some background on the topic of overdose deaths and the provider experience, discuss the clinical relevance of this topic, and then go through three different cases. So, to begin with, I think this probably doesn't even need to be stated, but overdose deaths continue to increase despite an increased awareness and attention to the opiate epidemic and an increase in access to treatment. And so in 2021, there were 109,000 deaths due to drugs in the United States. And unfortunately, we just continue to see this increase over the years and really need to be thinking about how we support ourselves and other people in coping with drug overdose deaths. And what we know is that medication for obese disorders does decrease overdose risk, but some risk remains. And so, you know, buprenorphine and methadone really have a substantial decrease in risk of death. Some people have been stabilized on those two medications for nachox and extended release. We have less kind of detailed data on what the risk reduction is. I do know that people have a decreased rate of overdoses when they're treated with Notrect and extend release when compared to controls. And so all three FDA approved medications are really important in decreasing overdose deaths and overdose risk. But despite that, and kind of although many patients with an Opus disorder stabilize the treatment, there are high rates of morbidity and mortality associated with Opus disorders. And so therefore, providers need to be prepared for a patient drug overdose death in your practice, and really to kind of help providers be prepared for patient death and to support themselves, colleagues, and the patient's family. It's helpful to know what is commonly experienced by providers and patients and patients families after a drug overdose. Staff so, unfortunately, we don't have a lot of information about what the family and providers experiences after a patient drug overdose staff, but I'll review what we do know from the literature over the course of the presentation. And since we don't know a lot about the provider or the family's experience after a patient drug overdose death. We did reference the literature on the experience of providers and experience of patients families after a patient death due to suicide. Because there are a lot of commonalities between suicide and overdose, both a suicide and an overdose are sudden and unexpected in terms of intentionality of death. Suicide death is intentional and with overdose we often don't know the intent and it's frequently assumed to be unintentional, but it sometimes is also intentional. And then both acts are associated with significant stigma, significant social and moral stigma associated with self inflicted death that can really isolate family and providers and grief. And so for that reason, we did draw upon the literature on providers and family members experiences after a loved one completed suicide to inform how we think about the experience of providers and families after a patient drug or overdose death. In terms of the families experience, we do know that the drug overdoses are sudden and families may or may not be aware of an individual substance misuse or the risk of death, or maybe someone's been stable for a period of time and had a recent resumption of use. The family was less aware of it. And we know that. What we know is that the bereavement process for families after an overdose is similar to the bereavement process for families after a death by suicide and more complicated than death due to other causes. So one study examined the experience of parents who had lost their child due to suicide, due to drug overdose death, and then due to. Other causes and found that those who had a child that died due to suicide or overdose were much more likely to have complicated grief, much more likely to have symptoms of posttraumatic stress disorder and much more likely to have symptoms of depression when their child died due to suicide or an overdose. And so there definitely are similarities in the breathing process that are important to be aware of. And then the other part to be thinking about is that there are significant stress associated with substance use within families and families cope with the stress in different ways. And so some families may kind of put up with the substance use, some might disengage and distance themselves from an individual when they're struggling with acceptance use disorder. Some might try to confront their family member and try to kind of force them or push them to make a change. And as we think about the family's experience after having a loved one die of an overdose death, it's really unclear what the implications are of these different coping strategies for families when a family member dies and how that might influence their burden process or their experience after a loved one. Stack as we think about the healthcare provider experience, there again have been two studies that have looked at the healthcare provider experience after patient drug overdose deaths. And these studies did find that there were themes in terms of emotions and reactions to patient overdose that came up. And providers often experience sadness, anxiety, anger, helplessness, guilt and self blame. And so a variety of different emotions can come up for providers after a patient drug overdose death. And it's important to be kind of thinking about this as we think about supporting ourselves and others. And what we do know is also as we think about the level of stress that a provider might experience after patient drug overdose death, we do know that when a provider has a patient who has a suicide death that their stress after the patient's suicide death can reach levels comparable to a clinical population. And one random survey of 259 practicing psychiatrists found that this was common for them to have a patient who died suicide in their practice. 51% had a patient died by suicide. And out of those people that had a patient die by suicide, 50% of those respondents had stress levels in the least following the suicide that were comparable to stress levels of people seeking treatment following a parent's death. And so this kind of level of stress associated with a sudden unexpected death in your practice, such as a death due to suicide or a death due to overdose, can cause substantial stress for some people. And one other thing that they found is that younger and less experienced psychiatrists were more impacted by patient suicide compared to older psychiatrists with greater clinical experience. Another study did look at kind of different people who were kind of different levels of impact after patient's death by suicide, people who had kind of highly impacted by the patient's suicide death and others who had less impact or less impacted by the patient's suicide death. And they looked at kind of different things that might influence someone's reaction or experience after patient suicide death, including their relationship to the patient, exposure to the suicide, support after the suicide and level of training. And what they found was that people who were highly impacted and had substantial stress after a patient's suicide were emotionally close to the patient and lacked support after the patient's suicide. And so as we try to translate this data to the experience of providers after a drug overdose death, important to be thinking about the importance of providing support to our colleagues if they do have this type of death in their practice. And so as we think about overall recommendations for providers, as we think about drug overdose deaths, there really aren't any guidelines to support us in thinking about what are kind of next steps or what we should do after a patient drug overdose step in our practice. But we can think about interventions that are done after suicide to support, to support providers after a patient drug overdose. And these interventions that are conducted after suicide to support breed are referred to as postvention. In general, postvention guidelines really stress the importance of seeking support and avoiding isolation. And this can include outreaching to colleagues and to supervisors. This may also include outreaching to your malpractice insurer for consultation is another place to kind of seek some support and guidance after this type of death in your practice. The other postvention guidelines that are recommended include preparing.

overdose death

supporting providers

caring for oneself

medication for opioid use disorders

experiences of providers

emotional reactions

seeking support

challenges faced by families