Leveraging a time-limited opportunity to study the impact of an intervention for individuals bereaved by drug overdose - The ongoing opioid epidemic has created a large number of people who have lost family, friends, or other close peers to drug overdose. People bereaved by overdose often experience psychological stressors and disruptions to life, and are at greater risk of experiencing more severe grief symptoms, substance misuse, and serious health problems compared to people bereaved by other types of deaths. The New York City Office of the Chief Medical Examiner (OCME) routinely encounters social networks of overdose decedents during death investigations and recently implemented a Social Worker Outreach and Resource Delivery (SWORD) intervention to reduce risks after loss. SWORD is delivered by a trained social worker and integrates evidence- based strategies for mitigating health risks, including motivational interviewing, social support, and linkage to services/resources. The SWORD service model is structured into five modules: bereavement logistics, grief and emotional support, substance use support, physical and mental health support, and social services. Due to insufficient resources, the OCME has not had the capacity to offer the intervention universally. Importantly, the OCME has used a random selection process to determine who is offered the service. Following success of the SWORD pilot, the OCME recently received funding as part of the National Opioid Settlement to expand this innovative service to network members of all overdose decedents. As the SWORD service expands and access is no longer rationed, there is a time-limited opportunity to compare outcomes of SWORD with a natural Control group that was selected at random within the nation’s largest medical examiner office. Despite abundant evidence demonstrating that people bereaved by overdose are at higher risk of poor health outcomes than people bereaved by other types of deaths, health interventions specifically designed for people who experience loss to overdose have not been scientifically studied. In this study, we will leverage the OCME’s random selection for SWORD by conducting surveys with 300 overdose bereaved individuals (150 SWORD, 150 Control) 6 months post-loss to examine the effect of SWORD on grief severity, substance use, and other measures of bereavement-related functioning (anxiety, depression, PTSD, coping). We will also characterize the needs of overdose-bereaved individuals and identify high-need subgroups and gaps in SWORD services using the survey data and through qualitative interviews with 30 overdose bereaved adults. The project has been strategically designed in partnership with the OCME to support intervention sustainability and opportunities for scientific innovation. Given the proposal’s innovation and high potential to reduce grief and risky substance use and improve bereavement-related functioning, it is critical to leverage this time-limited opportunity to study the impact of this intervention. Findings from this R21 study will be used to make enhancements to the SWORD intervention and design a future large-scale RCT of SWORD that ensures optimal intervention design and targets the most vulnerable people bereaved by overdose. This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction
