Pilot implementation of a drug overdose reporting tool among Texas harm reduction organizations: A mixed methods study

Background: Accurate overdose metrics in Texas are difficult to capture due to barriers in accessing the emergency medical system for overdose. Harm reduction organizations (HROs) are uniquely positioned to overcome these barriers and improve the accuracy of overdose information. Thus, the purpose of this study was to pilot an implementation protocol for a digital overdose tracking platform, TxCOPE, with HROs and examine organization-level characteristics that facilitated adoption of the platform.
Methods: We enrolled 11 HROs across 4 Texas counties (N = 70 harm reductionists) into an implementation protocol over 17 weeks. Reported overdose incidents were measured, including client demographics, naloxone administration, and whether 911 was called. Adoption and sustained use was measured via overdose reporting frequency over the pilot period. Additionally, we conducted individual qualitative interviews (N = 22) with participating HROs and stratified interviews between HROs that met sustained TxCOPE usage and HROs that adopted TxCOPE usage late. Thematic analysis of these interviews was carried out in order to understand the relative organizational characteristics between these HROs.
Results: 228 overdose reports were reported across HROs, with the majority indicating opioid use (i.e., heroin, fentanyl), successful naloxone administration, and that 911 was not called. Three counties achieved sustained TxCOPE usage and two adopted usage late. Thematic analyses revealed the following differences between sustaining and late adopting HROs: 1) TxCOPE implementation was prioritized via sustaining HROs’ responsibilities and processes relative to late adopting HROs, 2) Sustaining HROs valued improving overdose metric accuracy relative to late adopting HROs, and 3) Leadership at sustaining HROs set TxCOPE usage expectations with their team relative to late adopting HROs.
Conclusions: HROs serve a critical role in capturing overdose incidents that occur outside of the emergency medical system. Future research could incorporate these findings into effective implementation strategies to support HROs that experience challenges implementing digital platforms.