Houston Emergency Opioid Engagement System

The Houston Emergency Response Opioid Engagement System (HEROES) is a non-randomized cohort
study based at the University of Texas Health Science Center of Houston. This study seeks to
develop an emergency- initiated opioid system of care for individuals with prior opioid
overdose and opioid use disorder. The study involves both assertive outreach on individuals
who have recent overdoses within the last 72 hours, as well as individuals who are admitted
to local hospital emergency departments. The study explores the effect of the combination of
assertive outreach, same-day induction into medication-assisted treatment, ongoing
maintenance treatment, behavioral counseling, peer recovery support, and paramedic follow-up
on patient outcomes. The primary outcome is engagement and retention outpatient treatment.
Secondary outcomes include quality of life assessment as well as subsequent relapses and
overdoses. The hypothesis is that patients with earlier induction into MAT treatment in the
emergency department, who receive routine follow-up, are more likely to engage and be
retained in a longer-term treatment program for their addiction.

Inclusion Criteria:

- In otherwise good health based on physician assessment and medical history

- Tests positive in urine sample for opioids

- Patients express a willingness to stop opioid use

- Meet Diagnostic and Statistical Manual of Mental Disorders - Text Revision (DSM-IV-TR)
criteria for opioid dependence

- Patients must be able to speak English

- Be agreeable to and capable of signing informed consent

Exclusion Criteria:

- Non-English-speaking patients

- Have a known sensitivity to buprenorphine or naloxone

- Be physiologically dependent on alcohol, benzodiazepines or other drugs of abuse that
require immediate medical attention. Other substance use diagnoses are not
exclusionary.

- Have a medical condition that would, in the opinion of the study physician, make
participation medically hazardous, including unstable cardiovascular disease,
neurological deficits, trauma, acute hepatitis, stroke, and liver or renal disease)

- Be acutely psychotic, severely depressed, and in need of inpatient treatment, or is an
immediate suicide risk

- Be a nursing or pregnant female