Evaluating the Impact of a Publicly Funded Partial Hospitalization Program in Reducing Overdose Risk in Philadelphia

About This Grant

ABSTRACT Drug overdose continues to be a leading cause of injury death in the United States with rates rising significantly over the past two decades (Spencer et al., 2024). Although the first wave of the overdose crisis was attributed to the misuse of prescription opioids (Wave 1), subsequent waves have been driven by heroin (Wave 2), fentanyl (Wave 3), and fentanyl and stimulants (Wave 4; Ciccarone, 2021). In 2022, 107,941 drug overdose deaths were reported nationally, with the majority involving fentanyl and other synthetic opioids and/or stimulants (e.g., cocaine, methamphetamine; Spencer et al., 2023, 2024). Furthermore, anyone who uses drugs is at risk for overdose given the introduction of fentanyl and other adulterants into the illicit drug supply (Spencer et al., 2023). Provisional 2023 data suggest there was an overall decrease in overdose deaths nationally for the first time since 2018; however, decreases were not observed within all populations. In fact, increases in overdose deaths were observed among Black and Hispanic groups (Ahmad et al., 2024). Trends in Philadelphia, ranked third in number of fatal overdoses among big cities (Niamatullah et al., 2022), mirror those seen nationally. In 2017, as part of the Mayor’s Task Force to Combat the Opioid Epidemic in Philadelphia (City of Philadelphia, 2017), Public Health Management Corporation established Pathways to Recovery (PTR), Philadelphia’s only publicly funded partial hospitalization program for individuals with co- occurring substance use and mental health diagnoses (American Society of Addiction Medicine [ASAM] 2.5 level of care). PTR is located in Kensington, the area considered by many to be the epicenter of the epidemic in Philadelphia. As a secondary prevention program, PTR is designed to identify individuals appropriate for this intensive (20+ hours per week) community-based treatment and engage them in comprehensive care to address not only their substance use and mental health problems but also social determinants of health that may impact their substance use and overall health. The proposed 3-year mixed methods evaluation (Funding Option A: Implement and rigorously evaluate strategies) will compare 6-month outcomes of PTR-appropriate (i.e., requiring a 2.5 level of care) individuals who enroll in the program (n = 100) to those who do not (n = 100) using propensity score weighting procedures to equate the two samples. Participants will complete comprehensive biopsychosocial assessments and urine drug screens at baseline and months 3 and 6 post- baseline. In addition, a focus group will be held with 10 individuals who received PTR services. The specific aims are to (1) Evaluate the impact of PTR in reducing rates of fatal and non-fatal overdoses; (2) Evaluate the impact of PTR in reducing substance use and improving health-related quality of life, mental health functioning, and recovery capital; (3) Evaluate the impact of PTR in addressing social determinants of health including employment and housing status; and (4) Collect qualitative data from program participants to inform conclusions and identify areas for program improvement. If found to be effective, the PTR secondary prevention approach could serve as a model for other cities and municipalities.