Strategies to Facilitate Interorganizational Collaboration in County-Level Opioid Overdose Prevention and Response: A Qualitative Analysis

Community-level overdose prevention interventions often require collaboration among organizations from various sectors including emergency medicine, criminal justice, harm reduction, and drug treatment organizations, yet little is known about ways to foster interorganizational collaboration among organizations with very different missions and in different socio-political contexts. This paper presents results from interviews with key informants involved in overdose prevention coalitions in two counties in Wisconsin (n = 45). Key informants were purposively selected from 31 different organizations in sectors including harm reduction, drug treatment, emergency medicine, and law enforcement. Interviews asked participants to describe the overdose crisis in their communities and the work they do, including any partnerships or coalitions formed with other organizations. We conducted thematic analysis using inductive and deductive coding. Participants' experiences illuminate strategies and actions that facilitated coalitions' work (interorganizational processes) and changed the context in which they worked to be more accepting of harm reduction efforts and less stigmatizing and punitive toward people who use opioids (PWUO). These included getting the word out in community-facing events to educate the public and destigmatize harm reduction, working with representatives across the CoC in various sectors, and actively working with them to create shared missions. Key people acted as bridges while others had the power to convene multiple agencies to a common cause. Overdose Fatality Reviews (OFRs) were found to be particularly helpful in identifying gaps in the current Opioid CoC and developing programs in collaboration with other organizations to address them. Organizational empowerment offers a useful framework for understanding how to facilitate IOC at the intra- (e.g., community education to reduce stigma, inter- (bridging roles by key actors), and extra-organizational levels (e.g., policy changes supporting naloxone access). These strategies can be used by coalition members and tested in future community-level overdose responses.