Behavioral Interventions Delivered by Peer Recovery Support Specialists and Social Workers in the Emergency Department Have Similar Effects on Subsequent Overdose Rates

Non-fatal opioid overdose is an important predictor of fatal overdose, and often leads to an emergency department (ED) visit. Some EDs offer behavioral interventions with Peer Recovery Support Specialists (PRSS), but there is limited evidence to support their effectiveness. In this trial conducted in two EDs in Rhode Island, patients receiving treatment for opioid overdose or complications of opioid use disorder were randomized to a behavioral intervention delivered either by a PRSS or by a licensed clinical social worker (LCSW). The primary outcome was non-fatal overdose in the 18 months following the index ED visit.

• Of the 648 trial participants, 176 (27 percent) experienced at least one ED encounter for an opioid overdose.
• There was no difference in the rates of overdose between those randomized to PRSS or LCSW. An analysis adjusting for baseline characteristics hypothesized to be associated with the outcome of interest likewise found no difference.

Comments: ED visits for non-fatal opioid overdose are an opportunity to connect patients with resources and to initiate medications for opioid use disorder, which are the most effective intervention. A previous paper from this trial* reported that 25 percent of participants in both arms accessed methadone or buprenorphine within 30 days; this probably accounts for the lack of difference between groups. Future efforts should focus on improving these numbers.

Darius A. Rastegar, MD

References: Chambers LC, Li Y, Hallowell BD, et al. Effect of peer-led emergency department behavioral intervention on non-fatal opioid overdose: 18-month outcome in the Navigator randomized controlled trial. Addiction. 2024;119:2116–2128.

* Beaudoin FL, Jacka BP, Li Y, et al. Effect of a peer-led behavioral intervention for emergency department patients at high risk of fatal opioid overdose: a randomized clinical trial. JAMA Netw Open. 2022;5(8):e2225582.