Trained peers are as effective as clinical social workers in reducing opioid overdose, new trial finds

In Rhode Island, USA, over one in four emergency department (ED) patients at high risk of overdose has a non-fatal opioid overdose in the 18 months post-discharge.  A parallel, two-arm, randomized controlled trial conducted in Rhode Island of over 600 ED patients at high risk of opioid overdose found that support from a peer recovery support specialist (a trained support worker with lived experience of addiction) was as effective in reducing opioid overdose as support from a licensed clinical social worker.  In other words, interviewing and intervention techniques informed by lived experience were as effective as those informed by social work theory and practice. 

The standard form of support delivered by certified peer recovery support specialists is different from the standard form of support delivered by licensed clinical social workers, though both are evidence-based.  Both forms of support use evidence-based interviewing and intervention techniques and provide patients with referrals for post-ED support.  But certified peer recovery support specialists also provide ongoing support in the community for up to 90 days after ED discharge.  That support focuses on helping the patient to overcome barriers to treatment and recovery, educating the patient in overdose prevention, and promoting the patient’s retention in treatment.  Support from licensed clinical social workers typically ends when the patient leaves the ED.

This trial included 648 ED patients at high risk of opioid overdose, of whom 323 were randomized to receive support from a peer recovery support specialist and 325 from a licensed clinical social worker. Most participants (96.8%, n=627) completed the randomly assigned ED intervention.  Within 18 months, 81 participants randomized to the peer recovery support specialist arm (25.1%) experienced a non-fatal opioid overdose compared with 95 who were randomized to the licensed clinical social worker arm (29.2%, p=0.24). The study also found no significant difference between the peer recovery support specialist arm and the licensed clinical social worker arm on fatal opioid overdoses.

Lead author Dr. Laura Chambers, from the Brown University School of Public Health, says: “Non-fatal opioid overdoses are an important predictor of future overdose death, so when someone presents at an emergency room with an overdose or a recent history of overdose, there is an opportunity to offer risk-reduction services to someone with a high risk of future overdose. Some emergency departments now use peer recovery support specialists to deliver some of those services, but we’re still finding out how well that works compared with more accepted sources of support.  The results of our trial strongly suggest that trained peers, and the sort of sustained support they deliver, are just as effective at preventing opioid overdoses as the support offered by traditionally trained clinical social workers.”

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For editors:

This paper is available to read on the Wiley Online Library for one month after its publication (https://onlinelibrary.wiley.com/doi/10.1111/add.16581) or you may request a copy from Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org.

To speak with lead author Dr Laura Chambers, please contact her at the Brown University School of Public Health by e-mail (laura_chambers@brown.edu). Dr Chambers is Lead Research Scientist in the Department of Epidemiology with the School of Public Health.

To speak with co-author Dr Brandon Marshall [12-15 July only], please contact him at the Brown University School of Public Health by e-mail (brandon_marshall@brown.edu).  Dr Marshall is a professor in the Department of Epidemiology at the School of Public Health.

Full citation for article: Chambers LC, Li Y, Hallowell BD, Langdon KJ, Samuels EA, Mahoney LA, Beaudoin FL, and Marshall BDL. Effect of a peer-led emergency department behavioral intervention on non-fatal opioid overdose: 18-month outcome in the Navigator randomized controlled trial. Addiction. 2024. DOI: 10.1111/add.16581

Primary funding: The trial was funded by Arnold Ventures and the Cigna Foundation through investigator-initiated trial programs.

Declaration of interests: All authors declare that they have no conflicts of interest.

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, gambling, editorials, and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884.