We’re in the midst of an overdose crisis in the United States. In the past year alone, nearly 110,000 people died due to an overdose. Many experts believe we have the tools to prevent overdose deaths, but that we need to improve our ability to meet people where they are at and facilitate the full range of prevention options.
A new study published in the Journal of Addiction looked at the effect of a peer-led emergency department behavioral intervention on non-fatal opioid overdose.
“One piece of this is identifying and meeting patients’ needs in the ED,” study author Laura C. Chambers told us. “Some EDs are now offering peer support services, but there has not been a lot of research to understand how these services impact health outcomes. We wanted to help fill this gap and inform delivery of overdose prevention services in EDs. »
The overall goal of the study is to identify evidence-based interventions to help people reduce their risk of overdose and support engagement in addiction treatment. Emergency departments (EDs) are an important setting for identifying people at high risk of overdose and offering services to help reduce risk and facilitate treatment.
In a previous study, ED patients who were treated for opioid overdose and received behavioral counseling while in the ED were more likely to engage in formal addiction treatment following the ED visit. The vast majority (over 85%) of the patients who engaged in addiction treatment received either buprenorphine or methadone, which are both medications that greatly reduce risk of overdose and death.
“In the current study, we wanted to see if health outcomes differed depending on whether ED patients received the behavioral intervention from a peer specialist versus a social worker,” Chambers told us. “While peers and social workers both are trained in evidence-based interviewing and intervention techniques, counseling with a peer is informed by their lived experience with addiction and recovery, and counseling with a social worker is informed by social work theory and practice.”
Going into the study, the hypothesis was that risk of overdose would be lower and treatment engagement would be higher for study participants who received a behavioral intervention from a peer specialist compared to those who received a behavioral intervention from a social worker. The research team previously reported that participants who received a behavioral intervention from a peer specialist had a similar rate of treatment engagement as those who received a behavioral intervention from a social worker. In the current report, they share their findings for overdose risk.
“We enrolled ED patients at high risk of opioid overdose into the study, and then randomly assigned them to receive a behavioral intervention from either a peer specialist or a social worker during their ED visit,” Chambers told us. “We then followed the participants for the next 18 months to evaluate their health outcomes, including risk of non-fatal and fatal opioid overdose.”
Overall, the researchers found that 27% of study participants had a non-fatal opioid overdose and about 4% had a fatal opioid overdose in the 18 months following their initial ED visit. The researchers did not find any evidence that risk of non-fatal or fatal opioid overdose differed for patients who received the ED behavioral intervention from a peer specialist versus a social worker.
“We had expected that a behavioral intervention with a peer might be more effective than a behavioral intervention with a social worker, given that many people find it particularly helpful to talk with peers who have lived experience with addiction and recovery,” Chambers told us. “I think the findings are encouraging. Taken together, this study and prior work suggest that behavioral interventions are helpful for ED patients at high risk of overdose and that whether the intervention is delivered by a peer or social worker is probably less important than receiving one in the first place. As health systems integrate behavioral interventionists into ED cares teams, they may consider peers and social workers based on feasibility.”
Chambers believes there are some important questions that warrant additional research. For example, the peer specialists aimed to continue supporting patients following ED discharge, while the social workers typically only worked with patients during the ED visit.
“It would be helpful to understand the specific impact of ongoing contact with peers following discharge,” Chambers told us. “I think it would also be interesting to consider whether some subgroups of patients may benefit more from working with one type of specialist or the other.”