Peer Recovery Support May Benefit Patients in Emergency Departments for Opioid Overdose

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Patients in ED being treated for an opioid overdose were more likely to initiate medication for opioid use disorder after discharge when they received peer recovery support services.

An opioid overdose recovery program that incorporates emergency department-based peer recovery support services could help increase initiation rates of medication for opioid use disorder (MOUD) and decrease repeat overdoses, according to new research published in JAMA Network Open.1

Peer recovery support for opioid overdose may benefit patients in emergency departments / nilsversemann - stock.adobe.com

Peer recovery support for opioid overdose may benefit patients in emergency departments / nilsversemann - stock.adobe.com

In 2022, data from the CDC showed that there were over 109000 drug overdose deaths in the United States, with around 70% due to synthetic opioids like fentanyl.2 Emergency departments serve as key settings to provide services for patients with opioid use disorder (OUD) who survive an overdose. However, many patients who recover are often not given further intervention after they are discharged.

Key Takeaways

  • Recent research in JAMA Network Open suggests that integrating emergency department-based peer recovery support services could improve MOUD initiation rates and decrease repeat overdoses.
  • Rutgers University investigators analyzed data from over 12000 patients aged 25 to 44 with opioid use disorder. Findings indicated a 45% increase in the probability of MOUD initiation within 60 days of discharge with the implementation of the opioid overdose recovery program.
  • While the program showed promising results in increasing MOUD initiation and reducing repeat overdoses, outcomes varied across hospital facilities. Ongoing research aims to explore additional factors influencing program effectiveness.

Despite a lack of evidence, peer recovery support services are quickly being implemented in emergency departments across the country. These program involve having people with similar life experiences deliver interventions to patients who are recovering from an overdose.

READ MORE: On the Front Lines: Pharmacists' Role in Combating America's Opioid Epidemic

“People who themselves are in recovery can relate to someone who is going through the same experience,” Nina Cooperman, an author of the study, said in a release.3 “If a patient is ready to enter treatment, the peers will facilitate the transfer; if they are not, the peers maintain a relationship with the patient after discharge for eight weeks to provide support and facilitate linkage to treatment if they later become motivated.”

Investigators from Rutgers University conducted a cohort study to examine the association of an opioid overdose recovery program with post-discharge addiction treatment initiation, repeat overdose, and acute care utilization. Data was gathered from New Jersey Medicaid claims from 2014 through 2020.

The study cohort included 12046 patients between 25 to 44 years of age, of which 62% were male and 38% were female. Over 51% of patients had an OUD diagnosis, 57.5% had another type of substance use disorder (SUD), and 59.3% had a psychiatric illness. In the 180 days prior to the overdose, 24.6% received an MOUD and 25.1% received psychosocial treatment. In total, 69.5% of overdoses involved heroin or a synthetic opioid, and 10.6% were due to polysubstance use.

The primary study outcome was MOUD initiation within 60 days of discharge from the emergency department. Secondary outcomes included psychosocial treatment initiation, medically treated drug overdoses, and all-cause acute care visits.

Investigators found that the opioid overdose recovery program was associated with a 0.034 increase in the probability of 60-day MOUD initiation—representing a 45% increase from before the program was implemented. The program was also associated with fewer repeat medically treated overdoses.

However, the authors noted there was substantial variation in the program across hospital facilities. For example, there was no observed association between implementing the program and a reduction in overdoses for 17 hospitals. In 9 hospitals, overdoes actually increased compared to the comparison group.

Study limitations included an inability to identify patients who received the intervention, conservative effect estimates due to the intention-to-treat design, an inability to determine the level of service that patients received, and an inability to determine whether other interventions to address OUD were implemented.

“Our findings suggest that emergency department-based peer recovery support programs are associated with increased initiation of medication for opioid use disorder, but that outcome likely depended on additional factors, such as program characteristics, program implementation success and availability of other substance use disorder services either in the hospital or in the community,” Cooperman said in a release.3 “Evaluating these factors is the focus of our ongoing research.”

READ MORE: Substance Use Disorder Resource Center

References
1. Treitler P, Crystal S, Cantor J, et al. Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose. JAMA Netw Open. 2024;7(3):e243614. doi:10.1001/jamanetworkopen.2024.3614
2. Tanz LJ, Gladden RM, Dinwiddie AT, et al. Routes of drug use among drug overdose deaths—United States, 2020-2022. MMWR Surveill Summ. 2024;73(6):124-130. doi: 10.15585/mmwr.mm7306a2
3. From Opioid Overdose to Treatment Initiation: Outcomes Associated with Peer Support in Emergency Departments. News Release. Rutgers University. April 16, 2024. Accessed April 17, 2024. https://socialwork.rutgers.edu/news/opioid-overdose-treatment-initiation-outcomes-associated-peer-support-emergency-departments
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