Effect of a peer-led, emergency department-based behavioral intervention on opioid overdose: A randomized controlled trial

Author: Brandon Marshall, Yu Li, Laura Chambers, Kirsten Langdon, Linda Mahoney, Elizabeth Samuels, Benjamin Hallowell, Francesca Beaudoin

Theme: Epidemiology & Public Health Research Year: 2023

Emergency departments (EDs) provide an opportunity to identify persons at high risk of opioid overdose and reduce subsequent overdose risk. We evaluated the effect of an ED-based behavioral intervention delivered by peer recovery support specialists (PRSS) in Rhode Island, USA.

We enrolled 648 patients with opioid use disorder or who had a recent opioid overdose at two EDs (11/2018-05/2021). Participants were randomized to receive a behavioral intervention from a certified PRSS or clinical social worker. We identified post-discharge opioid overdoses in the 18 months following the index ED visit through linkage to a statewide emergency medical services database. Opioid overdoses were defined using a validated case definition. We compared the proportion of participants with any opioid overdose during follow-up by arm using chi-square tests. Next, we used the Fine-Gray subdistribution hazard model to estimate the effect of treatment arm on the cumulative incidence function of opioid overdose, accounting for competing risks.

The mean age of the sample was 36.9 years, 68.2% were male, and 68.5% were white. Overall, 176 participants (27.2%) had an opioid overdose within 18 months of the index ED visit. Among participants with an opioid overdose, the median time to first opioid overdose was 128.5 days (IQR=51-293), and 60 (34.1%) had >1 opioid overdose during follow-up. Among 325 participants randomized to the social work arm, 95 (29%) had an opioid overdose during follow-up, compared to 81 (25%) of the 323 randomized to the PRSS arm (p=0.235). Randomization to the PRSS arm reduced the incidence of opioid overdose by 15% (subdistribution hazard ratio=0.85, 95%CI=0.69-1.05, p=0.123).

ED-based interventions delivered by PRSS may reduce risk of subsequent overdose. Further research is needed to identify predictors of effectiveness.

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