Effect of a peer-led emergency department behavioral intervention on non-fatal opioid overdose: 18-month outcome in the Navigator randomized controlled trial

Details

• Alternative Title:
  Addiction
• Personal Author:
  Chambers, Laura C. ; Li, Yu ; Hallowell, Benjamin D. ; Langdon, Kirsten J. ; Samuels, Elizabeth A. ; Mahoney, Linda A. ; Beaudoin, Francesca L. ; Marshall, Brandon D.L.
• Description:
  Background and Aims:
  
  Emergency departments (EDs) provide an opportunity to identify people at risk of overdose and reduce risk. We evaluated the effect of an ED behavioral intervention delivered by peer recovery support specialists (PRSS) on non-fatal opioid overdose.
  
  Design:
  
  Two-arm, randomized trial.
  
  Setting:
  
  Two EDs in Rhode Island, USA.
  
  Participants:
  
  ED patients presenting with an opioid overdose, complications of opioid use disorder, or a recent history of opioid overdose (November 2018-May 2021). Among 648 participants, the mean age was 36.9 years, 68.2% were male, and 68.5% were White.
  
  Intervention and comparator:
  
  Participants were randomized to receive a behavioral intervention from a PRSS (n=323) or a licensed clinical social worker (LICSW) (n=325). PRSS and LICSW used evidence-based interviewing and intervention techniques, informed by their lived experience (PRSS) or clinical theory and practice (LICSW).
  
  Measurements:
  
  We identified non-fatal opioid overdoses in the 18 months following the ED visit through linkage to statewide emergency medical services data using a validated case definition. The primary outcome was any non-fatal opioid overdose during the 18-month follow-up period.
  
  Findings:
  
  Among 323 participants randomized to the PRSS arm, 81 (25.1%) had a non-fatal opioid overdose during follow-up compared with 95 (29.2%) of 325 participants randomized to the LICSW arm (p=0.24). There was no statistically significant difference in the effectiveness of randomization to the PRSS arm versus LICSW arm on risk of non-fatal opioid overdose, adjusting for history of previous overdose (relative risk=0.86, 95% confidence interval=0.67–1.11).
  
  Conclusions:
  
  In Rhode Island, USA, over one-in-four emergency department patients at high risk of overdose experiences a non-fatal opioid overdose in the 18 months post-discharge. We found no evidence that risk of non-fatal opioid overdose differs for emergency department patients receiving a behavioral intervention from a peer recovery support specialist versus a licensed clinical social worker.
  
  
• Subjects:
  Adult Behavior Therapy Emergency Service, Hospital Female Humans Male Middle Aged Opiate Overdose Opioid-Related Disorders Peer Group Rhode Island Social Workers

  More +
• Keywords:
  Behavioral Intervention Drug Overdose Opioid-related Disorders Opioid Overdose Peer Recovery Specialist Social Work Substance Use
• Source:
  Addiction. 119(12):2116-2128
• Pubmed ID:
  38987890
• Pubmed Central ID:
  PMC11568958
• Document Type:
  Journal Article
• Funding:
  Institute for Clinical and Economic Review/ ; R01CE003516/CC/CDC HHSUnited States/ ; R25 MH083620/MH/NIMH NIH HHSUnited States/ ; Arnold Ventures/ ; Cigna Foundation/ ; U54GM115677/GM/NIGMS NIH HHSUnited States/ ; United States Department of Defense/ ; NH/NIH HHSUnited States/ ; UR1TI080209/Substance Abuse and Mental Health Administration New England Addiction Technology Transfer Center/ ; U54 GM115677/GM/NIGMS NIH HHSUnited States/ ; R25MH083620/MH/NIMH NIH HHSUnited States/ ; P20GM125507/GM/NIGMS NIH HHSUnited States/ ; P20 GM125507/GM/NIGMS NIH HHSUnited States/ ; 3P30AI042853/National Institute of Allergy and Infectious Diseases/ ; K23DA046482/DA/NIDA NIH HHSUnited States/ ; P30 AI042853/AI/NIAID NIH HHSUnited States/ ; R01 CE003516/CE/NCIPC CDC HHSUnited States/ ; K23 DA046482/DA/NIDA NIH HHSUnited States/
• Volume:
  119
• Issue:
  12
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:3366965ba6c4ee140cb91079257be1e8ea33cd5b606104229dd790f768acc87ac386da9fc99f175721c9d007f800d698bf28fb4fddb5584ccbeefe44a7605b98
• Download URL:
  https://stacks.cdc.gov/view/cdc/170005/cdc_170005_DS1.pdf
• File Type:
  [PDF - 594.95 KB ]