Randomised clinical trial of an emergency department-based peer recovery support intervention to increase treatment uptake and reduce recurrent overdose among individuals at high risk for opioid overdose: study protocol for the navigator trial

Abstract

IntroductionEffective approaches to increase engagement in treatment for opioid use disorder (OUD) and reduce the risk of recurrent overdose and death following emergency department (ED) presentation for opioid overdose remain unknown. As such, we aim to compare the effectiveness of behavioural interventions delivered in the ED by certified peer recovery support specialists relative to those delivered by licensed clinical social workers (LCSWs) in promoting OUD treatment uptake and reducing recurrent ED visits for opioid overdose.Methods and analysisAdult ED patients who are at high risk for opioid overdose (ie, are being treated for an opioid overdose or identified by the treating physician as having OUD) (n=650) will be recruited from two EDs in a single healthcare system in Providence, Rhode Island into a two-arm randomised trial with 18 months of follow-up postrandomisation. Eligible participants will be randomly assigned (1:1) in the ED to receive a behavioural intervention from a certified peer recovery support specialist or a behavioural intervention from an LCSW. The primary outcomes are engagement in formal OUD treatment within 30 days of the initial ED visit and recurrent ED visits for opioid overdose within 18 months of the initial ED visit, as measured through statewide administrative records.Ethics and disseminationThis protocol was approved by the Rhode Island Hospital institutional review board (Approval Number: 212418). Data will be presented at national and international conferences and published in peer-reviewed journals.Trial registration numberNCT03684681.

Implementing hospital-based peer recovery support services for substance use disorder

“…In Massachusetts, inpatients with SUD who were seen by an addiction consult team including Recovery Specialists located in outpatient settings had lower 30-day readmission rates, reduced addiction severity, and a greater increase in the number of days of abstinence, though the relative contribution of Recovery Specialists is unknown (31,32). In Rhode Island, a review of peer recovery support consultations for ED patients at risk of opioid overdose demonstrated non-significant trends suggesting a shorter time to the initiation of medications for opioid use disorder, decreased ED revisits for opioid overdose, and decreased mortality; a randomized controlled trial with primary outcomes of engagement in SUD treatment and ED revisits for opioid overdose is also planned (33,34).…”

Implementation and maintenance of an emergency department naloxone distribution and peer recovery specialist program

“…Additionally, we were not able to assess the important RE‐AIM implementation outcome of LOOP efficacy, measured by follow‐up treatment engagement and overdose mortality following discharge. Preliminary research suggests improved outpatient treatment engagement with receipt of a peer recovery specialist, 13 but research evaluating the comparative efficacy of post‐overdose behavioral interventions is ongoing 45 …”

“…We used a modified RE‐AIM framework 23 to evaluate LOOP reach , adoption , implementation , and maintenance since the study site hospitals' certification by RIDOH as Level 1 facilities in September 2017. Preliminary studies have previously examined the efficacy of LOOP interventions 13 and are ongoing, 45 but was not examined in this study. Primary study outcomes were ED provision of (1) take‐home naloxone; (2) behavioral counseling (i.e., licensed clinical social worker, peer recovery support specialist, and/or psychiatric consultation); and (3) referral to community‐based treatment.…”

“…Temporal trends in the proportion of patients discharged from two hospitals following an opioid overdose event receiving (A) take-home naloxone, (B) behavioral counseling, and (C) referral to treatment, 2017-2020. Solid line represents the line of best fit ongoing 45. Minimal use of buprenorphine in the ED was a significant gap during the study period.…”

Emergency department buprenorphine/naloxone: What we can achieve with system-level support and local champions

“…4 This evidence demonstrates that the denominator of ED patients with opioid use disorder who we could identify and potentially impact is far larger than those presenting with opioid intoxication or withdrawal. Developing and implementing evidence-based methods to identify patients with opioid use disorder who are at-risk for an overdose and likely to benefit from a targeted intervention 5 (e.g., integrated screening or in situ peer navigators) remain a challenging but important task.…”