Effect of a peer-led emergency department behavioral intervention on non-fatal opioid overdose: 18-month outcome in the Navigator randomized controlled trial
Abstract
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…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 648 participants or records.
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