Treatment Initiation and Outcomes Associated With Receipt of Emergency Department-Based Peer Support Following Opioid...

To examine whether participation in the New Jersey Opioid Overdose Recovery Program (OORP), an emergency department-based peer recovery support service, was associated with drug treatment initiation and other postdischarge outcomes.

This retrospective cohort study used the 2015 to 2020 New Jersey Medicaid claims linked to OORP evaluation data. Outcomes during 180-day follow-up were compared between opioid overdoses among OORP participants and a propensity score-matched group of overdoses among nonparticipants. Outcomes included any medication for opioid use disorder initiation (primary), percentage of days covered with medication for opioid use disorder, psychosocial treatment initiation and engagement, repeat opioid and any drug overdose, and all-cause and opioid-related acute care utilization. Outcomes were assessed using linear regression (for medication for opioid use disorder percentage of days covered and psychosocial treatment engagement) and Cox proportional hazards (for all other outcomes) models.

A total of 7,109 overdose events among 5,475 patients were included (62.2% men; 28.1% Black, 8.0% Hispanic, 56.1% White; mean age: 40.1 years). OORP participants (N=1,383 events) initiated medication for opioid use disorder at higher rates than nonparticipants (15% versus 12%; hazard ratio [HR]=2.31, 95% confidence interval [CI] 1.55 to 3.45). OORP participation was also associated with greater medication for opioid use disorder percentage of days covered (3.56 percentage points, 95% CI 0.72 to 6.47), psychosocial treatment initiation (HR=1.73, 95% CI 1.13 to 2.65), and psychosocial treatment engagement (11.97 percentage points, 95% CI 7.23 to 16.73), and lower risk of all-cause acute care utilization (HR=0.83; 95% CI 0.72 to 0.97). The association of the program with repeat overdose and opioid-related ED or inpatient visits was not statistically significant.

Peer recovery support service can support treatment linkages following ED-treated opioid overdose. Additional efforts are needed to retain patients in medication for opioid use disorder long-term, to reduce their risk for repeat overdose.