Emergency Department Peer Recovery Support Services for Individuals with Substance Use Disorders: A Systematic Review...

Individuals with substance use disorders (SUDs) access care through emergency departments (EDs) more frequently than the general population, representing a critical opportunity for addiction treatment linkage. Peer recovery support services (PRSS) utilize individuals with lived recovery experience to provide peer support for those struggling with addiction. This service may be particularly helpful in the ED, where prior negative experiences can erode patient trust and care often involves extended waiting periods during which motivation can fluctuate. PRSS may enhance engagement in this setting by offering relationship-based support from someone who patients can identify with and who can provide practical information on service navigation. We conducted a systematic review of comparative studies evaluating ED-based PRSS for individuals with SUDs versus a non-PRSS comparator (eg, usual care). A medical librarian searched the literature through 8/2025; 1,801 citations were retrieved, 708 duplicates were removed, 1,093 records were screened, and 127 studies underwent full-text review. Nine studies published between 2011 and 2025, representing 14,883 unique individuals, met inclusion criteria. Most (seven) were considered moderate regarding global risk of bias. Types of substance and outcomes varied by study; opioids (n=7) were the most commonly evaluated substance, while overdose (n=6), all-cause hospital return (n=3), all-cause mortality (n=3), and SUD treatment linkage (n=3) were the most commonly evaluated outcomes. The findings were mixed; PRSS has not yet demonstrated clear superiority over non-PRSS comparators, though this may evolve as research continues. Consisting solely of quantitative studies, the present review fails to capture the qualitative patient experience of working with a peer, which may have been a positive, recovery-promoting encounter, even in the absence of statistical significance. While ED-based PRSS interventions are individualized services that promote connection and may increase patient comfort, the current evidence base remains heterogeneous, limited in comparative studies, and subject to bias.