Evaluating a Peer Navigator Intervention for Opioid-Related Overdose

Key Takeaways:

• In a randomized four-site emergency department trial, investigators found no significant difference in opioid-related adverse events between a peer navigator intervention and site-directed care.
• The Relay model began in the emergency department with peer support and education and included attempted follow-up contact for 90 days after discharge.

Investigators enrolled adult patients after opioid-involved overdose at four New York City emergency departments. Enrollment occurred from October 2020 through June 2022, and participants were followed for one year after study entry. The trial was designed as a direct comparison of Relay and usual site-directed care after emergency department presentation. In the intention-to-treat sample, 190 of 247 participants (76.9%) were men; participants were reported as 32.4% Black, 51.0% Hispanic or Latinx, 30.8% White, and 36.8% other race.

In the Relay peer navigator program, emergency department clinicians called a hotline when patients presented after suspected opioid-involved overdose. Trained peer wellness advocates then met patients in the emergency department in person. The emergency department encounter included peer support and brief overdose risk reduction education. Advocates also attempted contact for 90 days after discharge to provide ongoing support, education, and referrals.

In the intention-to-treat analysis, the primary outcome (opioid-related adverse events) was fatal or nonfatal opioid-involved overdose or another substance use–related emergency department visit during 12 months of follow-up. Researchers identified events using health care administrative data plus self-report. Among 253 randomized participants, 247 were included in the intention-to-treat analysis, with 125 assigned to Relay and 122 to site-directed care. Mean opioid-related adverse event counts were 3.29 in the Relay arm and 4.10 in the site-directed care arm. The study did not detect a significant between-group difference for the primary endpoint. Notably, Relay participants reported high satisfaction with the emergency department intervention.

By 12 months, 24 participants (9.7%) had died, and 17 of those deaths (70.8%) were due to overdose. The authors concluded that the trial did not find significant outcome differences between Relay and site-directed care.

These findings highlight the importance of intervening to save lives in this high-risk population and suggest the need for potential refinements to future ED peer intervention research.