Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose

Abstract

Importance: Patients treated in emergency departments (EDs) for opioid overdose often need drug treatment yet are rarely linked to services after discharge. Emergency department-based peer support is a promising approach for promoting treatment linkage, but evidence of its effectiveness is lacking.

Objective: To examine the association of the Opioid Overdose Recovery Program (OORP), an ED peer recovery support service, with postdischarge addiction treatment initiation, repeat overdose, and acute care utilization.

Design, setting, and participants: This intention-to-treat retrospective cohort study used 2014 to 2020 New Jersey Medicaid data for Medicaid enrollees aged 18 to 64 years who were treated for nonfatal opioid overdose from January 2015 to June 2020 at 70 New Jersey acute care hospitals. Data were analyzed from August 2022 to November 2023.

Exposure: Hospital OORP implementation.

Main outcomes and measures: The primary outcome was medication for opioid use disorder (MOUD) initiation within 60 days of discharge. Secondary outcomes included psychosocial treatment initiation, medically treated drug overdoses, and all-cause acute care visits after discharge. An event study design was used to compare 180-day outcomes between patients treated in OORP hospitals and those treated in non-OORP hospitals. Analyses adjusted for patient demographics, comorbidities, and prior service use and for community-level sociodemographics and drug treatment access.

Results: A total of 12 046 individuals were included in the study (62.0% male). Preimplementation outcome trends were similar for patients treated in OORP and non-OORP hospitals. Implementation of the OORP was associated with an increase of 0.034 (95% CI, 0.004-0.064) in the probability of 60-day MOUD initiation in the half-year after implementation, representing a 45% increase above the preimplementation mean probability of 0.075 (95% CI, 0.066-0.084). Program implementation was associated with fewer repeat medically treated overdoses 4 half-years (-0.086; 95% CI, -0.154 to -0.018) and 5 half-years (-0.106; 95% CI, -0.184 to -0.028) after implementation. Results differed slightly depending on the reference period used, and hospital-specific models showed substantial heterogeneity in program outcomes across facilities.

Conclusions and relevance: In this cohort study of patients treated for opioid overdose, OORP implementation was associated with an increase in MOUD initiation and a decrease in repeat medically treated overdoses. The large variation in outcomes across hospitals suggests that treatment effects were heterogeneous and may depend on factors such as implementation success, program embeddedness, and availability of other hospital- and community-based OUD services.

Figure 1.. Cohort Flow Diagram

ED indicates emergency department; MOUD, medication for opioid use disorder; NPI, National Provider Identifier.

Figure 2.. Unadjusted Patient Outcomes Before and After Opioid Overdose Recovery Program Implementation for Intervention and Comparison Groups

Error bars represent 95% CIs. MOUD indicates medication for opioid use disorder.

Figure 3.. Event Study Plots Showing Associations of Opioid Overdose Recovery Program (OORP) Implementation With Outcomes

Half-years are relative to OORP implementation, which is represented as half-year 0. Estimates represent the difference in outcomes relative to the half-year of OORP implementation (time 0) in patients treated in intervention vs comparison group hospitals. Models controlled for variables in the Table and the percentage of non-Hispanic White individuals in the community and included hospital and time fixed effects. Error bars represent 95% CIs, calculated with SEs clustered on hospital and patient zip code. MOUD indicates medication for opioid use disorder.

Figure 4.. Associations of Opioid Overdose Recovery Program Implementation With 60-Day Initiation of Medication for Opioid Use Disorder (MOUD) and 180-Day Drug Overdoses by Hospital

Treatment effects were estimated from 2 × 2 difference-in-differences models for 37 hospitals with 30 or more overdoses over the study period. Models controlled for variables in the Table. Differences in outcomes before and after OORP implementation in patients treated in the intervention hospitals vs the comparison group hospitals are shown. Error bars represent 95% CIs, calculated with SEs clustered on hospital and patient zip code.