# Peer Navigator Intervention and Opioid-Related Adverse Events for Emergency Department Patients: A Randomized Clinical Trial

## TL;DR

A study tested if peer support in emergency departments after opioid overdoses reduces future opioid-related issues, but found no significant difference compared to standard care.

## Contribution

This is one of the few rigorous trials evaluating peer navigator interventions in emergency departments for opioid use disorder.

## Key findings

- The peer navigator intervention did not significantly reduce opioid-related adverse events compared to standard care.
- High participant satisfaction with the peer intervention was reported despite no significant clinical benefit.
- Future research should explore modifications to improve engagement and outcomes in this high-risk population.

## Abstract

Does a peer navigator intervention delivered to patients presenting to an emergency department (ED) after a nonfatal opioid overdose reduce subsequent opioid-related adverse events?

In this randomized clinical trial of 247 patients from 4 New York City EDs, the peer intervention arm and site-directed care arm demonstrated similar numbers of opioid-related adverse events in the 12 months after baseline.

These results suggest that future research should further examine impacts on other outcomes, such as mortality, and intervention modifications to enhance follow-up contacts and engagement with medications for opioid use disorder.

This randomized clinical trial assesses whether receipt of a peer navigator intervention following presentation to the emergency department (ED) with opioid-involved overdose is associated with reductions in opioid-related adverse events compared with site-directed care.

Emergency departments (EDs) serve patients at high risk for overdose. There is increasing interest in peer-delivered ED interventions for substance use but little rigorous research on their effectiveness.

To examine the effectiveness of an initiative (Relay) operated by the New York City Health Department that dispatches trained peer wellness advocates (WAs) to support ED patients after a nonfatal opioid overdose.

This randomized clinical trial compared Relay and site-directed care (SDC) at 4 EDs in New York, New York. Adult patients presenting after opioid-involved overdose were enrolled from October 6, 2020, to June 30, 2022, with 12 months of outcome follow-up. Statistical analysis was performed from November 4, 2024, to May 6, 2025.

ED workers (generally physicians) called the Relay hotline for patients presenting after a suspected opioid-involved overdose. WAs met patients in the ED to provide peer support and brief overdose risk reduction education. WAs attempted to contact patients for 90 days to provide ongoing support, education, and referrals using a harm reduction framework.

Opioid-related adverse events (any opioid-involved overdose [fatal or nonfatal] or any other substance use–related ED visit) in the 12 months after enrollment were identified using health care administrative data plus self-report.

Among a total of 253 participants randomized, 127 were randomized to the Relay arm and 126 to the SDC arm. A total of 247 participants, 125 in the Relay arm and 122 in the SDC arm (190 [76.9%] men; 80 [32.4%] Black, 126 [51.0%] Hispanic or Latinx, 76 [30.8%] White, and 91 other race [36.8%]), were included in the intention-to-treat analyses. No statistically significant differences between arms were observed for the primary outcome (mean [SD] opioid-related adverse events, 3.29 [4.52] in the Relay arm and 4.10 [9.36] in the SDC arm; rate ratio, 1.02; 95% CI, 0.72-1.45; P = .90). By 12 months after enrollment, 24 participants (9.7%) had died (17 [70.8%] due to overdose). Relay participants reported high satisfaction with the ED intervention.

This randomized clinical trial examining the impact of an ED peer navigator intervention on subsequent opioid-related adverse events did not find significant outcome differences for Relay vs SDC participants. These findings highlight the importance of intervening to save lives in this high-risk population and suggest potential refinements to future ED peer intervention research.

ClinicalTrials.gov Identifier: NCT04317053