Navigating Substance Use Care in the Emergency Department: A Scoping Review

TL;DR

This review summarizes how emergency departments in North America use community health workers and peer recovery specialists to help patients with substance use disorders access treatment and reduce ED visits.

Contribution

The study provides a comprehensive overview of the design and outcomes of ED-based CHW and PRS programs in North America.

Findings

Most programs included services navigation and motivational interviewing, with some showing increased treatment engagement.

ED-based programs were associated with reduced ED visits after implementation.

Research on outcomes like overdose and mortality remains limited due to varied study quality and design.

Abstract

Emergency departments (ED) are increasingly implementing community health worker (CHW) and peer recovery specialist (PRS) programs to engage patients with substance use disorders and link them to harm reduction and addiction treatment services. This scoping review aims to provide a broad overview of current research on ED-based CHW and PRS programs in North America.

We conducted a comprehensive database search on PubMed, Embase, MEDLINE/OVID, and World of Science through December 31, 2022. Articles were screened for inclusion by 2 reviewers with conflicts resolved by a third reviewer. Data extraction from full-text articles was completed by 3 reviewers and checked for accuracy by a separate reviewer.

We screened 12,187 abstracts, reviewed 398 full-text articles, and selected 64 papers about 35 distinct programs for inclusion. Study design included a mix of retrospective and prospective analyses, including a few randomized control trials. Core program components include services navigation (97.1%), motivational interviewing and/or a brief intervention (65.7%), harm reduction services (42.9%), and case management (28.6%). Most programs evaluating addiction treatment engagement noted comparative increase in treatment engagement after program implementation, which includes initiation of medication for opioid use disorder and outpatient treatment engagement. Programs evaluating ED utilization noted a reduction in ED visits after program implementation. Comparative outcome research about overdose, hospitalizations, mortality, and cost were limited.

ED-based CHW and PRS programs varied in design and services provided. Most studies measuring engagement reported favorable effects, although with limited effect size and heterogenous study quality, design, and metrics that limit generalizability. Future research should evaluate program effectiveness and identify key elements of successful ED-based programs to inform implementation.

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