Grant Recipient: Rhode Island Hospital
Term: 2018 –2022
Principal Investigators: Francesca Beaudoin, M.D., Ph.D., Rhode Island Hospital
Brandon Marshall, Ph.D., Brown University
Summary: This is a randomized controlled trial (RCT) of a peer navigator program for emergency department (ED) patients presenting with an opioid overdose in Rhode Island, which has had one of the highest rates of overdose mortality in the nation. Peer navigators are individuals in long-term recovery for opioid addiction who have undergone extensive training to provide ED patients with recovery support and referrals to treatment, and remain engaged with patients for at least 90 days after their discharge from the ED. The peer navigator program was launched in 2014 at Rhode Island Hospital, which treats the majority of the state’s overdose patients.
The state currently plans to increase the number of certified peer navigators in Rhode Island in 2018 and would likely further expand the program should it be shown in this RCT to be more effective than standard care. Additionally, jurisdictions in New York, Connecticut, Massachusetts, New Hampshire, and New Jersey have, or are in the process of, creating programs based on the Rhode Island peer navigator model, with several other states expressing an interest in doing so.
Besides being a rapidly expanding approach to addressing the opioid crisis, the peer navigator model shares many similarities with the Recovery Coach model, which has been found in a large, well-conducted RCT to produce promising effects on substance use (e.g., a 29% reduction in the likelihood of mothers delivering a substance-exposed infant).
This study will randomly assign approximately 650 ED patients admitted for an opioid overdose to either a group that will receive peer navigator services or a control group that will receive usual care (i.e., a brief, one-time session with a social worker in the ED). Random assignment will take place on a rolling basis as patients present in the ED during the two-year study enrollment period.
The study’s primary outcomes will be (i) engagement in formal addiction treatment from a licensed substance abuse treatment provider within 30 days following patients’ original ED visit, and (ii) repeat ED visits for an opioid overdose within 18 months of the original ED visit. These outcomes will be measured using administrative data collected through Rhode Island’s overdose surveillance platform.
The study’s pre-specified analysis plan is linked here.