Abstract：
OBJECTIVE: Emergency departments (EDs) provide an opportunity to identify people at risk of overdose and reduce the risk. We evaluated the effect of an ED behavioral intervention delivered by peer recovery support specialists (PRSSs) on non-fatal opioid overdose.
METHODS: Two-arm, randomized trial.
METHODS: Two EDs in Rhode Island, USA.
METHODS: ED patients presenting with an opioid overdose, complications of opioid use disorder or a recent history of opioid overdose (November 2018-May 2021). Among 648 participants, the mean age was 36.9 years, 68.2% were male and 68.5% were White.
UNASSIGNED: Participants were randomized to receive a behavioral intervention from a PRSS (n = 323) or a licensed clinical social worker (LICSW) (n = 325). PRSS and LICSW used evidence-based interviewing and intervention techniques, informed by their lived experience (PRSS) or clinical theory and practice (LICSW).
METHODS: We identified non-fatal opioid overdoses in the 18 months following the ED visit through linkage to statewide emergency medical services data using a validated case definition. The primary outcome was any non-fatal opioid overdose during the 18-month follow-up period.
RESULTS: Among 323 participants randomized to the PRSS arm, 81 (25.1%) had a non-fatal opioid overdose during follow-up, compared with 95 (29.2%) of 325 participants randomized to the LICSW arm (P = 0.24). There was no statistically significant difference in the effectiveness of randomization to the PRSS arm versus the LICSW arm on the risk of non-fatal opioid overdose, adjusting for the history of previous overdose (relative risk = 0.86, 95% confidence interval = 0.67-1.11).
CONCLUSIONS: In Rhode Island, USA, over one-in-four emergency department patients at high risk of overdose experience a non-fatal opioid overdose in the 18 months post-discharge. We found no evidence that the risk of non-fatal opioid overdose differs for emergency department patients receiving a behavioral intervention from a peer recovery support specialist versus a licensed clinical social worker.
METHODS: Two-arm, randomized trial.
METHODS: Two EDs in Rhode Island, USA.
METHODS: ED patients presenting with an opioid overdose, complications of opioid use disorder or a recent history of opioid overdose (November 2018-May 2021). Among 648 participants, the mean age was 36.9 years, 68.2% were male and 68.5% were White.
UNASSIGNED: Participants were randomized to receive a behavioral intervention from a PRSS (n = 323) or a licensed clinical social worker (LICSW) (n = 325). PRSS and LICSW used evidence-based interviewing and intervention techniques, informed by their lived experience (PRSS) or clinical theory and practice (LICSW).
METHODS: We identified non-fatal opioid overdoses in the 18 months following the ED visit through linkage to statewide emergency medical services data using a validated case definition. The primary outcome was any non-fatal opioid overdose during the 18-month follow-up period.
RESULTS: Among 323 participants randomized to the PRSS arm, 81 (25.1%) had a non-fatal opioid overdose during follow-up, compared with 95 (29.2%) of 325 participants randomized to the LICSW arm (P = 0.24). There was no statistically significant difference in the effectiveness of randomization to the PRSS arm versus the LICSW arm on the risk of non-fatal opioid overdose, adjusting for the history of previous overdose (relative risk = 0.86, 95% confidence interval = 0.67-1.11).
CONCLUSIONS: In Rhode Island, USA, over one-in-four emergency department patients at high risk of overdose experience a non-fatal opioid overdose in the 18 months post-discharge. We found no evidence that the risk of non-fatal opioid overdose differs for emergency department patients receiving a behavioral intervention from a peer recovery support specialist versus a licensed clinical social worker.
摘要：
目的：急诊科（ED）提供了一个机会来识别有用药过量风险的人并降低风险。我们评估了由同伴康复支持专家（PRSS）提供的ED行为干预对非致命性阿片类药物过量的影响。
方法：双臂，随机试验。
方法：罗德岛州的两个ED，美国。
方法：出现阿片类药物过量的ED患者，阿片类药物使用障碍的并发症或近期阿片类药物过量史(2018年11月-2021年5月).在648名参与者中，平均年龄是36.9岁,男性占68.2％，白人占68.5％。
■参与者被随机分配接受来自PRSS（n=323）或有执照的临床社会工作者（LICSW）（n=325）的行为干预。PRSS和LICSW使用基于证据的访谈和干预技术，根据他们的生活经验(PRSS)或临床理论和实践(LICSW)。
方法：我们使用经过验证的病例定义，通过与全州紧急医疗服务数据的关联，确定了ED访视后18个月内的非致命性阿片类药物过量。主要结果是18个月随访期间的任何非致命性阿片类药物过量。
结果：在随机分配到PRSS组的323名参与者中，81（25.1％）在随访期间出现非致命性阿片类药物过量，与随机分配到LICSW组的325例参与者中的95例(29.2%)相比(P=0.24).在非致命性阿片类药物过量的风险上，PRSS组的随机化效果与LICSW组的随机化效果无统计学差异，调整既往用药过量史（相对风险=0.86，95％置信区间=0.67-1.11）。
结论：在罗德岛，美国,超过四分之一的急诊科高危患者在出院后18个月内经历非致命性阿片类药物过量.我们没有发现证据表明，接受同伴康复支持专家的行为干预的急诊科患者与持牌临床社会工作者的非致命性阿片类药物过量的风险不同。
方法：双臂，随机试验。
方法：罗德岛州的两个ED，美国。
方法：出现阿片类药物过量的ED患者，阿片类药物使用障碍的并发症或近期阿片类药物过量史(2018年11月-2021年5月).在648名参与者中，平均年龄是36.9岁,男性占68.2％，白人占68.5％。
■参与者被随机分配接受来自PRSS（n=323）或有执照的临床社会工作者（LICSW）（n=325）的行为干预。PRSS和LICSW使用基于证据的访谈和干预技术，根据他们的生活经验(PRSS)或临床理论和实践(LICSW)。
方法：我们使用经过验证的病例定义，通过与全州紧急医疗服务数据的关联，确定了ED访视后18个月内的非致命性阿片类药物过量。主要结果是18个月随访期间的任何非致命性阿片类药物过量。
结果：在随机分配到PRSS组的323名参与者中，81（25.1％）在随访期间出现非致命性阿片类药物过量，与随机分配到LICSW组的325例参与者中的95例(29.2%)相比(P=0.24).在非致命性阿片类药物过量的风险上，PRSS组的随机化效果与LICSW组的随机化效果无统计学差异，调整既往用药过量史（相对风险=0.86，95％置信区间=0.67-1.11）。
结论：在罗德岛，美国,超过四分之一的急诊科高危患者在出院后18个月内经历非致命性阿片类药物过量.我们没有发现证据表明，接受同伴康复支持专家的行为干预的急诊科患者与持牌临床社会工作者的非致命性阿片类药物过量的风险不同。
