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We evaluated the effect of an ED behavioral intervention delivered by peer recovery support specialists (PRSSs) on non\u2010fatal opioid overdose.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Two\u2010arm, randomized trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Two EDs in Rhode Island, USA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>ED patients presenting with an opioid overdose, complications of opioid use disorder or a recent history of opioid overdose (November 2018\u2013May 2021). Among 648 participants, the mean age was 36.9\u00a0years, 68.2% were male and 68.5% were White.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention and comparator<\/jats:title><jats:p>Participants were randomized to receive a behavioral intervention from a PRSS (<jats:italic>n<\/jats:italic>\u2009=\u2009323) or a licensed clinical social worker (LICSW) (<jats:italic>n<\/jats:italic>\u2009=\u2009325). PRSS and LICSW used evidence\u2010based interviewing and intervention techniques, informed by their lived experience (PRSS) or clinical theory and practice (LICSW).<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>We identified non\u2010fatal opioid overdoses in the 18\u2009months following the ED visit through linkage to statewide emergency medical services data using a validated case definition. The primary outcome was any non\u2010fatal opioid overdose during the 18\u2010month follow\u2010up period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Among 323 participants randomized to the PRSS arm, 81 (25.1%) had a non\u2010fatal opioid overdose during follow\u2010up, compared with 95 (29.2%) of 325 participants randomized to the LICSW arm (<jats:italic>P<\/jats:italic>\u2009=\u20090.24). There was no statistically significant difference in the effectiveness of randomization to the PRSS arm versus the LICSW arm on the risk of non\u2010fatal opioid overdose, adjusting for the history of previous overdose (relative risk\u2009=\u20090.86, 95% confidence interval\u2009=\u20090.67\u20131.11).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In Rhode Island, USA, over one\u2010in\u2010four emergency department patients at high risk of overdose experience a non\u2010fatal opioid overdose in the 18\u2009months post\u2010discharge. We found no evidence that the risk of non\u2010fatal opioid overdose differs for emergency department patients receiving a behavioral intervention from a peer recovery support specialist versus a licensed clinical social worker.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.16581","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T04:01:36Z","timestamp":1720670496000},"page":"2116-2128","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Effect of a peer\u2010led emergency department behavioral intervention on non\u2010fatal opioid overdose: 18\u2010month outcome in the Navigator randomized controlled trial"],"prefix":"10.1111","volume":"119","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1802-6578","authenticated-orcid":false,"given":"Laura C.","family":"Chambers","sequence":"first","affiliation":[{"name":"Department of Epidemiology Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6943-9615","authenticated-orcid":false,"given":"Benjamin D.","family":"Hallowell","sequence":"additional","affiliation":[{"name":"Substance Use Epidemiology Program Rhode Island Department of Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten J.","family":"Langdon","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Human Behavior Warren Alpert Medical School of Brown University  Providence Rhode Island USA"},{"name":"Department of Psychiatry Rhode Island Hospital  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Samuels","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine David Geffen School of Medicine at University of California at Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda A.","family":"Mahoney","sequence":"additional","affiliation":[{"name":"Behavioral Healthcare Division Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals  Cranston Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca L.","family":"Beaudoin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Brown University School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0134-7052","authenticated-orcid":false,"given":"Brandon D. 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