{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T14:41:09Z","timestamp":1767796869243,"version":"3.49.0"},"reference-count":36,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,7]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The USA is facing a substance use workforce crisis, due in part to a shortage of providers. Substance use peer workers (PWs) fill a critical gap in the care continuum and are a growing sector of the workforce. In their daily work of providing non-clinical services to highly vulnerable people who use drugs, PWs are repeatedly exposed to stress, trauma and loss, which can adversely affect their well-being and recovery. This review aims to synthesise available evidence on PWs\u2019 experiences working in the field, its impact on their recovery and their occupational support needs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will conduct a qualitative systematic review using the PRISMA flow diagram to illustrate article identification and screening. We will search six databases (Academic Search Complete, APA PsycInfo, CINAHL, MEDLINE, SocINDEX, PubMed) for English-language peer-reviewed scientific literature published between January 1, 2000, and August 13, 2025. Eligible articles must primarily focus on PWs\u2019 perspectives and experiences related to working in the field and the impact of this work on their recovery. Article screening and data extraction will be conducted independently by two trained research assistants and supervised by a third researcher who will resolve any disagreements. We will use a thematic synthesis approach to synthesise findings of included articles and report synthesised findings in accordance with Enhancing Transparency in Reporting the Synthesis of Qualitative Findings guidelines. We will assess article quality using the CASP Qualitative Checklist and assess our confidence in individual review findings using the GRADE-CERQual approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics approval is not required, as the research only involves published work. Findings will be disseminated via peer-reviewed publication, conference presentations and online via social media.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD420251105491<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-109353","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T10:13:47Z","timestamp":1764843227000},"page":"e109353","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding recovery experiences and occupational support needs among substance use peer workers: a qualitative systematic review protocol"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5841-5247","authenticated-orcid":false,"given":"Katie","family":"McCormick","sequence":"first","affiliation":[{"name":"School of Social Work, The University of Texas at Austin, Austin, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8415-3869","authenticated-orcid":false,"given":"Kasey","family":"Claborn","sequence":"additional","affiliation":[{"name":"School of Social Work, The University of Texas at Austin, Austin, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"2026010703464254000_15.12.e109353.1","unstructured":"Substance abuse and mental health services administration . Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health (HHS Publication no.PEP24-07-021, NSDUH Series H-59). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 2024. Available: https:\/\/www.samhsa.gov\/data\/report\/2023-nsduh-annual-national-report"},{"key":"2026010703464254000_15.12.e109353.2","unstructured":"Centers for Disease Control and Prevention, National Center for Health Statistics . U.S. overdose deaths decrease almost 27% in 2024 [Press release], 2024. Available: https:\/\/www.cdc.gov\/nchs\/pressroom\/nchs_press_releases\/2025\/20250514.htm [Accessed 15 Jul 2025]."},{"key":"2026010703464254000_15.12.e109353.3","unstructured":"National Safety Council . Top 10 preventable injuries \u2013 data details. in injury facts. Available: https:\/\/injuryfacts.nsc.org\/all-injuries\/deaths-by-demographics\/top-10-preventable-injuries\/data-details\/ [Accessed 15 Jul 2025]."},{"key":"2026010703464254000_15.12.e109353.4","unstructured":"National Association of State Alcohol and Drug Abuse Directors . The substance use workforce crisis: Drivers, challenges, and promising strategies (POST-2), 2025. Available: https:\/\/nasadad.org\/wp-content\/uploads\/2025\/04\/The-Substance-Use-Workforce-Crisis-Drivers-Challenges-and-Promising-Strategies_POST-2.pdf"},{"key":"2026010703464254000_15.12.e109353.5","unstructured":"Substance Abuse and Mental Health Services Administration, National Model Standards for Peer Support Certification . Publication no.PEP23-10-01-001, Substance Abuse and Mental Health Services Administration, 2023. Available: https:\/\/library.samhsa.gov\/sites\/default\/files\/pep23-10-01-001.pdf"},{"key":"2026010703464254000_15.12.e109353.6","unstructured":"U.S. Department of Health and Human Services . U.S. Department of Health and Human Services; Peer support specialist: A growing mental health and addictions workforce (PEP24-08-005), 2024. Available: https:\/\/library.samhsa.gov\/sites\/default\/files\/peer-support-mh-addictions-workforce-pep24-08-005.pdf"},{"key":"2026010703464254000_15.12.e109353.7","doi-asserted-by":"crossref","DOI":"10.1186\/s12954-023-00898-4","article-title":"\u201cIt\u2019s starting to weigh on me\u201d: Exploring the Experiences and Support Needs of Harm Reduction Staff in Connecticut using the Social-Ecological Model","volume":"20","author":"Hill","year":"2023","journal-title":"Harm Reduct J"},{"key":"2026010703464254000_15.12.e109353.8","doi-asserted-by":"crossref","first-page":"103076","DOI":"10.1016\/j.drugpo.2020.103076","article-title":"Essential work, precarious labour: The need for safer and equitable harm reduction work in the era of COVID-19","volume":"90","author":"Olding","year":"2021","journal-title":"Int J Drug Policy"},{"key":"2026010703464254000_15.12.e109353.9","unstructured":"National Certification Board for Behavioral Health Professionals . National certified peer specialist (NCPS)."},{"key":"2026010703464254000_15.12.e109353.10","unstructured":"Substance abuse and mental health services administration . Chapter 6 \u2013 how to become a peer specialist. in incorporating peer support into substance use disorder treatment services (treatment improvement protocol series no.64). U.S. Department of Health and Human Services, 2023. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK596268\/"},{"key":"2026010703464254000_15.12.e109353.11","unstructured":"Substance Abuse and Mental Health Services Administration . Peer support workers for those in recovery. U.S. Department of Health and Human Services; 2024."},{"key":"2026010703464254000_15.12.e109353.12","unstructured":"Substance Abuse and Mental Health Services Administration . U.S. Department of Health and Human Services; Incorporating peer support into substance use disorder treatment services (Treatment Improvement Protocol Series no.64), 2024. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK596262\/pdf\/Bookshelf_NBK596262.pdf"},{"key":"2026010703464254000_15.12.e109353.13","unstructured":"National Institutes of Health . Optimizing the quality, reach, and impact of addiction services. U.S. Department of Health and Human Services; 2025."},{"key":"2026010703464254000_15.12.e109353.14","unstructured":"National Institutes of Health . Research recovery networks. U.S. Department of Health and Human Services; 2025."},{"key":"2026010703464254000_15.12.e109353.15","doi-asserted-by":"crossref","first-page":"104419","DOI":"10.1016\/j.drugpo.2024.104419","article-title":"\u201cEverybody is impacted. Everybody\u2019s hurting\u201d: Grief, loss and the emotional impacts of overdose on harm reduction workers","volume":"127","author":"Kolla","year":"2024","journal-title":"Int J Drug Policy"},{"key":"2026010703464254000_15.12.e109353.16","doi-asserted-by":"crossref","DOI":"10.1186\/s12954-024-00975-2","article-title":"\u201cWanna cry this out real quick?\u201d: an examination of secondary traumatic stress risk and resilience among post-overdose outreach staff in Massachusetts","volume":"21","author":"Schoenberger","year":"2024","journal-title":"Harm Reduct J"},{"key":"2026010703464254000_15.12.e109353.17","doi-asserted-by":"crossref","first-page":"113631","DOI":"10.1016\/j.socscimed.2020.113631","article-title":"\u201cAnd we just have to keep going\u201d: Task shifting and the production of burnout among overdose response workers with lived experience","volume":"270","author":"Olding","year":"2021","journal-title":"Social Science & Medicine"},{"key":"2026010703464254000_15.12.e109353.18","doi-asserted-by":"crossref","unstructured":"McCormick K , Shah R , Kulkarni S , et al . Caught between crisis and criminalization: Unveiling occupational stressors affecting harm reduction workers. J Soc Social Work Res 2025. doi:10.1086\/736304","DOI":"10.1086\/736304"},{"key":"2026010703464254000_15.12.e109353.19","doi-asserted-by":"crossref","first-page":"102796","DOI":"10.1016\/j.drugpo.2020.102796","article-title":"The Bell Tolls for Thee & Thine: Compassion Fatigue & the Overdose Epidemic","volume":"85","author":"Winstanley","year":"2020","journal-title":"Int J Drug Policy"},{"key":"2026010703464254000_15.12.e109353.20","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/s41542-019-00045-1","article-title":"Compassion Fatigue, Secondary Traumatic Stress, and Vicarious Traumatization: a Qualitative Review and Research Agenda","volume":"3","author":"Rauvola","year":"2019","journal-title":"Occup Health Sci"},{"key":"2026010703464254000_15.12.e109353.21","doi-asserted-by":"crossref","DOI":"10.1186\/s12954-021-00507-2","article-title":"Organizational support for frontline harm reduction and systems navigation work among workers with living and lived experience: qualitative findings from British Columbia, Canada","volume":"18","author":"Greer","year":"2021","journal-title":"Harm Reduct J"},{"key":"2026010703464254000_15.12.e109353.22","unstructured":"Substance Abuse and Mental Health Services Administration (SAMHSA) . Addressing Burnout in the Behavioral Health Workforce Through Organizational Strategies. Rockville, MD: National Mental Health and Substance Use Policy Laboratory. SAMHSA: SAMHSA Publication no.PEP22-06-02-005, 2022. Available: https:\/\/library.samhsa.gov\/sites\/default\/files\/pep22-06-02-005.pdf"},{"key":"2026010703464254000_15.12.e109353.23","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1177\/29767342241281009","article-title":"What We Know About the Peer Workforce and Economic Evaluation for Peer Recovery Support Services: A Systematic Review","volume":"46","author":"Castedo de Martell","year":"2025","journal-title":"Substance Use & Addiction Journal"},{"key":"2026010703464254000_15.12.e109353.24","first-page":"256","article-title":"Roles and Effects of Peer Recovery Coach Intervention in the Field of Substance Abuse: An Integrative Literature Review","volume":"16","author":"Kang","year":"2022","journal-title":"Asian Nurs Res (Korean Soc Nurs Sci)"},{"key":"2026010703464254000_15.12.e109353.25","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2024.1515264","article-title":"Workforce outcomes among substance use peer supports: a scoping review of individual and organizational influences","volume":"12","author":"Bell","year":"2024","journal-title":"Front Public Health"},{"key":"2026010703464254000_15.12.e109353.26","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-025-23006-6","article-title":"\u201cYou are helping from the heart not just from the head\u201d: a systematic review and qualitative evidence synthesis of the experiences of peer workers working with people experiencing homelessness and substance use","volume":"25","author":"Carver","year":"2025","journal-title":"BMC Public Health"},{"key":"2026010703464254000_15.12.e109353.27","doi-asserted-by":"crossref","unstructured":"Aromataris E , Lockwood C , Porritt K , eds. JBI Manual for Evidence Synthesis (JBI).2024. Available: https:\/\/synthesismanual.jbi.global","DOI":"10.46658\/JBIMES-24-01"},{"key":"2026010703464254000_15.12.e109353.28","unstructured":"Glenton C , Bohren MA , Downe S , et al . Cochrane Qualitative Evidence Synthesis: Protocol and review template. Version 1.4b. Cochrane Person Centred Care, Health Systems and Public Health and Cochrane Norway 2023. doi:10.5281\/zenodo.5101812"},{"key":"2026010703464254000_15.12.e109353.29","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g7647","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation","volume":"350","author":"Shamseer","year":"2015","journal-title":"BMJ"},{"key":"2026010703464254000_15.12.e109353.30","unstructured":"Melbourne, AU: Veritas Health Innovation; Covidence Systematic Review Software, 2025. 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Interactive Summary of Qualitative Findings, Available: https:\/\/isoq.epistemonikos.org\/about [Accessed 30 Jun 2025]."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-109353","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:48:13Z","timestamp":1767786493000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-109353"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":36,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,4]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bmjopen-2025-109353"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-109353","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}