Written by Elizabeth Cairns, Mobilize Recovery Special Projects and Michael Masiowski, MD, reviewed by Code Recover Clinician Advisors, August 2026

Peer recovery support specialist Rob Banghart talks about how a peer interaction made the difference for him to seek help.

Peer recovery support specialist Dr. Nicole Criss talks about barriers to care for people with OUD and how the hospital can intervene

The evidence for peer involvement is strongest where it matters most for the ED's role: connecting patients to ongoing treatment. In a study of more than 12,000 Medicaid patients treated for opioid overdose across 70 New Jersey hospitals, implementation of an ED-based peer recovery support program was associated with a significant increase in initiation of medication for opioid use disorder (MOUD) within 60 days of discharge. (source) That same study found the program's effects varied considerably from hospital to hospital — a reminder that peer programs deliver their benefit when they are well-implemented and embedded alongside other OUD interventions like ED buprenorphine initiation, rather than simply added on. Peers can often establish a baseline of trust that helps motivate patients who might otherwise leave against medical advice.

For the clinician, peers are invaluable teammates. They reduce burden by addressing well-established barriers to care — helping with stigma, readiness to accept care, and practical considerations such as housing, insurance, or social issues. Peer support across the OUD treatment cascade is associated with improved engagement and treatment retention. (source) By securing a warm handoff and providing post-discharge follow-up, peers also help address the high-risk period immediately following an overdose, when the risk of a subsequent overdose is elevated. (source)

When a clinician says "you need help," it can sound like a directive or even an insult; when a peer says "I've been where you are, and there's a way out," it sounds like a lifeline. This shifts the ED culture from one of judgement, neglect, or fear to one of safety, compassion, and care. A peer can also engage with the patient's family members when appropriate and permissible, orienting patients and families to the basics of recovery practices.

For clinicians, working beside someone who has been through active addiction and recovered can change the perception of what the future holds for that patient. This relationship puts a positive human face on SUD, fostering a more optimistic outlook and reducing stigma.

In summary, peers help ED clinicians by:

• Helping patients stay engaged in care in the ED (reducing AMA departures)
• Supporting linkage to treatment and increasing MOUD initiation after discharge
• Improving engagement and retention in treatment over the longer term
• Addressing barriers to care and social determinants of health
• Increasing patients' sense of safety and reducing fear
• Supporting patients during the high-risk post-overdose period
• Increasing clinician optimism about SUD outcomes
• Engaging with family members (within HIPAA restrictions)
• Mentoring patients on recovery practices