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

Dr. Lindsey Jennings talks about her experience working with peers in her Emergency Department over nearly ten years.

As part of the care team, a peer is a person who has valuable lived experience of overcoming the disease of addiction. In addition, they are trained and certified in peer support. Clinicians should view peers as subject matter experts on the lived experience of OUD and on overcoming the barriers that SUD often presents. When a peer suggests that a patient is not ready for a conversation or that a specific approach might be triggering, the clinical team should take that feedback seriously.

At the same time, peers should be mindful of the clinician's role and responsibility and respect medical decisions (such as medication prescription) without pushback. Finding a mutually respectful balance is key.

What to hand off to a peer — and what not to

Clinicians new to working with peers tend to err in one of two directions: underusing the peer as though they were a transport or paperwork service, or overusing them as though they were unlicensed clinical staff. Neither serves the patient. Peers are best deployed for the work only they can do: building rapport, easing fear, explaining what happens next in language the patient can absorb, troubleshooting barriers like housing or transportation, and securing the connection to ongoing care. They should not be asked to perform clinical tasks, deliver diagnoses, or be used as a de-escalation tool for an agitated patient without clinical support present. A peer's value is relational, not procedural, and directing them toward clerical work pulls them away from the patients who need them.

Introducing the peer

The clinician's role in introducing the peer is brief but decisive: rather than simply telling a patient that "someone will come talk to you," introduce the peer directly, by name, and frame their role in a sentence — that this is someone who has been through recovery themselves and is here to help. A direct, in-person introduction from a trusted clinician signals to the patient that the peer is part of the care team, not an outsider, which can make the difference in whether the patient is willing to engage.

Confidentiality and documentation

SUD treatment records carry federal protections beyond HIPAA under 42 CFR Part 2, with enforcement of the updated Part 2 rule beginning in February 2026. (source) In practice, peers are typically given access to the electronic health record — often at a restricted level — so they can document their interactions with patients. This documentation is not incidental; it is a core part of the workflow, giving the rest of the care team visibility into what the peer has learned and what the patient needs, and making the handoff to ongoing care possible. Peers should be trained on the institution's documentation standards and on Part 2's requirements around redisclosure, so that the patient's SUD information is shared appropriately and only with proper consent. Protecting patient privacy is the shared responsibility of the whole team.

Dr. Phillip Moschella talks about best practices for peer access to patient records.

Communication and language

Effective communication is paramount. Peers should be included in conversations about patient care. Clinicians should avoid stigmatizing language such as "junkie" or "frequent flyer" when referring to patients — remember that the peer has been in the patient's situation in the past, and such language lands differently on a colleague with lived experience. The peer is a colleague and a resource; being open to and respectful of their suggestions, and drawing on their expertise when needed, will benefit you and your patients.

Sustaining the peer

Peer work is emotionally demanding, and the field sees high turnover. Research on ED peer programs identifies burnout, role confusion, and poor integration into the clinical team as primary reasons these programs underperform or fail. (source) How the clinical team treats its peers is therefore not only a matter of collegiality but of program survival. Respecting a peer's boundaries, protecting their time, and recognizing the weight of the work are part of what keeps a peer program — and its benefit to patients — intact.