Peer Recovery Specialists and Referrals to Treatment: Clinical Correlates Among Patients of an Opioid Overdose Recovery Program in New Jersey.

BACKGROUND: Peer recovery programs increase recovery support and treatment engagement among individuals with opioid use disorder. Peer recovery specialists (PRS) are critical in the cascade of care of treating addiction and related conditions. Work remains to help identify the benefits of PRS, particularly time spent with a PRS as a clinical indicator associated with referral to substance use treatment services. Gaps in the literature do not consider the nested hierarchical intercorrelations of opioid recovery data within multiple emergency departments. PURPOSE: The current study examined demographic and clinical correlates with referral to substance use treatment services including prior engagement within an opioid overdose recovery program, mental health diagnosis, the number of naloxone administrations, prior overdoses, and hospital-level variability of PRS time associated with treatment referrals. METHOD: This study used data collected by providers among patients who engaged in an opioid overdose recovery program. Data were collected between January 2016 and September 2020. Generalized linear mixed effect multilevel regression analyses tested the associations on clinical referral to substance use services. RESULTS: A total of 5655 patients participated in the study (male: 68.91%; age: mean = 37.75 ± 12.43; White non-Hispanic: 62.48%). Significant individual-level associations were identified between demographic and clinical variables and referral to substance use treatment services. At the hospital level, recovery specialist time spent with the patient also showed a positive and significant association with referral to substance use treatment services. CONCLUSION: The cross-level interaction effect displayed that any period of time spent with PRS played an important role for those patients with a greater number of prior overdoses on referral to treatment. Results provide important information on the role of PRS in the cascade of care, as well as the time spent with those in this role for both individuals with varying number of prior overdoses.

Polysubstance use latent class membership in New Jersey: Association with prior overdoses, prior emergency department peer recovery engagement, and mental health diagnosis among participants in an opioid overdose recovery program.

Background: Epidemiological research has indicated higher polysubstance use among individuals who misuse opioids in the United States. Polysubstance use is also associated with multiple emergency department (ED) engagements in intervention services. Less is known about polysubstance use among individuals who use opioids or were engaged in an ED setting as part of an opioid recovery intervention program. Examining emerging patterns of polysubstance use among individuals who use opioids may help shape policy and practice around developing drug markets and social norms. The objective of this study was to understand subpopulations who demonstrated distinct patterns of polysubstance use among participants in an ED Opioid Overdose Recovery Program (OORP) in New Jersey. Method: This study investigated patterns of polysubstance use among participants in a New Jersey OORP using latent class analysis (LCA; N = 1690; 70.2% male; 84.7% White non-Hispanic; meanage = 35.72 ± 11.95). Multinomial logistic regression analyses examined latent class (LC) membership based on clinically relevant indicators. Results: Five latent classes were identified (Model fit: L2 = 33.76, BIC = 4482.69, AIC = 4245.01, and the bootstrap L2p-value =0.27; standard R2 value of 0.85). Multinomial logistic regression analyses showed that subgroups with the greatest odds of prior OORP engagement related to those participants in subgroups with heroin and polysubstance use. Conclusion: It is critical to examine the heterogeneity among people engaging in prescription opioid use and polysubstance use in the United States. This study represents an important contribution in identifying polysubstance use LC membership groups and associations with clinically relevant indicators among those engaged in an opioid recovery program. Results can be valuable in understanding the nature of the larger epidemic and how it can be addressed.