TOPLINE:

A peer navigator intervention conducted in emergency departments (EDs) received high satisfaction ratings but did not significantly reduce opioid-related adverse events compared with standard care, according to a new trial in the US. Overall, 9.7% of participants died within 12 months, mostly due to opioid overdose.

METHODOLOGY:

• Researchers conducted a multisite randomized clinical trial involving 247 adults (76.9% men; 51.0% Hispanic/Latinx individuals; 30.8% White individuals; 32.4% Black individuals) who presented to four EDs in New York City with opioid use disorder (OUD) from 2020 to 2022. Participants were randomly assigned to either a peer navigator intervention program arm (Relay group; n = 125) or a usual/standard ED care arm (SDC group; n = 122).
• Participants in the Relay group received individualized education on overdose risk reduction, overdose rescue training with naloxone kits, a tangible support kit, service referrals as needed, and follow-up support from wellness advocates after discharge.
• Participants in the SDC group received standard ED care plus naloxone kits, a flyer on naloxone use and overdose response, a list of local addiction treatment programs, and an informational flyer about Relay.
• The primary outcome was a composite count of opioid-related adverse events (any fatal or nonfatal overdoses and substance use-related ED visits) over 12 months. Secondary outcomes included self-reported initiation of medication for OUD, overdose risk behaviors, all-cause ED visits, and ED use.

TAKEAWAY:

• No significant difference was observed between participants in the Relay and SDC arms for opioid-related adverse events (rate ratio [RR], 1.02; P =.90).
• At 6 months, participants in the Relay arm reported a higher risk for overdose behaviors than those in the SDC arm (mean difference in Overdose Risk Behavior scores, 1.75; 95% CI, 0.42-3.08), with no significant differences in other secondary outcomes.
• Overall, 9.7% of participants died within 12 months (7.2% vs 12.3% in the Relay vs SDC arm), mostly due to opioid overdose (70.8%).
• The Relay intervention was associated with high satisfaction among participants during baseline ED visits, and approximately half of the participants maintained contact with wellness advocates via telephone after the baseline visit.

IN PRACTICE:

"We did not find statistically significant differences in next-year opioid-related adverse events favoring the Relay peer navigator intervention vs SDC for ED patients presenting after a nonfatal opioid-involved overdose," the authors wrote.

"More research is needed to clarify the impact of peer interventions on mortality and other key outcomes and to further optimize the design and delivery of peer-led ED interventions such as Relay," they added.

SOURCE:

The study was led by Kelly M. Doran, MD, MHS, NYU School of Medicine, New York City. It was published online on February 6, 2026, in JAMA Network Open.

LIMITATIONS:

The COVID-19 pandemic affected study execution, leading to modifications in intervention delivery and a smaller sample size than planned. The study had limited power to detect differences in mortality. The control group received enhanced care, including naloxone kits and treatment program information, which may have reduced the observable effect of the intervention. The sample size and missing data were additional limitations.

DISCLOSURES:

The study was funded by the Centers for Disease Control and Prevention. Some authors reported having financial or other ties with various organizations. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.