Peer Recovery Support for Opioid Use Disorder

(PRSS Trial)

Overseen By Marc J Fishman, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Potomac Health Foundations

Must not be taking: Buprenorphine, Methadone, XR-naltrexone

Disqualifiers: Recent buprenorphine, methadone, XR-naltrexone

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 8 weeks

35 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if peer recovery support can assist individuals with opioid use disorder in starting medication treatment during a residential program. It emphasizes support from those with similar experiences to encourage the initiation of medications like methadone, buprenorphine, or naltrexone. The PRSS intervention for MOUD initiation is tested for practicality and participant satisfaction. It suits individuals seeking inpatient treatment who have not recently begun medication treatment and can access medication through insurance. As an unphased trial, this study provides a unique opportunity for patients to contribute to innovative approaches in addiction recovery.

Will I have to stop taking my current medications?

The trial requires that you have not taken sublingual buprenorphine or methadone within 14 days before starting the inpatient treatment, and you must not have received XR-buprenorphine or XR-naltrexone within 45 days before starting. If you are currently on these medications, you may need to stop them before participating.

What prior data suggests that this PRSS intervention is safe for MOUD initiation?

Research shows that Peer Recovery Support Services (PRSS) are generally safe for people with opioid use disorder (OUD). A review of studies found that PRSS helps reduce drug use and the chances of relapse, while also helping people stay in treatment longer. Additionally, research has shown that peer support can improve relationships with healthcare providers and strengthen social support networks, leading to fewer cases of substance use disorder (SUD) and relapse.

While specific safety data for PRSS in this trial is not available, PRSS has been used in emergency departments before. In those cases, PRSS was linked to more people starting medications for opioid use disorder (MOUD) and fewer repeated overdoses. Although exact safety data for PRSS in residential settings is lacking, its use in other settings suggests it is well-tolerated and safe for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Peer Recovery Support Services (PRSS) intervention for opioid use disorder because it offers a fresh approach to starting medication-assisted treatments like buprenorphine, methadone, or naltrexone. Unlike traditional treatments that focus solely on medication, PRSS emphasizes peer support, which can enhance motivation and adherence by connecting individuals with others who have successfully managed their recovery. This peer-driven model can provide emotional support and practical advice, potentially improving initiation and retention rates in medication for opioid use disorder (MOUD) programs. By leveraging the power of shared experiences, PRSS aims to complement existing medical treatments and address the social and emotional aspects of recovery, which are often overlooked in conventional approaches.

What evidence suggests that this PRSS intervention is effective for MOUD initiation?

Research has shown that peer recovery support services (PRSS) can help individuals start medications for opioid use disorder (MOUD). This trial will focus on the PRSS intervention for MOUD initiation. While studies have found PRSS to be helpful in emergency settings, its effects in residential treatment settings remain under investigation. PRSS aims to support individuals starting MOUD by providing motivation and sharing experiences from peers who have faced similar challenges. Although more research is needed, early findings suggest that PRSS can encourage individuals to begin and continue MOUD treatment, potentially lowering the risk of relapse and overdose. ^{2 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for adults over 18 with Opioid Use Disorder (OUD) who are seeking inpatient treatment at Maryland Treatment Centers, speak English, can consent to the study, and have insurance coverage for Medications for Opioid Use Disorder (MOUD).

Inclusion Criteria

I am over 18, have opioid use disorder, seeking treatment, speak English, can consent, and have insurance for medication.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive an 8-week course of Peer Recovery Support Services (PRSS) to promote MOUD initiation during inpatient SUD treatment

8 weeks

Inpatient stay

Follow-up

Participants are monitored for MOUD initiation and retention after discharge from inpatient treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• PRSS intervention for MOUD initiation

Trial Overview The trial tests a Peer Recovery Support Services (PRSS) intervention designed to encourage initiation of MOUD during residential substance use disorder treatment. It involves motivational strategies by peers and an 8-week course of treatment.

How Is the Trial Designed?

Group I: single-arm of an uncontrolled trial of the PRSS intervention for MOUD initiation Experimental Treatment 1 Intervention

Who Is Running the Clinical Trial?

Potomac Health Foundations

Lead Sponsor

Trials

7

Recruited

490+

National Institute of Drug Abuse

Collaborator

Trials

11

Recruited

12,500+

National Institutes of Health (NIH)

Collaborator

Trials

2,896

Recruited

8,053,000+

National Institute on Drug Abuse (NIDA)

Collaborator

Trials

2,658

Recruited

3,409,000+

Published Research Related to This Trial

A pilot randomized controlled trial involving 25 hospitalized adults with opioid use disorder (OUD) tested a peer recovery coach intervention to improve retention in medications for opioid use disorder (MOUD) after discharge.

The study found no significant differences in MOUD retention rates, hospital readmissions, or time to treatment discontinuation between the recovery coach intervention group and the treatment-as-usual group, indicating that the intervention did not enhance treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Peer Recovery Coach Intervention for Hospitalized Patients with Opioid Use Disorder: A Pilot Randomized Controlled Trial. Suzuki, J., Martin, B., Loguidice, F., et al.[2023]

A qualitative study involving 26 patients receiving methadone treatment found that a peer recovery specialist-delivered behavioral activation intervention (Peer Activate) was perceived as acceptable and feasible, particularly due to its flexibility and the supportive qualities of the peer specialists.

Participants highlighted the importance of connecting with the intervention content and building skills, while also noting stigma related to substance use and methadone treatment as barriers to engagement, suggesting that addressing these issues could enhance treatment retention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"You rise up and then you start pulling people up with you": Patient experiences with a peer-delivered behavioral activation intervention to support methadone treatment. Kleinman, MB., Hines, AC., Anvari, MS., et al.[2023]

A 20-minute telephone-delivered peer recovery support service (PRSS) intervention led to a higher enrollment in medication for opioid use disorder (MOUD) among participants, with 32.5% of PRSS participants enrolling compared to 17.5% in the control group.

Participants receiving PRSS were significantly less likely to experience an opioid overdose (OOD) within 12 months, with only 12.5% reporting an OOD compared to 32.5% in the control group, indicating the potential effectiveness of PRSS in enhancing safety for individuals with opioid use disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A brief telephone-delivered peer intervention to encourage enrollment in medication for opioid use disorder in individuals surviving an opioid overdose: Results from a randomized pilot trial. Winhusen, T., Wilder, C., Kropp, F., et al.[2022]

In a pilot study involving 80 adults with recent non-fatal opioid overdoses, trained peer interventionists successfully delivered a Peer Recovery Support Services (PRSS) intervention, achieving a treatment enrollment success rate between 16% and 60%.

The interventionists reported no negative effects from their role, indicating that peer-led interventions can be implemented safely and effectively with limited training, although further research is needed to understand the factors influencing their varying success rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The feasibility and safety of training patients in opioid treatment to serve as peer recovery support service interventionists. Kropp, F., Wilder, C., Theobald, J., et al.[2022]

Peer recovery support services (PRSS) show promise in improving outcomes for individuals with substance use disorder (SUD), including reduced substance use, lower relapse rates, and increased treatment satisfaction, based on a systematic review of various studies.

However, the existing research has significant methodological limitations, such as inconsistent definitions of peer roles and a lack of appropriate comparison groups, highlighting the need for more rigorous studies to better understand the efficacy and implementation of PRSS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching. Eddie, D., Hoffman, L., Vilsaint, C., et al.[2023]

Patients receiving methadone treatment reported experiencing various forms of stigma related to substance use and medication, which significantly hindered their retention in opioid use disorder treatment programs.

Peer recovery specialists (PRSs), who share similar experiences with substance use and recovery, have the potential to reduce stigma and improve retention in medication for opioid use disorder by leveraging their unique perspectives and support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"In their mind, they always felt less than": The role of peers in shifting stigma as a barrier to opioid use disorder treatment retention. Anvari, MS., Kleinman, MB., Massey, EC., et al.[2023]

The Peer Recovery Program implemented in 20 hospitals provided 24/7 support for patients with substance use disorder, receiving referrals during over 30,000 patient visits from 2016 to 2019, with a high acceptance rate of continued support services between 74.8% and 83.0%.

The program demonstrated efficient response times, with Recovery Specialists arriving at the patient's bedside within an average of eight minutes, and facilitated numerous follow-up contacts, although further evidence of improved patient outcomes is necessary for broader implementation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing hospital-based peer recovery support services for substance use disorder. Liebling, EJ., Perez, JJS., Litterer, MM., et al.[2021]

Peer recovery support services (PRSS) have been integrated into the recovery process for opioid use disorder (OUD), but their effectiveness on clinical outcomes remains unclear, as only 12 out of 123 studies met the inclusion criteria for review.

Most studies reported on PRSS engagement and medication for OUD (MOUD) initiation, but findings were inconsistent and varied due to the lack of standardized PRSS interventions and methodological limitations, indicating a need for further research before widespread implementation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of peer recovery support services on stages of the opioid use disorder treatment cascade: A systematic review. Gormley, MA., Pericot-Valverde, I., Diaz, L., et al.[2022]

Citations

1. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0376871621006189

Effectiveness of peer recovery support services on stages ... In 2019, approximately 1.6 million Americans (12 years and older) reported an Opioid Use Disorder (OUD) (Substance Abuse and Mental Health ...

2. cdc.gov cdc.gov/overdose-prevention/data-research/facts-stats/moud-study.html

Medications for Opioid Use Disorder (MOUD) Study The publicly available data from the MOUD Study include: Type of OUD treatment. Substance use. Drug overdose. Health-related quality of life.

3. clinicaltrials.gov clinicaltrials.gov/study/NCT05616949

Peer Recovery Support Services for Individuals in ... Rates of MOUD retention are alarmingly low and MOUD dropout predicts opioid use/relapse, overdose, and death. While previous research has identified predictors ...

4. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/34700201/

Effectiveness of peer recovery support services on stages ... Effectiveness of PRSS interventions on stages of the OUD treatment cascade remain inconclusive. Additional research is necessary before ...

5. bloustein.rutgers.edu bloustein.rutgers.edu/new-research-peer-support-after-opioid-overdose/

Impact of Peer Support After Opioid Overdose Key Points. Question Is implementation of an emergency department (ED)–based peer recovery support program for opioid overdose associated with improvements in ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11322658/

Peer support for patients with opioid use disorder in the ... In this narrative review, we synthesize the existing evidence on how to develop and implement peer programs for OUD in the ED setting.

7. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2816733

Emergency Department Peer Support Program and Patient ... In this cohort study of patients treated for opioid overdose, OORP implementation was associated with an increase in MOUD initiation and a decrease in repeat ...

8. frontiersin.org frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1529078/full

Systematizing peer recovery support services for ... A systematic review revealed that PRSS models contribute to reductions in substance use and relapse rates and improve treatment retention and ...

9. harmreductionjournal.biomedcentral.com harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-024-01041-7

Is peer support a tipping point for the opioid use disorder crisis ... Qualitative findings suggest that PRSS can enhance relationships with providers and social support networks, reduce SUD and relapse rates, and ...