In January 2020, the National Council for Mental Wellbeing hosted a technical experts’ panel (TEP) to identify best and promising practices to engage individuals surviving overdose and assist individuals with opioid use disorder (OUD) presenting in emergency department (ED) settings. At the conclusion of the panel, recommendations were identified and prioritized, outlining the core components necessary to effectively address the needs of individuals with OUD within ED settings. This report identifies key policy and practice recommendations informed by existing research, case examples and findings from the TEP.

Bringing peer workers and prescribers together as components of a care coordination team allows elements of relationship, engagement and medical care to move beyond merely coexisting and towards a holistic approach that could prove to have a lasting effect on patients. The two approaches are ready-made for collaboration and synthesis in a singular but multi-faceted intervention that acknowledges the urgency of a crisis moment, moves toward stabilization and follows the patient from hospital to community with an arsenal of resources.

Bringing diverse cultures is never simple and requires a thoughtful process. Practices involving peer workers and practices involving medical professionals can be as different as night and day. However, it is a mistake to see them as oppositional, especially when combining them can have significant impact on patients receiving care. Each of our expert panelists has demonstrated that with focused attention and an eye toward practical solutions, any cultural differences between medical professionals and peer workers can be resolved for the greater good. The bottom line is that during the brief time a person presenting with an overdose is physically at the ED, there is a window of opportunity to engage before they are out the door. This requires a concerted team effort to avoid another missed opportunity and potentially save someone’s life from a future overdose.

Finally, as witnessed from several of the expert panelists, this hybrid model of peer workers and medical professionals can lead to significant cultural transformation in ED environments. While ED settings by their nature will always be driven by crisis and efficiency, this does not mean that they must be traumatizing or devoid of compassion. Patients presenting with overdoses have already absorbed a litany of traumatic experiences before coming to the ED. Labeling, blame and shame only add to an already negative experience. The opportunity to develop new attitudes toward these patients, demonstrated first by peer workers and picked up by other staff, can move the work culture to one that is trauma-informed and recovery-oriented. If initiating this culture shift has already shown an impact on patients who present with an overdose, imagine what effect it can have on other  patients, staff and administrators.

[Appendix D. resources and tools]