Exploring the role of peers in addressing the toxic drug crisis in emergency departments

Introduction: Health systems across Canada are facing high numbers of patients who use substances, have a diagnosed substance use disorder, or are experiencing a toxic drug poisoning, necessitating innovative approaches to care. The article discusses a unique pilot project that incorporates individuals with experience using unregulated substances (i.e., peers) into emergency departments to improve patient outcomes and enhance staff satisfaction, in response to the significant impact of the toxic drug crisis on healthcare systems. Methods: The project used an overarching Plan-Do-Study-Act quality improvement framework, and an adapted ‘Four Approaches to Evaluation’ to assess the impacts of embedding peers into the emergency department. Data collection included quantitative/qualitative intake forms, patient/staff experience surveys, and a focus group. Results: The most common reasons for peer encounters (N = 764) were emotional support, harm reduction, referrals, witnessed consumption, and requests for necessities. The patient survey (N = 51) results demonstrated how the peers helped majority of patients feel safe and more supported while accessing emergency care. ED staff (N = 22) shared positive experiences with the new program, citing improvements in quality of life, access to harm reduction services, and creating a more supportive health system. During focus groups, peers (N = 2) outlined the importance of having this role embedded into emergency departments to ensure patients are receiving the care they need in a high-stress environment that, historically, has had the potential to cause significant harm through stigma and biases to people who use substances. Conclusion: Integrating peers into EDs during the toxic drug crisis has greatly improved support for both patients and staff. This approach boosts staff morale, reduces workload stress, decreases stigma, and enhances patient care. Overall, it optimizes resources and strengthens both patient and provider experiences.