Beyond the Emergency Department: Facilitating Linkage to Care Through Virtual Peer Recovery Support

Emergency department (ED)-based peer recovery support services (PRSSs) offer an opportunity for individuals with substance use disorders (SUDs), an important cause for ED visits in the United States, to engage in care. This evaluation examined linkage to and retention in care among individuals engaged with a virtual peer recovery program from two hospital EDs from September 2019 to August 2025. Peer recovery specialists (PRSs) engaged with individuals presenting with SUD and/or overdose at the EDs and linked them with services and conducted follow-up at 30 days and 6 months for linked individuals. Descriptive statistics, bivariate analyses and multivariate logistic regression were conducted. Of the 1902 clients who met with PRSs, 98.3% received one or more referrals and 92.1% successfully linked to one or more treatment-related services. Most were non-Hispanic, White males (mean age: 41.5 years); many reported polysubstance use, housing instability, unemployment and Medicaid coverage. The most common barrier to linkage was clients leaving ED prior to linking with services. Follow-up was completed for 448 (30 days) and 138 clients (6 months) and 70.3% and 46.4% of respondents, respectively, reported ongoing retention in care. ED-based virtual PRSSs can effectively facilitate linkage to and retention in care while highlighting challenges related to engagement, retention and social determinants of health.