Peer Recovery Services for Substance Use Disorder

Substance use disorder (SUD) remains one of the most persistent public health challenges across the nation and in Minnesota. In 2021, nearly 1,300 Minnesotans died of a drug overdose, making this the leading cause of injury deaths in the state. One intervention to help people with SUD is peer recovery services (PRS). PRS is a form on non-clinical support where trained individuals who are more established in recovery come alongside people currently in the recovery journey and provide guidance in the treatment process, help in accessing resources, and offer an empathetic ear. In combination with other services in the continuum of care, PRS seeks to reduce harm from disordered use.

In 2018, Minnesota made PRS for SUD a Medicaid (MA)-reimbursable service. While prior literature demonstrates promising effects of PRS for SUD, especially in treatment retention and participant experience, most studies evaluated PRS in limited settings, rather than in a large-scale implementation.

Our study estimated the causal impact of MA-reimbursable PRS for SUD on treatment, overdose, mortality, access to care, housing, and child welfare. We used administrative data to compare outcomes for people who participated in PRS through MA with similar eligible SUD patients who did not use PRS, over the course of a year. Overall, we found evidence of a system that may not be fully built; PRS leads to positive results but has not produced all of the benefits stakeholders expect or desire. In particular:

Patients with at least one PRS session were more likely to complete outpatient treatment in the follow-up year than comparison patients. At the end of follow-up, PRS patients were 61% (95% confidence interval [CI]: 14%, 127%) more likely to complete outpatient than the comparison group.
PRS patients were also more likely to visit a physician’s office for medical care than comparison patients. In the first quarter of follow-up, 73% (95% CI: 70%, 76%) of PRS patients visited a physician’s office compared to just 62% (95% CI: 59%, 66%) of comparison patients. This statistically significant difference was limited to the first quarter of follow-up.
We found no impact of PRS on diagnosed non-fatal overdose, all-cause mortality, inpatient treatment admission, housing instability, or child welfare maltreatment reports.
The impact of PRS for patients with sustained participation was similar to the overall impact for all participants.
We found no differences in the impact of PRS across race, sex, opioid use status, or geography.

While PRS shows promise in improving treatment retention and access to care, we did not find benefits of PRS for other desired outcomes stakeholders identified. We discuss potential reason for this, including the wide variation in PRS delivery and the need for improved training, mentoring, and supports for peers and participants. These evidence-informed lessons have the potential to improve PRS’s impact. We end by noting the need for more data collection and further qualitative and quantitative study.