Emergency departments (EDs) often treat patients with substance use disorders for a variety of medical problems. The Mosaic Group's Reverse the Cycle (RTC) intervention integrates peer recovery coach (PRC) support within EDs to address substance use through universal screening, peer-led interventions, initiation of medications for opioid use disorder, and facilitating linkage to community-based care.

This study evaluated RTC services in seven Maryland hospitals ( N   =  10,462). Data on RTC services were linked with statewide hospital utilization data in the 6 months pre- and 6 months post- intervention. Generalized estimating equations were used to examine any hospital utilization, all-cause ED visits, all-cause inpatient admissions, and overdose-related hospital utilization among 6566 patients who received an RTC intervention.

Among patients eligible for RTC services, approximately 60 % received an intervention from PRCs. Patients who received an RTC intervention had a significant reduction in ED utilization (predicted probabilities [PP] = 0.83 pre vs. 0.50 post) and overdose-related hospital events (PP = 0.07 pre vs. 0.04 post), but an increase in inpatient admissions (PP = 0.21 pre vs. 0.28 post; all Ps   <  0.001).

Most ED patients who were eligible for services received an RTC intervention. Overall, patients who received an intervention subsequently reduced their acute care utilization, with a substantial reduction in ED utilization. The observed increase in inpatient admissions may reflect the high medical acuity of this population. The findings underscore the value of embedding PRCs within EDs and the potential to alter broader patterns of acute care utilization among people who use substances.