Discussion
’, overdose, OUD, OUDs
This analysis of the ED experiences of patients with OUDs or at high risk for overdose demonstrates how ED-based interactions and service provision can impact ED care engagement and service utilization. Participants underscored the varied experiences of people who use drugs when accessing EDs, and how providers should build rapport with patients prior to encouraging treatment services. Specifically, participants stressed the importance of lived experience in care provision and how this can improve ED experiences through increased rapport and trust. Our study adds to a growing body of literature demonstrating the integration of peer-based supports in an ED-based setting for patients who use drugs.Our findings document that rapport-building between some patients and providers can impact clinical experiences. In our study, rapport building was juxtaposed with ‘pushing’ services onto patients and was thus framed as an important element for reaffirming patients’ agency in ED settings. Previous research has underscored how rapport building in ED settings is important for establishing trust in care pathways and assuring patients their utilization of services or resources offered is voluntary [Prior research has documented how people who have an OUD or have had an overdose experience discrimination and stigma within clinical settings (e.g., [Peer-based supports have been well-established in community harm reduction (e.g., [Although the ED has been framed as an opportunistic place to provide substance use-related interventions [This study has several limitations. First, the diversity of the participant sample was limited. We also were unable to reach all participants who had agreed to be contacted for the qualitative sub-study. This may have led to an underreporting of barriers and facilitators in ED settings, particularly for structurally vulnerable populations, and how this intersects across social identities. Utilizing alternative ways to reach participants (e.g., social media outreach, leaving messages with outreach workers) may be helpful for future studies. Our findings are also specific to hospitals in Rhode Island and, while they generate insights that may be relevant across other settings, they may be limited given availability of peer recovery specialists and social workers in other hospital settings. Lastly, we did not interview peer recovery specialists regarding care for patients following an overdose. Further research into their perspectives should be undertaken.