Size-dependent variation in thermal tolerance among tropical bee species.

Opioid overdoses have been a leading driver of declining life expectancy in the U.S. Provisional data show that fatal opioid overdoses exceeded 80,000 in 2023, with high overdose mortality continuing into 2024. Nonfatal overdoses are far more common and often precede fatal overdoses, making them a vital touchpoint for intervention. Individuals experiencing nonfatal opioid overdose frequently present to emergency departments (EDs), yet often receive no or minimal care for opioid use disorder (OUD). Fewer than one-third of patients initiate medications for opioid use disorder (MOUD), the most effective treatment for OUD, in the months following medically-treated overdose. Barriers to substance use disorder (SUD) services in EDs include lack of OUD training/expertise among ED-based providers, time constraints, inadequate referral resources, beliefs that OUD is outside ED scope, stigma, and difficulty ensuring safe discharge to stable environments. ED-based peer recovery support services (PRSS), which pair individuals with shared lived experiences with those they are serving (i.e., “peers”), is promising for engaging patients at a potentially reachable moment. In contrast to the traditional addiction workforce (e.g., psychiatrists, counselors), peers’ expertise derives primarily from their lived experience and training related to their roles (e.g., resource navigation, motivational interviewing). In most states, peers meeting training and experiential requirements can obtain certification from state licensing boards. The goals of PRSS are to help others strengthen their recovery, support treatment engagement, reduce substance misuse, and prevent future overdoses and other adverse SUD-related outcomes. Despite increasing implementation of PRSS in EDs nationwide, research on their impact on patient outcomes is limited. Understanding the impact of ED-based PRSS is critical, given the resource and space constraints in EDs. In non-ED health care settings PRSS has demonstrated improved treatment engagement and reduced substance use and related adverse outcomes. A few studies have found that hospital-based PRSS may increase post-discharge treatment initiation and engagement, but findings for other outcomes have been mixed. Some have shown associations with reductions in overdose and drug-related ED/inpatient utilization, whereas others have found no such effects. A previous analysis of this study’s ED-based PRSS program found a modest association of the program with increased MOUD initiation and decreased risk of opioid overdose. However, the previous analysis did not take individual-level program participation into account, but instead examined effects of implementing the intervention on the population of patients presenting for overdose in hospitals implementing the program (i.e., a hospital-level effect). The current study examines outcomes among patients who received the service. Assessing whether effect estimates are robust across these complementary hospital-level and person-level (as-treated) perspectives is important. As ED-based PRSS continue to expand, there is a need to understand their impact on patient outcomes, using a variety of observational and experimental study designs.