Recommendations for the Role of Peer Workers in Medication for Opioid Use Disorder Linkage and Retention

Background: Peer workers – nonclinical service providers with lived experience of addiction recovery – are well-positioned to support people who could benefit from medications for opioid use disorder (MOUD). However, peers have expressed uncertainty about if and how MOUD falls within their scope of work. Role ambiguity is compounded by lack of exposure and stigma toward MOUD among the peer workforce, which is often intertwined with peers’ own personal recovery pathways. As a result, peers sometimes avoid conversations about MOUD, share misinformation about MOUD, and encourage clients to discontinue treatment. Toward the development of a training for peers to improve MOUD linkage and retention, this study explored experts’ recommendations for peers’ roles and responsibilities related to MOUD.

Methods: A national panel of experts in peer recovery support services (N=72), including certified peers (68.9%), peer supervisors (57.4%), service recipients (39.3%), and researchers (19.7%), was surveyed using real-time Delphi software. Most experts were in recovery (86.9%) and about half had in their lifetime used MOUD (49.2%). Delphi statements captured experts’ recommendations for peers’ responsibilities surrounding MOUD on a 5-point scale, supported with open-ended comments. Three items solicited the experts’ recommendations as to whether peers should initiate conversations about MOUD, encourage MOUD continuation, and disclose their own recovery pathway. Data were coded independently by three team members following Braun and Clark’s (2006) approach to inductive thematic analysis.

Results: Experts’ recommendations were classified within four overarching themes: providing education, supporting self-determination, reducing stigma, and sharing lived experience. Experts consistently framed MOUD as evidence-based and emphasized that peers should ensure their clients have accurate information about evidence-based practices. Thus, experts recommended that peers provide education about MOUD, including the potential risks and benefits of discontinuation, to help clients make informed decisions about their treatment and recovery goals. Many underscored that education should be limited to information and referral to prescribers, rather than offering personal opinions or advice. Supporting clients’ self-determination was a prominent theme. When working with clients who are uninterested in initiating MOUD or are considering discontinuation, peers were encouraged to explore clients’ motives, address identified barriers to MOUD initiation or maintenance, and collaborate with clients to identify alternative recovery goals. Engaging clients in conversations about MOUD was highlighted as a potential strategy for reducing self-stigma among clients taking or considering MOUD. Finally, most experts indicated peers should use discretion when disclosing their own recovery experiences, ensuring such disclosures support rather than unintentionally undermine clients’ chosen recovery paths.

Conclusions and Implications: Findings provide direction for the training and supervision of peer workers. Experts suggest peers should be well-versed in the science supporting MOUD, able to navigate nuanced conversations about MOUD initiation and discontinuation, and trained to use self-disclosure with sensitivity. These recommendations are timely, as peers formalize their role in the addiction workforce through credentialing and professionalization.