Exploring the role of peers in addressing the toxic drug crisis in emergency departments

Authors

DOI:

https://doi.org/10.29173/cjen248

Keywords:

emergency department, substance use, toxic drug crisis, peer support workers, quality improvement, lived experience

Abstract

Introduction: Health systems across Canada are facing high numbers of patients who use substances, have a diagnosed substance use disorder, or are experiencing a toxic drug poisoning, necessitating innovative approaches to care. The article discusses a unique pilot project that incorporates individuals with experience using unregulated substances (i.e., peers) into emergency departments to improve patient outcomes and enhance staff satisfaction, in response to the significant impact of the toxic drug crisis on healthcare systems.

Methods: The project used an overarching Plan-Do-Study-Act quality improvement framework, and an adapted ‘Four Approaches to Evaluation’ to assess the impacts of embedding peers into the emergency department. Data collection included quantitative/qualitative intake forms, patient/staff experience surveys, and a focus group.

Results: The most common reasons for peer encounters (N = 764) were emotional support, harm reduction, referrals, witnessed consumption, and requests for necessities. The patient survey (N = 51) results demonstrated how the peers helped majority of patients feel safe and more supported while accessing emergency care. ED staff (N = 22) shared positive experiences with the new program, citing improvements in quality of life, access to harm reduction services, and creating a more supportive health system. During focus groups, peers (N = 2) outlined the importance of having this role embedded into emergency departments to ensure patients are receiving the care they need in a high-stress environment that, historically, has had the potential to cause significant harm through stigma and biases to people who use substances.

Conclusion: Integrating peers into EDs during the toxic drug crisis has greatly improved support for both patients and staff. This approach boosts staff morale, reduces workload stress, decreases stigma, and enhances patient care. Overall, it optimizes resources and strengthens both patient and provider experiences.

Author Biographies

Janelle Tarnow, Emergency Network, Fraser Health Authority

Janelle Tarnow is a registered nurse working as the regional emergency clinical nurse educator with Fraser Health Authority in British Columbia. She specializes in supporting emergency departments with toxic drug response and Indigenous cultural safety initiatives. She is currently completing a Master of Nursing in Advanced Practice Leadership at the University of Victoria and recently presented at the 2024 Health Quality B.C. Conference on the peers in emergency initiative. She loves traveling the world, waking up in the mountains, scuba diving and the Seahawks.  

Rita Metwally, Toxic Drug Response and Priority Populations, Fraser Health Authority

Rita Metwally is an evaluation specialist for the Toxic Drug Response and Priority Populations portfolio at Fraser Health. She is currently completing a Master’s in Public Administration from the Johnson-Shoyama School of Public Policy at the University of Saskatchewan. Rita is passionate about ensuring programs aimed at addressing social needs are successfully implemented, and she enjoys reading, dance, and spending time in nature when not at work.

Aven Sidhu, Clinical Quality and Patient Safety, Fraser Health Authority

Aven Sidhu is a quality improvement lead for the Clinical Quality & Patient Safety Department at Fraser Health. He holds a medical degree from the Royal College of Surgeons in Ireland-Bahrain and a Master of Science (Public Health) from the London School of Health and Tropical Medicine. Aven is dedicated to translating data into actionable insights for clinical scenarios and identifying information that assesses the broader impact on the health system; he enjoys golf, hockey, and reading in his free time.

Jade Black, Toxic Drug Response and Priority Populations, Fraser Health Authority

Jade Black is a Harm Reduction Lead for the Toxic Drug Response and Priority Populations Portfolio at Fraser Health Authority. She holds a Master’s Degree in Critical Criminology with a specialization in Addiction & Gender Studies. Jade is committed to supporting harm reduction best practice, engaging in community health research and advocating for women in education & the workplace. She enjoys Pilates, musical theatre and reading literature on personal wellness.

Tracy Stoneson, Chilliwack General Hospital, Fraser Health Authority

Chilliwack General Hospital, Emergency Department, Manager 

Mary Van Osch, Emergency Network, Fraser Health Authority

Fraser Health Authority, Emergency Network, Lead

Kassaundra Benoit, Chilliwack General Hospital, Fraser Health Authority

Chilliwack General Hospital, Emergency Department, Peer Support Worker

Kim Wood, Chilliwack General Hospital, Fraser Health Authority

Chilliwack General Hospital, Emergency Department, Peer Support Worker

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Published

2025-03-24

How to Cite

Tarnow, J., Metwally, R., Sidhu, A., Black, J., Stoneson, T., Van Osch, M., … Wood, K. (2025). Exploring the role of peers in addressing the toxic drug crisis in emergency departments. Canadian Journal of Emergency Nursing, 48(1), 74–94. https://doi.org/10.29173/cjen248

Issue

Section

Peer Reviewed Articles