The evidence on peer support workers is limited; however, “Nothing About Us Without Us”: Greater, Meaningful Involvement of People Who Use Drugs: A Public Health, Ethical, and Human Rights Imperative identifies several important benefits to peer involvement especially relevant for the provision of OAT. These include more patient “buy-in” to the program; the ability for patients’ needs to be recognized and addressed; service delivery that meets the needs of patients by being realistic, low-barrier, and useful; and providing a sense of ownership for peers.357 

A 2018 qualitative study of a peer-run overdose response program in emergency shelters in Vancouver, BC, identified several factors that lead to increased feelings of safety from peer workers compared to non-peer paid staff, including social safety due to shared experiences, an absence of uneven power dynamics, and a perception of being cared for that contrasted with their everyday experiences.358 A 2019 qualitative study of peer workers in overdose prevention sites in Vancouver found that peer workers help create a sense of community characterized by safety, inclusivity, and comfort.359

Peer-based support groups are widely available community resources often recommended as an adjunct to clinical management of substance use disorders, or as a source of additional guidance and support following treatment (e.g., aftercare). A widely recognized example is Narcotics Anonymous (NA), an international fellowship of support groups comprised of individuals in recovery, which offers emotional support and a structured “12-step” approach to achieving abstinence. Research and evaluation of peer-based support has primarily focused on 12-step facilitation approaches, which refers specifically to 12-step programs led by a trained professional, such as a substance use counsellor. There have been no well-designed, controlled studies of the effectiveness of these groups in supporting treatment goals of individuals with OUD, although a small number of observational studies have reported associations between active participation in 12-step programs and improved treatment outcomes among individuals with substance use disorders.360-362 

It should be noted that the 12-step facilitation model has been occasionally supportive of the use of OAT for the treatment of OUD. Underlying philosophical conflicts, if present, can also negatively affect engagement and disclosure and deter regular attendance.  If patients identify incompatibilities between personal beliefs and 12-step facilitation as barriers to participation, alternative options can be provided when possible. For example, peer support groups with a secular mandate (e.g., SMART Recovery, LifeRing), or groups for specific populations (e.g., youth, women, Indigenous peoples, individuals with concurrent mental health issues) may be locally available; however, it is noted that the efficacy of these support groups has not been empirically studied. 

While the evidence base is limited, 12-step groups, which are widely accessible in both urban and rural settings, may be beneficial to patients and families in navigating life changes and challenges related to treatment and recovery.