Bizzell opioid video series

Bizzell Responds to the Opioid Crisis

Bizzell Responds to the Opioid Crisis

A Message About the Opioid Crisis

From Anton C. Bizzell, M.D.

Bizzell, President & Chief Executive Officer


[Anton C. Bizzell] The opioid crisis in
the United States, driven largely by illicitly obtained synthetic
opioids such as fentanyl, is impacting communities and
families across the country and is far from being over.
From December 1999 to June 2023,
opioid related overdose deaths increased 100 and threefold.
Hardly a day goes by when there
isn’t a news item about a family losing a loved one on illicit
fentanyl seizure. A recent fentanyl seizure by
California police of 4.2 kilos was enough to potentially kill
2.1 million people. Significant spikes in the US
overdose crisis are linked to poly substance use of synthetic
compounds such as xylazine, a veterinary tranquilizer.
Xylazine extends the duration of
action of fentanyl but does not respond to naloxone.
If an overdose occurs, it is
also associated with an increased risk of soft tissue
infections. Fentanyl impacts minorities at
an alarming rate, with overdose rates among non Hispanic blacks
suffering the highest mortality due to synthetic opioids other
than methadone. A new CDC report shows that more
black Americans died from fentanyl overdoses than any
other drug in 2021 and at a far higher rate than whites or
Hispanics. As a minority owned business,
Bizzell is committed to providing solutions to address
the current opioid crisis. At Bizzell US, all employees are
required to watch a brief training on a five step response
to an opioid overdose and are encouraged to carry naloxone
with them to stress the wide-ranging impact of the
opioid epidemic or frontline providers. Bizzell has created a
testimonial video with descriptions of the difficulties
and heart breaks of managing the opioid crisis as well as the
importance of treatment initiation in emergency
departments. An additional story about
fentanyl test strips comes from an emergency department
physician. As his daughter was heading off
to college. He taught her how to use
fentanyl test strips just in case. His foresight saved many lives
at a campus party because of this knowledge.
Bizzell US is proud to have created a variety of tools and
resources for public use in conjunction with the National
Institute on Drug Abuse Clinical Trials Network Dissemination
Initiative, bringing research based information to clinicians
on a variety of topics related to substance use disorders.
I invite you to take the time to
review all of these important resources. There is hope. With dedicated
professionals across the United States and around the world,
Bizzell is working to help turn around the opioid crisis which
effects all of us. Please join us in our efforts by
getting trained in how to recognize and manage an opioid
overdose and carry naloxone with you so you can be a first
responder. Also, please encourage anyone
you know who is using opioids to seek treatment.
Thank you.

Responding to an Overdose

This 5–step response to a possible opioid overdose, which encourages using 911 for immediate assistance and recommends that everyone carry naloxone is a quick and accessible resource.


[Maia Brown] If you come across someone with
an opiate overdose, I’d like to share with you how you can help
in five easy steps.

Step one. Check for signs of
opiate overdose. Remember that these patients
have pinpoint pupils and decreased respiratory drive,
meaning they’re breathing less than 5 times a minute or not at all. You may also see signs of drug
use on scene, like pills on the ground or an IV needle sticking
out of their arm.

Step two. Call 911 so we can
come and help you.

Step three. If you have
naloxone, go ahead and give it. You will not hurt the patient by
trying to give this medication.

Step four. Help the patient with
their breathing. If they’re not already on their
back, roll them onto their back and put them in a sniffing
position so that they have a nice open airway. Remember that naloxone can cause
patients to vomit, in which case roll them onto their side into
the recovery position.

Step 5. Continue to monitor the patient
and look for any changes in how they present to you and wait for
help to arrive. That’s all there is to it. Thank you for being willing to

Personal Testimonials

Testimonials from front line community providers stress the wide-ranging impact of the opioid crisis. Each clip describes the difficulties and heartbreaks of managing the crisis while offering hope and stressing the importance of treatment initiation in Emergency Departments.


[Ben Savitch] I worked for many years in inner
city hospitals in Chicago, and I remember distinctly one shift
many years ago where I was working in the overnight shift
and in the morning I looked up from my computer station and I
saw that our emergency department was overwhelmed with
people that were there due to opioid overdoses. Many of these individuals had
received Narcan in the field by EMS and additional doses in the
emergency department. And that was really a
recognition point for me that we were immersed in this epidemic. And certainly the issue has
persisted and extends across our entire country.

[Angadpreet “Preet” Sidhu] My community
has been disproportionately affected by the opiate crisis. Earlier this year, New York City
Health and Hygiene released their 2021 data on overdose
deaths. One particular statistic was
breakdown by neighborhood. Metropolitan Serves East Harlem,
which ranked #5 in neighborhoods with overdose deaths in all of
New York City for 100,000 residents #6 on the list was
Harlem neighborhood served by my hospital, Harlem Hospital.

[Alan Grow] They asked that any members of
the community that know of anybody struggling with
addiction to any sort of drug or alcohol, please get them help. The most important thing is
getting these people help, realizing that the stuff that
they’re doing is not only bad for them, but it’s going to harm
somebody else.

[Kavita Babu] I think it’s a real testament
to emergency medicine how much our care of patients with a opioid
use disorder has changed in my more than 20 years in practice. When I started, we would simply
give patients a handout advising them not to use drugs, but now
we’re able to send them out of our emergency departments with
things like buprenorphine, naloxone or Suboxone, meloxone
or Narcan, as well as harm reduction supplies and won’t
hand offs to treatment programs. Prescribing buprenorphine is one
of my favorite parts of my practice. Now that there’s no X waiver
required, we’re able to bring this safe and effective
treatment to our patients in a way that decreases their
mortality, all causes and opioid related by up to 50%. Getting Narcan into the right
folks hands. We know that one in seven kids
is going to be used in a reversal to save the life. Ultimately, I’m hoping that
emergency medicine can continue its trajectory towards a stigma
free environment for these patients. Patients with OUD and all of our
patients are worth saving. Thank you for being a lifesaver.

[Angadpreet “Preet” Sidhu] What needs to be
done more is to break down the stigma of medication to opiate, of
medications for opiate use disorders such as Suboxone. Narcan saves lives, but also
Suboxone saves lives as well.

Fentanyl Strips Save Lives

Dr. Edward Boyer provides a personal anecdote on how the use of fentanyl test strips saved many lives at a college campus party.


[Edward W. Boyer] Hello everyone. My name is Ed Boyer
and I have a fentanyl story. So I’m an ER doc and a medical
toxicologist. So my area of sub specialization
is overdoses, poisonings, drug interactions and that sort of
thing. I also have a certain amount of
experience and background in the drug abuse world as well. Now, my daughter was going to
college at Syracuse University and I wanted to make sure that
she went off prepared. And one of the things that I did
was I got 5 fentanyl test strips from one of our harm reduction
colleagues at Ohio State. And I gave them to her. And my message was, I’m not
condoning. I’m not expecting you to use. I don’t expect you to
experiment. But if you ever wind up in a
situation where somebody gives you something and there’s a
temptation to use it, I want you to be safe by testing it with
these test strips. She goes off to college and time
passes, and she actually does well in college. So I’m pretty confident about
how things are going. And then in April of last year,
I got a text at like 2:00 in the morning from my daughter. And it said, essentially you
saved 300 people last night. One of the fraternities had
bought some pills and they gave them around to a whole bunch of
students. And when they got back to the
dorm, some of my daughter’s friends, “friends” wanted to use
them. So they used the fentanyl test
strips. They all contain fentanyl. You know, like, I I, I don’t
know exactly how accurate it is. I don’t know what reporting
happened, you know, the Panhellenic Council heard about
it afterward. But it highlights how the easy
availability of fentanyl test strips can save lives. And it also speaks to how a
broader based public health effort is necessary to help
minimize the the impact of, you know, like adulteration of all
sorts of substances with fentanyl.

Resources and Education

Bizzell US is proud to have created a variety of tools and resources for public use in conjunction with the National Institute of Drug Abuse Clinical Trials Network Dissemination Initiative, bringing researched based information to clinicians on a variety of topics related to substance use disorders. The links provided focus on the resources created specifically to address the opioid crisis.

Reducing the Risk of Fentanyl in the U.S. Video

We can work to decrease overdose deaths by increasing awareness of the dangers of illicitly manufactured fentanyl, learning how to discuss treatment options, and demonstrating how to respond to an overdose.

NIDA CTN Slide 5

Reducing the Risk of Fentanyl in the U.S. Factsheets

Use these infographics, available in English and Spanish, to educate patients, families and communities about the dangers of illicitly manufactured fentanyl. Share the steps for recognizing and reversing overdose using naloxone.



NIDA CTN Slide 6

Overdose Prevention Education for Clinicians Treating Patients with Opioid Use Disorder Video

This brief video offers strategies for overdose prevention through identification of an individual’s risk factors, stressing the importance of treatment adherence, safety planning, and overdose rescue preparation.

NIDA CTN Slide 8

Overdose Prevention Education for Clinicians Treating Patients with Opioids for Chronic Pain

Treating patients with opioids for chronic pain includes the risk of development of opioid use disorder and overdose. This brief video offers strategies for avoiding onset of opioid use disorder as well as overdose prevention through identification of individual risk, safety planning and overdose rescue preparation.

NIDA CTN Slide 9

The Case for Buprenorphine Initiation in the Emergency Department: Why, When, and How?

Listen and learn from nationally recognized experts in these 15-minute podcasts about the importance and effectiveness of starting buprenorphine treatment for opioid use disorder (OUD) in emergency departments.

NIDA CTN Slide 11

Opioid Use Disorder in Emergency Departments

Learn best practices for patient-centered approaches to addressing opioid use disorder in the emergency department.

NIDA CTN Slide 12

Bizzell Releases Essential Opioid Overdose Response Video in Wake of National Crisis

Bizzell Releases Essential Opioid Overdose Response Video in Wake of National Crisis

January 22, 2024, New Carrollton, Maryland – As the opioid crisis continues to devastate communities with over 136 American deaths daily, primarily from fentanyl-laced drugs, Bizzell US (Bizzell) has developed and unveiled a vital educational tool. The company has released “Opioid 5 Steps to Respond to Opioid Overdose,” a video outlining critical steps to respond to an opioid overdose, developed under the guidance of leading experts in the field.

The video’s creation was informed by the extensive knowledge and experience of Bizzell’s team of specialists, including experts in health and human services, behavioral health, public health, substance use disorders, treatment and prevention, maternal and child health, medication-assisted treatment, mental health, and pharmacy operations. This collective expertise ensures that the video is not only informative but also grounded in the latest research and best practices.

Anton C. Bizzell, MD, Chairman and CEO, William H. Scarbrough, III, PhD, and Todd W. Mandell, MD are among some of notable experts at Bizzell who contributed their insights, reflecting decades of experience in fields relevant to opioid crisis management, behavioral health, and substance use disorders. Their involvement underscores Bizzell’s commitment to leveraging deep expertise in tackling this pressing public health issue.

This initiative is part of Bizzell’s broader effort to educate and empower individuals and communities in the fight against the opioid epidemic. The video is mandatory viewing for all Bizzell employees and is accompanied by a call to action to carry naloxone (Narcan), an effective emergency response medication now available over the counter.

The educational video will also be accessible on the Bizzell and the Behavioral Health Advancement Resource Center (BHARC) website, forming part of an informative mini-series on the opioid crisis.

About Bizzell US

Bizzell is a strategy, consulting, investment, & technology firm headquartered in New Carrollton, Maryland. Bizzell is a partner of choice for federal, state, and local government agencies, and private organizations. With a strong emphasis on innovation and impact, Bizzell transforms small ideas into powerful catalysts that drive change across markets worldwide. Learn more at

About Behavioral Health Advancement Resource Center (BHARC)

Bizzell established the Behavioral Health Advancement Resource Center (BHARC) to provide expert information and resources to support the behavioral health community. With BHARC, Bizzell disseminates new ideas, tools, and solutions to critical behavioral health issues including the opioid epidemic, substance use disorders, suicide prevention, and more. As a leader in behavioral health initiatives, we bring together subject matter experts with exceptional experience, as well as commitment to behavioral health solutions.

For more information, visit

Dr. David Sleet Co-Authors Report on Reducing Homelessness at Canadian Emergency Departments

Dr. David Sleet Co-Authors Report on Reducing Homelessness at Canadian Emergency Departments

A novel Canadian program (The Bridge Healing program) aims to break the cycle of homelessness and prevent unsustainable, repeated “social admits” of homeless individuals to emergency departments (EDs).

Dr. David Sleet, Bizzell Senior Associate, Injury Prevention, co-authored “Bridge Healing: A Pilot Project of a New Model to Prevent Repeat “Social Admit” Visits to the Emergency Department and Help Break the Cycle of Homelessness in Canada,” published in the International Journal of Environmental Research and Public Health. The article describes the program designed to provide healthcare services that act as transitional housing for homeless individuals who would not normally receive any other housing assistance.

Dr. Sleet stated that, “the project design facilitates reintegrating residents into the community, preventing poor health outcomes and unnecessary costs to the healthcare system. Multiple stakeholders have endorsed the model and grassroots community-level organizations have financially supported it.”

Significant successes included the establishment of relationships with government agencies to facilitate the acquisition of permanent housing. The study found that collaborating with income support services that cover basic needs allowed staff to focus on acquiring permanent housing, thus minimizing reliance on EDs.

“We hope that our research eases the burden on local emergency departments and increases the resources so desperately needed by individuals working to exit the cycle of homelessness and housing insecurity,” added Dr. Sleet.

About Bizzell

Bizzell is a strategy, consulting, and technology firm with a mission to improve lives and accelerate change. We develop innovative solutions to some of the most critical issues of our time such as health care services equity, global health, workforce innovation, and other urgent needs facing the world. Learn more about how we develop data-driven, research-informed, innovative solutions to complex, real-world challenges.

Learn more at


The Behavioral Health Advancement Resource Center (BHARC) is an authoritative source for behavioral health information, insights, technical assistance, training, and innovative tools. BHARC is a mechanism to share evidence-based behavioral health interventions and best practices. The BHARC Advisory Council consists of experts in substance use, mental health, clinical trials, pharmaceuticals, and healthcare standards and quality. Learn more about the Behavioral Health Advancement Resource Center at

Peer Recovery Support Services

Peer Recovery Support Services:

A Promising Approach to Combat Substance Use Disorders

By K. Ceres Wright, MA; William Scarbrough, PhD; and Jenny Twesten, MPH

February 2023

Substance Use Disorder in the United States

During 2021, an estimated 107,622 people in the United States died of a drug overdose, an increase of almost 15% from 2020 (93,655).1 People with substance use disorders (SUD) are at increased risk for one or more chronic conditions. Co-occurring SUD and mental health disorders have risen among adults ages 18 or older, from 8.07 million in 20152 to 9.54 million in 2019.3 In 2019, 20.4 million people ages 12 or older in the United States had a past-year SUD.4 Only 10.3% received SUD treatment.5 The growing prevalence of SUDs and mental health disorders suggest opportunities to improve access to and delivery of SUD treatments to prevent future deaths.

In 2019, 20.4 million people ages 12 or older in the United States had a past-year SUD.4 Only 10.3% received SUD treatment.5

Traditional and Sustained Recovery Management Model Approaches to SUD Treatment

Many SUD treatment programs are based on acute care models that reduce symptoms, stabilize the SUD, and discharge the person seeking treatment. The individual is then expected to achieve lifelong recovery relying on what they learned from treatment. Acute care models of SUD intervention are generally effective for people with low to moderate SUDs and who also have considerable recovery capital. Recovery capital is defined as “the breadth and depth of internal and external resources that can be drawn upon to initiate and sustain recovery,” such as physical health, financial assets, problem-solving capacities, food, and family support.7 The fundamental flaw in the acute care model is the gap in providing connections to resources to support recovery and continued abstinence, particularly among those who do not have considerable recovery capital. This flaw is reflected in the high relapse rate of those who completed SUD treatment.

To address the limitations of the acute care model for SUD, the field has shifted toward exploring the use of the sustained recovery management model (SRMM). This approach accounts for the chronic nature of addiction through the provision of continuing care and encouragement of people to leverage resources designed to provide sustained recovery. Peer recovery support is an important component of the SRMM. In this article, we review the evidence on peer recovery support and the impact it is having on addressing SUD in the United States.

Of people who complete SUD treatment, about half resume their drug use within a year of discharge, only rarely having been connected to aftercare services.6

What is peer recovery support?

Recovery is facilitated by four types of social support: emotional (compassion), informational (sharing of knowledge or training), instrumental (concrete assistance), and social (community resources). Peer recovery support services are services designed and delivered by people who have experienced both SUD and recovery. They are designed to provide hope and support to those seeking recovery from a mental health condition or SUD and can help encourage others to build the skills necessary to achieve success in recovery. Services may be delivered in whole or in part. For example, a person in recovery who is seeking a job may just need a referral for an open position but may also need job-readiness training (informational support), a ride to the interview and childcare (instrumental support), and access to social events that support sobriety (social support).8

Peer recovery support services can also extend the capacity of health care workers. A recent study by the Association of American Medical Colleges predicts that the demand for doctors will outstrip the supply by 2030 and there will be a shortage of up to 121,300 physicians.9 During this time of health care worker shortages, many communities have sought alternative ways to meet the needs of people seeking to recover from SUD. The American Association of Emergency Psychiatrists recommends expanding the capacity of psychiatrists by employing clinical social workers, psychologists, and counselors, noting that some emergency settings also employ individuals with lived experiences (peers).10 One Australian study acknowledged the lack of resources for medication-assisted treatment for opioid dependence and employed the services of pharmacists in prescribing medications, in addition to building a collaborative model of care with health care workers, academicians, patients, consumer organizations, advisory boards, and workgroups.11

Who are peer recovery support specialists and what do they do?

A peer recovery support specialist—as defined by the Substance Abuse and Mental Health Services Administration (SAMHSA)—is “a person who uses his or her lived experience of recovery from mental illness and/or SUD, plus skills learned in formal training, to deliver services in behavioral health settings to promote mind–body recovery and resiliency.”12 Peer recovery support specialists assist with determining goals for recovery, developing action plans, finding housing, and building a new life around sobriety, from improving job skills to making new friends. The relationship between peer recovery support specialists and peers is more supportive than directive, as peer recovery support specialists are often managing their own long-term recovery.8

Peer recovery specialists are able to leverage the flexibility inherent in peer recovery support services to customize an approach for their peers that meets their unique needs.13

Peer recovery support can be leveraged within existing SUD treatment programs in a variety of settings

As far back as the 18th century, peer-delivered services have been integrated into health care, mental health, and other community and treatment settings as a support for clinical staff. However, in the field of SUD treatment, there are special considerations for the integration of peer recovery support services, such as defining roles, setting boundaries, bridging philosophic differences, and destigmatizing drug use.14

One strength of peer recovery support is the ability to adapt service delivery within different settings, including telehealth, and customize to a variety of populations.12 This adaptability makes such services effective in expending support beyond traditional health care workers, shoring up gaps in worker shortages and lack of accessible clinics.8

Recovery Community Organization Settings

Recovery community organizations (RCOs) provide credentialed recovery services across the care continuum, including medication for opioid use disorder (MOUD), mutual-help group meetings, and access to an array of relevant programs and services, including harm-reduction services such as naloxone education and distribution, fentanyl education and testing strip distribution, syringe exchange programs, and HIV and hepatitis C testing.14

Two systematic reviews of RCOs showed positive outcomes of SUD treatment, including decreased substance use; increased abstinence; increased housing stability; increased number of primary care visits; increased recovery capital; decreased hospital, emergency room, and detoxification use; decreased criminal charges; reduced reports of anxiety and tension14; and lowered negative health events.15

Police departments

Police departments across the country are incorporating peer recovery support specialists in their quick-response teams for drug overdoses. An initiative in Madison, WI, called the Madison Addiction Recovery Initiative (MARI) is a diversion program designed to reduce crime and improve health (i.e., reduce overdose deaths). The program includes training the police officer workforce to identify and assess people eligible for the MARI program, and collaborating with clinical partners for treatment need assessment, treatment placement, and peer support services.16 

Another program in Arizona, the Tempe First-Responder Opioid Recovery Project, involves training police officers to administer Narcan, and deploys a Crisis Outreach Response Team comprising social workers, substance use peer counselors, public health professionals, police researchers, and drug-policy/harm-reduction researchers.17

Community and outpatient settings

Peer recovery support specialists perform community-based outreach to people outside of the context of treatment or correctional settings. In outpatient addiction treatment and community settings, one study found that the delivery of peer recovery support services resulted in reduced substance use, injection and sexual transmission risk behaviors, and craving; improved treatment engagement and self-efficacy; and increased positive behavior change.18

A systematic review of peer recovery and recovery coaching found that peer recovery support services integrated into community outreach programs may increase participants’ self-awareness of problematic substance use and lead to reductions in alcohol and other drug use, and particularly emphasized the benefit to marginalized and/or stigmatized populations.19

One peer recovery program was established by researchers in Central Appalachia. Since the area has been disproportionately affected by the opioid epidemic and overdose fatalities, researchers at West Virginia University developed the West Virginia Peers Enhancing Education, Recovery, and Survival (WV PEERS) program. In the program, of the 63.9% of individuals who accessed services for SUDs and/or mental health problems, over half entered substance use and/or mental health treatment, and nearly a third remained in treatment over 6 months.12

Peer recovery support services have also been shown to be successful in American Indian communities. Aspects of culture that may facilitate recovery include a balance of physical, emotional, spiritual, and mental supports, such as talking circles, sweat lodges, prayer, and smudging, which are unique to American Indian populations. In a longitudinal study comparing European Americans and Navajos, the Navajos were more likely to quit drinking at an earlier age and report that treatment did not help them quit, citing family support, religion, and spirituality as the elements that supported their long-term sobriety.13

Hospital and emergency department settings

Many health care organizations have seen the advantages of implementing peer recovery support services to help encourage patients’ engagement with SUD treatment and other recovery support programs and services, and to discourage relapse.19 Patients often present to the emergency department (ED) with stated symptoms such as opioid withdrawal, acute intoxication, or medical complications related to OUD. This situation presents an opportunity for ED providers to initiate treatment and introduce the patient to peer recovery support services.20

Peer recovery support specialists can be integrated into hospitals, EDs, and other health care settings where they connect people to services such as MOUD, intensive outpatient or residential SUD treatment, social services, or harm-reduction resources. Peer recovery support specialists can also educate clinical staff on issues surrounding recovery, facilitate communication, model informal patient interactions, help reduce stigma, and facilitate changes in perceptions of people who use drugs (PWUD).14 Working within hospitals, peer recovery support specialists can reduce the amount of time from a doctor’s referral to arrival at bedside to initiate treatment, which helps to prevent discharge before the arrival of a peer recovery support specialist.18

Jail and prison settings

Peer recovery support specialists who work in jails and prisons typically have experienced incarceration and can leverage that experience to build rapport with the people they serve. Peer recovery support specialists may reach out to those with an upcoming release date to provide encouragement and develop a plan for support after release. At release, they may provide transportation to the person’s house or to community resources to obtain food or clothing. They may also help ease entry into a treatment program. One administrative data analysis using data from the Serious and Violent Offender Reentry Initiative found that the formerly incarcerated who received peer support experienced decreased substance use and recidivism. In another study, participants reported increased self-efficacy, perceived social support, positive relations with family and friends, improved quality of life, and decreased stress.14

Barriers to Delivering and Receiving Peer Recovery Support Services

Although the barriers for peer recovery support services may overlap with general barriers for SUD treatment, the following are presented within a peer recovery support services framework.

Personal barriers

A main barrier to receiving SUD treatment is the perspective of PWUD not believing they need treatment and not being ready to stop using substances. Other barriers include not being able to afford treatment without health care coverage, a lack of knowledge about where to obtain treatment, being a minority, having a psychiatric comorbidity, having low motivation, lacking basic resources, and having a fear of stigma in the workplace and the community.21

Barriers to Delivering and Receiving Peer Recovery Support Services. Personal Barriers. Lack of Retention of Peers and Peer Recovery Specialists. Difficulty in Sharing Information Among Treatment Centers. Lack of National Standards for Scope of Work and Wages. Varying Processes and Requirements for Reimbursement.

Lack of retention of peers and peer recovery support specialists

A review of the literature21 found that dropout rates for treatment programs vary significantly by population treated, substance of choice, and treatment characteristics. Rates range between 20–70% for inpatient programs, 23–50% for outpatient programs, and about 50% for office-based opioid treatment programs. People with psychiatric co-morbidities experienced higher odds of treatment dropout and shorter stays in treatment. Other demographic characteristics such as younger age, homelessness, having a history of physical or sexual abuse, unemployment, Black and Hispanic race/ethnicity, and being positive for hepatitis C had positive correlations with early dropout from substance use treatment.

Difficulty in sharing information among treatment centers

Treatment centers, hospitals, and peer services often lack the ability to share information across services. Organizations use a variety of electronic medical record systems, which typically do not interface with each other. The 42 CFR Part 2 regulations serve to protect patient records created by federally assisted programs for the treatment of substance use disorders. Such restrictions on information sharing make it difficult to coordinate care among outpatient clinics and peer recovery support services. Possible solutions include companies that are developing platforms that interface with each other to facilitate the sharing of patient data.22

Lack of national standards for scope of work and wages

Most states require peer recovery support specialists to obtain some level of certification; however, the eligibility requirements vary by state. There is a National Certified Peer Specialist certification program sponsored by the Florida Certification Board.23 However, this credentialing is not linked to tiered wage levels, and current reported wages range between $10 to $20 per hour with limited career advancement for employees. In treatment settings, peer recovery support specialists often assume additional responsibilities, such as case management, group facilitation, and advocacy, especially when program funding decreases. These additional tasks increase workloads and stress, without an accompanying increase in compensation.14

Varying processes and requirements for reimbursement

A study of interviews with state policymakers, directors of training and certification bodies, peer recovery support specialists, and other staff in mental health and substance use treatment and recovery organizations across four states identified multiple challenges with billing the Centers for Medicare & Medicaid Services for peer recovery support services. Interviewees reported that the burden of navigating a complex billing structure with little to no experience with the technology led to challenges that hindered their relationships with their peers. States and organizations may fund peer recovery support services using complex blended funding structures, such as SAMHSA grants (e.g., block grants) or state or federal drug court funds.14 In addition, many states have failed to expand Medicaid services after passage of the Affordable Care Act. Over three-quarters of all rural counties in Georgia have little or no access to SUD treatment for OUD. Integrating peer-delivered services within rural health care systems may prove beneficial and may serve as a model to states without expanded Medicaid.24

In emergency departments, it is difficult to determine whether a patient is eligible for Medicaid due to varying requirements across states. Peer recovery support services may require patients to be insured or eligible for Medicaid. As there are only 11 states where peer recovery support services may be billed to Medicaid, this requirement may prove a barrier to the uninsured.22

Call to Action

To support individuals in sustaining their recovery within a peer recovery program, the following elements are recommended for integration into community, health care, and other institutional settings:

  • Educate health care professionals, policymakers, and the public on the benefits of peer recovery support services.
  • Promote the inclusion of peer recovery support specialists in all aspects of primary health care and preventive services.
  • Promote the equitable payment of peer recovery support specialists, whether as individuals or as part of integrated service delivery models.
  • Tailor peer recovery support services to the community and populations that receive these services, with input from both community members and peer recovery support specialists.25

Peer recovery support services have been shown to be beneficial to people in SUD treatment across various settings. They can also extend the capacity of health care workers, which is desperately needed in areas with shortages of available physicians and accessible services. The integration of peer recovery support services into community, health care, and institutional settings will enhance long-term sobriety and improve the quality of life for people seeking SUD treatment.

Additional Resources

Bizzell US is poised to support federal, state, and local governments, as well as assist other stakeholders in navigating the growing demand for mental health and behavioral health care services. Bizzell’s Behavioral Health Advancement Resource Center (BHARC) is an ever-growing and trusted source for current behavioral health program development and research findings, examples of evidence-informed and promising practices, and emerging behavioral health policy and interventions. The BHARC Advisory Council consists of experts in substance use, mental health, clinical trials, pharmaceuticals, and health care standards and quality.

About Bizzell US (Bizzell)

Established in 2010, Bizzell is a U.S. Small Business Administration (SBA) HUBZone-certified strategy, consulting, and technology firm with a mission to improve lives and accelerate change. Bizzell develops innovative solutions to some of the most critical issues of our time such as health care services equity, global health, workforce innovation, and other urgent needs facing the world. Under the leadership and vision of founder, Anton C. Bizzell, MD, the company has grown into a thriving firm headquartered in New Carrollton, Maryland, with staff and offices in various regions around the country, including California, Colorado, Oklahoma, Connecticut, and Georgia, and globally in Africa, Asia, and Central America. To learn more about how we develop data-driven, research-informed, innovative solutions to complex, real-world challenges, visit: Bizzell US.


  1. Centers for Disease Control and Prevention Atlanta: CDC; 2022 [cited 2022 Nov 28]. U.S. overdose deaths in 2021 increased half as much as in 2020 – but are still up 15%. Available from:
  2. Substance Abuse and Mental Health Services Administration (SAMHSA). Table 8.27A – Co-occurring substance use disorder and any mental illness in past year among persons aged 18 or older, by age group and demographic characteristics: numbers in thousands, 2014 and 2015 [Internet]. Rockville, MD: Author. c2016 [cited 2022 Dec 19]. Available from:
  3. SAMHSA. Co-occurring substance use disorder and any mental illness in past year among persons aged 18 or older, by age group and demographic characteristics: numbers in thousands, 2018 and 2019 (Table 8.9A). Rockville, MD: Author. c2016 [cited 2022 Dec 19]. Available from:
  4. SAMHSA. Key substance use and mental health indicators in the United States: results from the 2019 National Survey on Drug Use and Health. Figure 46 – People Aged 12 or Older with a Past Year Substance Use Disorder (SUD): 2019. Rockville, MD: Author. c2020 [cited 2022 Dec 19]. Available from:
  5. SAMHSA. Received Illicit Drug Use Treatment at Any Location in Past Year among Persons Aged 12 or Older with Past Year Illicit Drug Use Disorder, Received Alcohol Use Treatment at Any Location in Past Year among Persons Aged 12 or Older with Past Year Alcohol Use Disorder, and Received Substance Use Treatment at Any Location in Past Year among Persons Aged 12 or Older with Past Year Substance Use Disorder, by Age Group: Percentages, 2015-2019 (Table 7.56B). Rockville, MD: Author. c2020 [cited 2022 Dec 19]. Available from:
  6. White WL, Kelly JF. Recovery management: what if we really believed that addiction was a chronic disorder? In: Kelly J, White W, editors. Addiction recovery management. Current clinical psychiatry. Totowa, NJ: Humana Press; 2011. p. 67-84. doi: 10.1007/978-1-60327-960-4_5
  7. White W, Cloud W. Recovery capital: a primer for addictions professionals. Counselor. 2008;9(5):22-27.
  8. Center for Substance Abuse Treatment. What are peer recovery support services? HHS Publication No. (SMA) 09-4454. Rockville, MD: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. c2009 [cited 2023 Jan 11]. Available from:
  9. Zhang X, Lin D, Pforsich H, Lin VW. Physician workforce in the United States of America: forecasting nationwide shortages. Hum Resource Health. 2020;18:8. doi: 1186/s12960-020-0448-3
  10. Richmond JS, Dragatsi D, Stiebel V, Rozel JS, Rasimus JJ. American Association for Emergency Psychiatry recommendations to address psychiatric staff shortages in emergency settings. Psychiatr Serv. 2021 Apr 1;72(4):437-443. doi: 10.1176/
  11. Nielsen S, Cheetham A, Jackson J, Lord S, Petrie D, Jacka D, Picco L, Morgan K. A prospective, multisite implementation-efficacy trial of a collaborative prescriber-pharmacist model of care for medication assisted treatment for opioid dependence: protocol for the EPIC-MATOD study. Res Social Adm Pharm. 2022 Aug;18(8):3394-3401. doi: 10.1016/j.sapharm.2021.11.007
  12. Davis SM, Stover AN, Linn H, Dower J, McCawley D, Winstanley EL, Feinberg J. Establishing peer recovery support services to address the Central Appalachian opioid epidemic: the West Virginia Peers Enhancing Education, Recovery, and Survival (WV PEERS) pilot program. J Appalach Health. 2021 Jul 25;3(3):36-50. doi: 10.13023/jah.0303.04
  13. Kelley A, Bingham D, Brown E, Pepion L. Assessing the impact of American Indian peer recovery support on substance use and health. J Groups Addict Recover. 2017;12(4):296-308. doi: 10.1080/1556035x.2017.1337531
  14. Stack E, Hildebran C, Leichtling G, Waddell EN, Leahy JM, Martin E, Korthuis PT. Peer recovery support services across the continuum: in community, hospital, corrections, and treatment and recovery agency settings – a narrative review. J Addict Med. 2022 Jan-Feb 01;16(1):93-100. doi: 10.1097/adm.0000000000000810
  15. Ashford RD, Brown A, Canode B, Sledd A, Potter JS, Bergman BG. Peer-based recovery support services delivered at recovery community organizations: predictors of improvements in individual recovery capital. Addict Behav. 2021 Aug;119:106945. doi: 10.1016/j.addbeh.2021.106945
  16. Zgierska AE, White VM, Balles J, Nelson C, Freedman J, Nguyen TH, Johnson SC. Pre-arrest diversion to addiction treatment by law enforcement: protocol for the community-level policing initiative to reduce addiction-related harm, including crime. Health Justice 2021 9(9). doi: 10.1186/s40352-021-00134-w
  17. White MD, Perrone D, Watts S, Malm A. Moving beyond Narcan: a police, social service, and researcher collaborative response to the opioid crisis. Am J Crim Justice. 2021;46(4):626-643. doi: 10.1007/s12103-021-09625-w
  18. Liebling EJ, Perez JJS, Litterer MM, Greene C. Implementing hospital-based peer recovery support services for substance use disorder. Am J Drug Alcohol Abuse. 2021 Mar 4;47(2):229-237. doi: 10.1080/00952990.2020.1841218
  19. Eddie D, Hoffman L, Vilsaint C, Abry A, Bergman B, Hoeppner B, Weinstein C, Kelly JF. Lived experience in new models of care for substance use disorder: a systematic review of peer recovery support services and recovery coaching. Front Psychol. 2019 Jun 13;10:1052. doi: 10.3389/fpsyg.2019.01052
  20. Crowthers RA, Arya M, Venkataraman A, Lister JL, Cooper SE, Enich M, Stevens S, Bender E, Sanders R, Stagliano K, Jermyn RT. Impact of an osteopathic peer recovery coaching model on treatment outcomes in high-risk men entering residential treatment for substance use disorders. J Osteopath Med. 2022 122(10):521-9. doi: 10.1515/jom-2022-0066
  21. Stanojlović M, Davidson L. Targeting the barriers in the substance use disorder continuum of care with peer recovery support. Subst Abuse. 2021 Jun 17;15:1-10. doi: 10.1177/1178221820976988
  22. Kauffman E, Qiu Y, Frey JA, Bischof JJ. Barriers and facilitators to peer support services for patients with opioid use disorder in the emergency department. Cureus. 2022 Mar 14;14(3):e23145. doi: 10.7759/cureus.23145
  23. Florida Certification Board. National certified peer specialist (NCPS). Tallahassee, FL. c2022 [cited 2022 Dec 19]. Available from:
  24. Ashford, RD, Meeks M, Curtis BL, Brown AM. Utilization of peer-based substance use disorder and recovery interventions in rural emergency departments: patient characteristics and exploratory analysis. Rural Ment Health. 2019;43:17–29.
  25. Society of Behavioral Medicine. Call to action: integrating peer support in prevention and health care under the Affordable Care Act. Milwaukee, WI: Author. c2015 [cited 2022 Dec 19]. Available from:
1 2 3 6