PROJECT SUMMARY: Deaths from drug overdose have risen to record levels since the onset of the COVID- 19 pandemic, disproportionately impacting Black individuals and people experiencing homelessness.(2-6) Fewer than one-third of the 8.3 million individuals living with an illicit drug use disorder in 2019 reported receiving treatment.(7) Telemedicine services have increased access to care for many patients living with substance use disorders (SUD), but the long-term role of this treatment approach in SUD care is uncertain.(8- 11) Multifaceted strategies are needed to build recovery capital and link vulnerable individuals to recovery resources.(12) Emergency department (ED) visits are an opportunity to screen for SUDs, initiate treatment, and link to recovery resources.(13, 14) Observational studies have noted that consultation with a peer recovery coach (PRC) was well-received in EDs, with high rates of engagement and satisfaction.(15, 16) PRCs facilitate conversations allowing patients to express their ideal pathway to recovery, provide linkage to services across the social ecology,(17, 18) and follow up to support recovery, including re-linkage to resources as needed. Nonetheless, their role in ED screening and linkage to resources, including the potential role of telemedicine, has not been rigorously evaluated.(13) The objective of this prospective study is to develop a robust evidence base supporting a novel approach to embedding peer recovery coaches in the ED setting to link patients with an illicit SUD to recovery support services. Investigators will conduct a Hybrid Type 1 effectiveness- implementation trial at Grady Memorial Hospital, a large, urban level 1 trauma center that serves a socioeconomically vulnerable and racial minority population with a high rate of substance use.(25, 26) The implementation component will be guided by the EPIS framework,(28, 29) and the effectiveness component will include a randomized controlled trial enrolling 600 subjects across three arms: in-person peer coaching with linkage to recovery support services and callbacks, telemedicine-based peer coaching with linkage and callbacks, or usual care. The public health impact of ED PRCs will be measured across the dimensions of the RE-AIM framework.(27) This work builds established partnerships with Georgia Council on Substance Abuse and other local community organizations to implement ED PRCs while uniquely integrating and evaluating their utility. Results will inform other EDs considering a peer recovery coach program for patients presenting with SUD-related conditions. By utilizing telemedicine, this model will be rapidly scalable and readily implemented at other facilities. This study’s focus directly aligns with the CDC’s funding priority to support interdisciplinary teams implementing evidence-based scalable approaches for linking individuals from communities experiencing a disproportionate burden of illicit substance use and overdose, such as the racially,...