Peer navigators provide direct, informational, and facilitation support for OUD during community re-entry

BACKGROUND: For individuals with opioid use disorder (OUD) re-entering the community after incarceration, peer navigator (PN) support is increasingly implemented to support treatment initiation and continuity. However, little is known about the specific services PNs deliver in real-time encounters, contexts in which these services occur, and how they address barriers that affect access to medications for OUD (MOUD). This study presents the first empirically derived typology of PN support for criminal legal-involved (CLI) adults with OUD. METHODS: We applied qualitative content analysis (QCA) to PN encounters from the Connecticut (CT) site of a multi-site randomized controlled trial (RCT) evaluating extended-release buprenorphine (XR-B), extended-release naltrexone (XR-NTX), and enhanced treatment as usual (ETAU) among CLI adults with OUD. Of the 151 individuals enrolled in CT, this analysis focuses on the 108 participants who had at least one PN encounter. Two PNs with lived experience supported participants across all study arms and recorded 1316 real-time engagement notes in REDCap between January 2021 and January 2024. Descriptive quantitative data were triangulated with QCA findings, and Lincoln and Guba's criteria guided qualitative analytic rigor. RESULTS: Participants averaged 37.6 years (SD ± 7.7); 72% were men, 85% White, and 23% Hispanic. Three domains of support were identified: (1) Direct Services (41.9% of encounters), where PNs provided tangible resources, including transportation (29.3% of direct services) to pharmacies, court dates, and the provision of food and clothing. (2) Informational Services (40.6% of all encounters) involved educating peers about resources (29.1% of informational services), including employment for CLI individuals, as well as goal setting (12.0% of informational services) and MOUD visit reminders. (3) Facilitation Services (17.5% of all encounters) involved PNs helping participants navigate systems through advocacy (32.8% of facilitation services) with parole officers or housing managers, negotiating during evictions, and assistance with paperwork to receive social service benefits (14.5% of facilitation services). These service patterns reflected participants' high needs: 41.1% had unstable housing, only 4.4% were employed full-time, and 13.5% reported active substance use during PN encounters. CONCLUSIONS: Peer Navigators provide direct, informational, and facilitation support during community re-entry that can help with MOUD access. Future research should examine how these service domains align with participant priorities and contribute to treatment outcomes.