Integrating Peer Support Workers into Hospital-Based Addiction Care : Experiences of and Impact on Patients, Healthcare Providers and Peers

People who use drugs (PWUD) frequently encounter stigma, mistrust, and structural barriers within acute care settings, which can contribute to disengagement from treatment and patient-initiated discharge. Healthcare providers (HCPs) may also experience challenges when caring for this population, including managing complex and overlapping concerns related to withdrawal, pain, mental health, housing instability, communication barriers, and previous experiences of healthcare-related harm. HCPs may feel underprepared or constrained by task-focused hospital systems, contributing to moral distress and difficulties establishing therapeutic relationships. Peer support workers (PSWs), whose expertise is grounded in lived and living experience, may help bridge gaps between patients and HCPs; however, their integration into inpatient addiction care remains understudied. This qualitative quality improvement evaluation explored how PSWs influence the hospital experiences of PWUD and examined the perceived impact of peer integration from the perspectives of patients, HCPs, and PSWs. The study was conducted within a hospital-based addiction medicine consult team at an urban tertiary care centre in Vancouver, Canada. Semi-structured interviews were completed with 23 participants, including ten patients, eight healthcare providers, and five PSWs. Data were analyzed using Braun and Clarke’s six-phase thematic analysis, informed by Interpretive Description and principles of trauma- and violence-informed, equity-oriented, and relational care. Preliminary findings indicate that PSWs foster trust and relational safety through shared experience, improve communication between patients and clinical teams, and support advocacy and engagement in medical care. Participants described peers as helping HCPs better understand patients’ experiences, needs, and substance use patterns, while increasing HCPs confidence and perceived safety when delivering care. Peers also helped patients navigate the healthcare system, participate in necessary treatments, and remain in the hospital during periods of distress. Dedicated peer leadership emerged as essential to role clarity, psychological safety, workforce sustainability, and the meaningful integration of lived experience within healthcare teams. These findings suggest that PSWs can strengthen compassionate, person-centred, and equity-oriented inpatient addiction care while supporting HCPs in navigating complex clinical and relational situations. Sustainable implementation requires organizational structures that protect the relational integrity of the peer role, recognize lived experience as expertise, and provide peer-specific leadership, mentorship, and support.