Abstract / Summary
Peer support workers have become an integral part of harm reduction and behavioral health services, offering support to people who use drugs (PWUD) rooted in lived experience. Unlike traditional providers, peers use lived experience as a type of experiential expertise to foster trust and credibility amongst PWUD. Peer roles have become increasingly formalized through certification and credentialing. However, discrepancies between the value of lived experience and its translation into professional work settings have not been adequately explored. This paper explores the experiences of peers and peer supervisors working in Maryland harm reduction settings using Borkman’s (1976) concept of “experiential expertise” as a framework to guide analysis. Data were collected through 30 in-depth interviews with peers (n=18) and peer supervisors (n=12) across county health departments and nonprofit organizations. Using abductive thematic analysis, and an open coding format through MAXQDA, we identified three core themes. The three core themes identified: (1) lived experience and credentialing, (2) career advancement and supervision, and (3) motivation versus pay. These findings illustrated the value of lived and professional expertise in the peer workforce. Participants emphasized the unique contribution of lived experience when building connections with PWUD, while stating the importance of credentialing in gaining institutional recognition. However, career advancement pathways remained narrow with many positions that require higher education or being limited to a supervisory role. Peers also reported experiencing organizational stagnation, perceiving peer work to be a stepping stone rather than a long-term career. Despite these barriers peers demonstrated a strong intrinsic motivation rooted in altruism for their work. Many peers reported living paycheck to paycheck with some relying on secondary income sources to remain in the role. The combination of low pay, high emotional labor, and limited upward mobility raises ethical concerns about the exploitation of peer work in broader health recovery settings. This paper draws on peer experiences to highlight the need for structural reform including improved compensation, upward mobility, career pathways, and professional development to help sustain the peer workforce. Legitimizing and recognizing experiential expertise as comparable to professional experience is essential in securing the long term vitality of the peer workforce. Not applicable.