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Brief ED Interventions with Drug Abusers Show Little Effect

October 9th, 2016

ALBUQUERQUE, NM – Could emergency departments do more than just acute medical stabilization for patients who present with substance abuse?

It may sound good on paper, but a new study published in JAMA Internal Medicine suggests that might be very difficult with current tools.

Noting that medical treatment settings such as EDs offer important opportunities to address problematic substance use beyond acute treatment, the study led by researchers from the University of New Mexico Health Sciences Center in Albuquerque sought to contrast the effects of a brief intervention with telephone boosters (BI-B) with those of screening, assessment, and referral to treatment (SAR) and minimal screening only (MSO) among drug-using ED patients.

The study, conducted between October 2010 and February 2012, focused on 1,285 adult ED patients from six academic hospitals in the United States. All scored 3 or greater on the 10-item Drug Abuse Screening Test, indicating moderate to severe problems related to drug use, and were currently using drugs.

With 431 study subjects randomized to MSO, 427 to SAR and 427 to BI-B, follow-up assessments were conducted at 3, 6, and 12 months by blinded interviewers.

Following screening, MSO participants received only an informational pamphlet. The SAR participants received assessment plus referral to addiction treatment if indicated. The BI-B participants, however, received assessment and referral as in SAR, plus a manual-guided counseling session based on motivational interviewing principles and up to two “booster” sessions by telephone during the month following the ED visit.

At follow-up visits, researchers evaluated effects based on self-reported days using the patient-defined primary problem drug, days using any drug, days of heavy drinking, and drug use based on analysis of hair samples.

Results indicate that estimated differences in number of days of use were:

  • MSO vs BI-B, 0.72 (−0.80 to 2.24);
  • SAR vs BI-B, 0.70 (−0.83 to 2.23),
  • SAR vs MSO, −0.02 (−1.53 to 1.50).

“There were no significant differences between groups in self-reported days using the primary drug, days using any drug, or heavy drinking days at 3, 6, or 12 months,” the authors report. “At the 3-month follow-up, participants in the SAR group had a higher rate of hair samples positive for their primary drug of abuse (265 of 280 [95%]) than did participants in the MSO group (253 of 287 [88%]) or the BI-B group (244 of 275 [89%]). Hair analysis differences between groups at other time points were not significant.”

The study laments that, in this sample of drug users seeking emergency medical treatment, “a relatively robust brief intervention did not improve substance use outcomes. More work is needed to determine how drug use disorders may be addressed effectively in the ED.