Enhanced brief Intervention for linking opiate abusing EMS patients to treatment

描述（由申请人提供）：阿片类药物滥用和过量在过去15年中激增。药物过量，主要是阿片类药物，现在是美国意外死亡的第二大原因。大多数药物滥用治疗系统采用被动方法将药物滥用者与治疗联系起来，导致延迟接受治疗，往往随后对健康和社会产生不利影响。主要的结构性和动机障碍阻碍了阿片剂滥用者接受治疗。最近的医疗保健改革立法提供了机会，可以测试积极主动的公共卫生方法，以确定药物滥用者并将其与治疗联系起来。虽然筛查和短暂干预（BI）在解决医疗机构中的酒精滥用问题方面显示出有效性，但研究表明，对于那些药物依赖者，需要加强BI并与专业治疗联系起来。阿片类药物滥用者不成比例地使用紧急医疗服务（EMS），就像他们使用急诊科一样，我们的研究表明，有相当一部分人拒绝被送往急诊科。虽然紧急医疗服务系统在干预药物滥用方面处于主要地位，但目前很少这样做。研究表明，在出现卫生紧急情况时，可能会促使药物滥用者接受治疗，而短暂干预、免费治疗和奖励措施可能会进一步增加接受治疗的人数。在先前的一项研究中，EMS提供者在过量用药时与患者讨论药物治疗与他们进入治疗有关。然而，只有17%的EMS提供者讨论了治疗，这意味着错过了干预的机会。拟议的研究测试了一种新的EMS方法对药物滥用筛查的可行性和影响，以及协调，增强BI以改善当前与治疗实践的联系。所有参与者都将获得免费治疗的代金券，并通过巴尔的摩市卫生局（BCHD）的常规做法，即治疗信息和转诊（I&R）电话线路，在该市任何治疗机构进行按需治疗的积极转诊。随机分配到奖励组的一半参与者将获得经记录审查确认的名义上的有形奖励。该研究将比较各研究组的结果，并与I&R客户的匹配样本进行比较，这些客户（自我）使用通常的联系进行阿片类药物滥用治疗。在药物滥用治疗研究中很少使用的电子信息系统使这项研究成为可能。学术机构间的合作建立在研究小组成员数十年来与研究人群成功进行相关研究的基础上。

DESCRIPTION (provided by applicant): Opiate abuse and overdose have surged in the past 15 years. Drug overdose, mostly from opiates, is now the US' second leading cause of accidental death. Most drug abuse treatment systems use passive approaches to link drug abusers to treatment, resulting in delayed entry into treatment, often subsequent to adverse impacts on health and society. Major structural and motivational barriers impede opiate abusers' engagement in treatment. Recent healthcare reform legislation presents opportunities to test proactive, public health approaches to identifying and linking drug abusers to treatment. While screening and brief intervention (BI) have shown effectiveness in addressing alcohol abuse in healthcare settings, research suggests that for those drug dependent, there is a need for enhanced BI and linkage to specialty treatment. Opiate abusers disproportionately use emergency medical services (EMS), as they do EDs, and our research suggests a significant number refuse transport to EDs. While EMS systems are in a prime position to intervene on drug abuse, few currently do so. Research suggests drug abusers may be motivated to engage in treatment at times of health emergencies, and that brief intervention (BI), free treatment, and incentives may further enhance treatment entry. In a prior study, EMS providers' discussing drug treatment with patients at times of overdose was associated with their entering treatment. Yet only 17% of EMS providers discussed treatment then, representing a missed opportunity for intervention. The proposed study tests the feasibility and effects on opiate abuse treatment entry of a novel EMS approach to drug abuse screening, and coordinated, enhanced BI to improve current linkage to treatment practices. All participants will be given vouchers for free treatment and active referral for on-demand treatment at any of the city's treatment facilities through the Baltimore City Health Department's (BCHD's) usual practice, a treatment information and referral (I&R) phone line. The half of participants randomized to the incentive arm will receive a nominal tangible incentive for treatment entry confirmed by record review. The study will compare outcomes across study arms and to a matched sample of I&R clients who (self-) refer using usual linkage to opiate abuse treatment practices. The study is enabled by electronic information systems seldom used in drug abuse treatment research. The academic-interagency collaboration builds on study team members' decades of successful relevant research with the study population. . PUBLIC HEALTH RELEVANCE: The study addresses the dearth of rigorous studies on universal screening and brief intervention to link drug abusers to drug treatment. The study uses a novel EMS approach and capitalizes on recent healthcare reform legislation, and early implementation at the study site, that expands funding streams and availability of drug abuse treatment. Findings will inform policymakers on a low cost, high impact model for linking acute care seeking opiate abusers to treatment, with implications to patient outcomes and healthcare costs.