Models of SBIRT for Opioid Dependent Patients in the Emergency Department

描述(申请人提供)：海洛因和处方阿片依赖患者的不良健康后果的风险增加，并经常使用急诊科(ED)作为他们的医疗保健来源。筛查、短暂干预和转介治疗在减少酒精和烟草使用等高危行为以及不安全性行为方面是有效的。关于对阿片类药物依赖进行短暂干预的有效性的数据有限。这项针对阿片类药物依赖受试者(N=360)的前瞻性随机对照试验将比较两种短期干预模式和对照条件。有阿片依赖的ED患者将被随机分为：(1)筛查，促进转诊至治疗(SBIRT)的短暂干预；(2)筛查，与ED发起的丁丙诺啡治疗(SBI+Bup)的短暂干预；或(3)标准护理(SC)，其中包括一份详细介绍该地区药物滥用治疗中心的讲义。主要结果将是30天后自我报告参加正式的药物滥用治疗，并通过与治疗计划的联系进行核实。在30天、2个月、6个月和12个月时测量的其他结果包括阿片类药物使用的变化(自我报告和尿毒学分析)、艾滋病毒危险行为和卫生保健服务利用情况。还将对这三种干预措施的成本效益进行比较。我们将检验SBI+Bup将优于SBIRT和SC的假设，并且SBIRT将在以下方面优于SC：(1)在30天内增加接受正式药物滥用治疗的患者的比例；(2)减少非法阿片类药物的使用；(3)减少艾滋病毒危险行为；(4)减少医疗服务的利用。此外，我们假设，与SBIRT或SC相比，SBI+Bup每阿片类药物戒断天数的社会成本将具有成本效益；SBIRT将相对于SC具有成本效益。将对随机抽样患者的治疗意向进行数据分析。这项研究由一个对阿片类药物依赖的简短干预和治疗进行评估的丰富经验的研究小组进行，其独特之处在于：(1)比较了两种短暂干预模式与标准护理；(2)纳入了ED发起的治疗臂；(3)使用手动干预，对依从性和能力进行了系统评估；以及(4)收集详细的成本数据，以帮助指导未来的医疗政策。公共卫生相关性：阿片类药物依赖是一个主要的公共卫生问题，在美国主要仍然是一种未经治疗的医疗状况。2006年，约有56万人使用海洛因，1140万人出于非医疗原因使用处方阿片类药物。阿片类药物依赖的经济成本估计超过210亿美元/年，对个人、工作场所、社会和医疗保健系统具有深远影响。治疗与巨大的个人和社会利益相关；急诊科就诊通常是阿片依赖患者与医疗系统的唯一接触，是筛查、干预和转介治疗的独特机会。

DESCRIPTION (provided by applicant): Patients with heroin and prescription opioid dependence are at increased risk for adverse health consequences and often utilize the Emergency Department (ED) as their source of medical care. Screening, brief intervention and referral to treatment has been effective in decreasing high risk behaviors such as alcohol and tobacco use, and unsafe sexual practices. The data on the effectiveness of brief interventions with opioid dependence is limited. This prospective, randomized controlled trial of opioid dependent subjects (N=360) will compare two models of brief intervention with a control condition. ED patients with opioid dependence will be randomized to either: (1) Screening, Brief Intervention with a Facilitated Referral to Treatment (SBIRT); (2) Screening, Brief Intervention with ED initiated Buprenorphine Treatment (SBI+Bup); or (3) standard care (SC) which includes a handout detailing substance abuse treatment centers in the area. The primary outcome will be self-reported engagement in formal substance abuse treatment at 30 days, verified by contact with the treatment program. Other outcomes measured at 30 days, 2, 6 and 12 months include changes in opioid use (self-report and urine toxicology analysis), HIV risk behaviors, and health care service utilization. The three interventions will also be compared on their cost-effectiveness. We will test the hypotheses that SBI+Bup will be superior to SBIRT and SC, and SBIRT will be superior to SC in (1) increasing the proportion of patients engaged in formal substance abuse treatment at 30 days; (2) reducing illicit opioid use; (3) reducing HIV risk behaviors; and (4) reducing health care service utilization. In addition, we hypothesize that the societal costs of SBI+Bup, per number of days of opioid abstinence, will be cost effective relative to SBIRT or SC; and that SBIRT will be cost effective relative to SC. Data analyses will be conducted on the intention to treat sample of randomized patients. This study, conducted by a research team with extensive experience evaluating brief interventions and treatments for opioid dependence, will be unique in its: (1) comparison of two models of brief intervention with standard care; (2) inclusion of an ED initiated treatment arm; (3) use of manual-guided interventions with systematic assessment of adherence and competence; and (4) collection of detailed cost data to help guide future healthcare policy. PUBLIC HEALTH RELEVANCE: Opioid dependence is a major public health concern and remains primarily an untreated medical condition in the United States. In 2006, approximately 560,000 individuals used heroin and 11.4 million individuals used prescription opioids for non-medical reasons. The economic costs of opioid dependence, estimated at greater than $21 billion/year, have far reaching implications for the individual, workplace, society and the healthcare system. Treatment is associated with substantial individual and societal benefits; and the Emergency Department visit, often the opioid dependent patient's only contact with the medical system, is a unique opportunity for screening, intervention and referral to treatment.