Models of SBIRT for Opioid Dependent Patients in the Emergency Department

描述（由申请人提供）：海洛因和处方阿片类药物依赖的患者出现不良健康后果的风险增加，并且经常利用急诊科（ED）作为他们的医疗护理来源。筛查、短暂干预和转诊治疗对于减少酗酒和吸烟等高风险行为以及不安全的性行为是有效的。关于阿片类药物依赖的短期干预有效性的数据是有限的。这项前瞻性、随机对照阿片类药物依赖受试者（N=360）的试验将比较两种具有对照条件的短暂干预模式。有阿片类药物依赖的ED患者将被随机分为两组：(1)筛查、短暂干预和促进转诊治疗（SBIRT）；(2)筛查、短暂干预ED启动丁丙诺啡治疗（SBI+Bup）；(3)标准治疗（SC），其中包括一份详细说明该地区药物滥用治疗中心的讲义。主要结果将是在30天内进行正式药物滥用治疗的自我报告，并通过与治疗项目的接触来验证。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（自我报告和尿液毒理学分析）、艾滋病毒风险行为和卫生保健服务利用的变化。还将比较这三种干预措施的成本效益。我们将检验SBI+Bup优于SBIRT和SC的假设，并且SBIRT在(1)增加30天正式药物滥用治疗的患者比例方面优于SC；(2)减少非法阿片类药物使用；(3)减少艾滋病毒风险行为；(4)降低卫生保健服务利用率。此外，我们假设SBI+Bup的社会成本，每阿片类药物戒断天数，相对于SBIRT或SC将具有成本效益；与SC相比，SBIRT将具有成本效益。将对随机患者样本的治疗意向进行数据分析。这项研究由一个具有丰富经验的研究小组进行，他们对阿片类药物依赖的简短干预和治疗进行了评估，其独特之处在于：(1)比较了两种简短干预与标准护理的模式；(2)纳入ED启动治疗组；(3)使用手册指导的干预措施，并对依从性和能力进行系统评估；(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，在美国主要是一种未经治疗的医疗状况。2006年，约56万人因非医疗原因使用海洛因，1140万人因非医疗原因使用处方类阿片。阿片类药物依赖的经济成本估计每年超过210亿美元，对个人、工作场所、社会和医疗保健系统产生深远影响。治疗可带来巨大的个人和社会效益；急诊科就诊通常是阿片类药物依赖患者与医疗系统的唯一接触，是筛查、干预和转诊治疗的独特机会。

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.