Enhanced brief Intervention for linking opiate abusing EMS patients to treatment

描述(申请人提供)：鸦片类药物滥用和过量用药在过去15年中激增。吸毒过量，主要来自鸦片类药物，现在是美国第二大意外死亡原因。大多数药物滥用治疗系统使用被动的方法将吸毒者与治疗联系起来，导致延迟接受治疗，往往是在对健康和社会造成不利影响之后。主要的结构和动机障碍阻碍了鸦片滥用者参与治疗。最近的医疗改革立法提供了测试积极主动的公共卫生方法的机会，以确定吸毒者并将其与治疗联系起来。虽然筛查和短暂干预(BI)在解决医疗保健环境中的酒精滥用问题方面已经显示出有效性，但研究表明，对于那些药物依赖者，有必要加强BI并与专业治疗联系起来。阿片类药物滥用者使用紧急医疗服务(EMS)的比例不成比例，就像他们使用急诊室一样，我们的研究表明，相当多的人拒绝将其运送到急诊室。虽然EMS系统处于干预药物滥用的首要地位，但目前很少有人这样做。研究表明，在卫生紧急情况下，吸毒者可能会被激励进行治疗，而短暂干预(BI)、免费治疗和激励措施可能会进一步增加治疗的进入。在之前的一项研究中，EMS提供者在过量服药时与患者讨论药物治疗与他们进入治疗有关。然而，当时只有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药物滥用筛查的EMS方法的可行性和对阿片滥用治疗进入的影响，并协调、增强了BI，以改善目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、治疗信息和转诊(I&R)电话，在该市的任何治疗机构主动转介进行按需治疗。随机进入激励组的一半参与者将获得经过记录审查确认的名义上的有形治疗激励。这项研究将比较研究部门的结果，并与I&R客户的匹配样本进行比较，这些客户(自我)使用通常与阿片滥用治疗做法有关的联系。这项研究是由很少用于药物滥用治疗研究的电子信息系统实现的。学术与机构间的合作建立在研究团队成员数十年来与研究人群成功相关研究的基础上。。

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. .