Comparing Interventions for Opioid Dependent Patients Presenting in Medical EDs

描述（由申请人提供）：随着成瘾治疗越来越多地融入医疗保健系统，两种模式正确地受到了极大的关注。第一个是使用SBIRT模型来识别病例，提供治疗联系，并将更严重的病例转介给长期护理。第二个是利用医学治疗模式治疗成瘾，包括那些可以在初级保健环境中实施的模式。很少有人关注优化策略，以弥合SBIRT和更密集/更长期治疗之间的差距，对那些严重的频谱。这一因素对于阿片类药物依赖患者至关重要，因为短期干预或短期治疗无法满足他们的需求。物质使用障碍的急诊室干预措施在很大程度上限于简短的干预/SBIRT模式，这些主要集中在酒精。虽然有大量文献记录了病例管理在将吸毒者与治疗联系起来方面的价值，但这种方法尚未应用于艾德环境中的吸毒者。 在一个样本中的阿片类药物依赖患者看到的医疗艾德谁是目前没有从事治疗，这项研究将比较的效果，简短的力量为基础的个案管理（SBCM）和简短的干预与助推器会议（BIB），动机增强治疗（MET）的基础上，筛选，评估和转诊单独（SAR）的影响。选择这些治疗模式是因为它们的证据基础，因为它们在ED中实施是可行的。符合DSM-IV阿片类药物依赖标准的参与者将被随机分配（每组150名）接受1）BIB干预，包括在艾德进行30分钟的动机访谈，然后进行两次20分钟的电话强化; 2）基于Rapp及其同事在先前研究中实施的模型的最多6次SBCM;或3）SAR。对治疗状况不知情的工作人员将在3个月和6个月时完成随访评估。该研究的目的是确定SBCM和BIB对药物滥用治疗启动和参与，阿片类药物和其他药物的使用以及更广泛的健康和生活功能测量的主要影响;检查治疗分配和选定参与者属性之间的相互作用，以预测治疗启动，参与和药物使用结果;并检查三个治疗组中治疗参与对物质使用结果的影响。 这项拟议的研究将是第一项使用病例管理方法将ED中的药物依赖患者与长期成瘾治疗联系起来的试验。这将是第一批专门针对医疗ED中阿片类药物依赖患者的试验之一。另一个创新特点是，病例管理方法将强调与药物治疗的联系，特别是将促进与需要这种治疗的患者的基于办公室的丁丙诺啡的联系。

DESCRIPTION (provided by applicant): As addiction treatment becomes increasingly integrated into the medical care system, two models have rightly received a great deal of attention. The first is the use of SBIRT models to identify cases, provide therapeutic contact, and refer the more severe cases to longer-term care. The second is the treatment of addictions using medical models of treatment, including those that can be implemented in primary care settings. Much less attention has been paid to optimizing strategies for bridging the gap between SBIRT and more intensive/longer-term treatment for those on the severe end of the spectrum. This factor is of critical importance for opioid dependent patients, whose needs are not met by brief interventions or brief treatment. Emergency room interventions for substance use disorders have been largely limited to brief interventions/SBIRT models, and these have focused primarily on alcohol. Although there is a substantial literature documenting the value of case management in linking drug users to treatment, this approach has not been applied to drug users in the ED setting. In a sample of opioid dependent patients seen in a medical ED who are not currently engaged in treatment, this study will compare the effects of brief strengths-based case management (SBCM) and those of a brief intervention with booster sessions (BIB), based on Motivational Enhancement Therapy (MET), to the effects of screening, assessment and referral alone (SAR). These treatment models were selected because of their evidence base and because they are feasible to implement in the ED. Participants meeting DSM-IV criteria for opioid dependence will be randomly assigned (150 per group) to receive 1) the BIB intervention including a 30-minute motivational interviewing session in the ED, followed by two 20-minute booster phone sessions; 2) up to 6 sessions of SBCM based on the model previously implemented by Rapp and colleagues in prior studies; or 3) SAR. Staffs that are blinded to treatment condition will complete follow-up assessments at 3 and 6 months. Aims of the study are to identify the main effects of SBCM and BIB on substance abuse treatment initiation and engagement, use of opioids and other drugs, and broader measures of health and life functioning; to examine the interactions between treatment assignment and selected participant attributes in predicting treatment initiation, engagement, and substance use outcomes; and to examine effects of treatment involvement on substance use outcomes in the three treatment groups. The proposed study will be the first trial using a case management approach to link drug dependent patients presenting in EDs to longer-term addiction treatment. It will be one of the first trials focusing specifically on opioid dependent patients in medical EDs. A further innovative feature is that the case management approach will emphasize linkage to pharmacotherapy, and in particular will facilitate linkage to office-based buprenorphine for patients who desire this treatment.