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，有两种模式受到了极大的关注。首先是使用SBIRT模型来识别病例，提供治疗接触，并将较严重的病例转介到长期护理。第二是使用医疗治疗模式治疗成瘾，包括那些可以在初级保健机构实施的治疗模式。很少有人关注如何优化策略，以弥合SBIRT与对严重端患者进行更强化/更长期治疗之间的差距。这一因素对阿片类药物依赖患者至关重要，他们的需求不能通过短暂的干预或短暂的治疗来满足。急诊室对物质使用障碍的干预在很大程度上仅限于简短的干预/SBIRT模型，这些主要集中在酒精上。尽管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急诊科环境中的吸毒者。在一个目前没有接受治疗的医疗急诊科阿片类药物依赖患者的样本中，本研究将比较基于动机增强疗法（MET）的基于简短优势的病例管理（SBCM）和简短干预与强化会议（BIB）的效果，以及单独筛查、评估和转诊（SAR）的效果。选择这些治疗模式是因为它们的证据基础，因为它们在急诊科中实施是可行的。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人）接受1)BIB干预，包括在急诊科进行30分钟的动机性访谈，随后是两次20分钟的助推器电话会议；2)基于Rapp及其同事在先前研究中实施的模型进行最多6次的SBCM；3) SAR。对治疗情况不知情的工作人员将在第3个月和第6个月完成随访评估。该研究的目的是确定SBCM和BIB对药物滥用治疗的开始和参与、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措施的主要影响；研究在预测治疗开始、参与和药物使用结果方面，治疗分配和选定参与者属性之间的相互作用；并检查治疗参与对三个治疗组药物使用结果的影响。这项拟议的研究将是第一个使用病例管理方法将急诊科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急诊科阿片类药物依赖患者的试验之一。进一步的创新特征是，病例管理方法将强调与药物治疗的联系，特别是将促进与希望这种治疗的患者的办公室丁丙诺啡的联系。

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.