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患者出现不良健康后果的风险增加，通常将急诊室（艾德）作为其医疗护理来源。筛查、短暂干预和转诊治疗在减少酗酒和吸烟等高危行为以及不安全的性行为方面一直很有效。关于阿片类药物依赖的短期干预措施的有效性的数据有限。这项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型与对照条件。阿片类药物依赖的艾德患者将被随机分配至：（1）筛选、短暂干预和促进转诊治疗（SBIRT）;（2）筛选、短暂干预和艾德启动丁丙诺啡治疗（SBI+Bup）;或（3）标准治疗（SC），包括详细介绍该地区药物滥用治疗中心的讲义。主要结局将是在30天时自我报告的正式药物滥用治疗参与情况，并通过与治疗计划的联系进行验证。在30天、2个月、6个月和12个月测量的其他结果包括阿片类药物使用的变化（自我报告和尿液毒理学分析）、艾滋病毒风险行为和卫生保健服务利用。还将比较这三种干预措施的成本效益。我们将检验以下假设：SBI+Bup上级SBIRT和SC，SBIRT在以下方面上级SC：（1）增加30天时接受正式药物滥用治疗的患者比例;（2）减少非法阿片类药物使用;（3）减少HIV风险行为;（4）减少医疗保健服务利用。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具有成本效益; SBIRT相对于SC具有成本效益。将对随机化患者的意向治疗样本进行数据分析。本研究由一个具有丰富经验的研究团队进行，评估阿片类药物依赖的短期干预和治疗，其独特之处在于：（1）比较两种短期干预与标准治疗模式;（2）纳入艾德启动的治疗组;（3）使用手动指导干预，系统评估依从性和能力;（4）收集详细的成本数据，以帮助指导未来的医疗政策。阿片类药物依赖是一个主要的公共卫生问题，在美国仍然主要是一种未经治疗的医疗状况。2006年，约有560，000人使用海洛因，1，140万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超过210亿美元/年，对个人、工作场所、社会和医疗保健系统产生深远影响。治疗与实质性的个人和社会效益有关;急诊室就诊，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.