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Research Summary

Brief Intervention in the Hospital May Reduce Prescription Drug Misuse

Although psychoactive prescription drug (PD) misuse in the general population has garnered more publicity, problematic use among hospitalized patients is more prevalent. German investigators randomized 126 inpatients with PD abuse or dependence (per DSM-IV criteria) or PD use on more than 60 days in the previous 3 months to receive either a booklet on health behavior (control) or a brief intervention (BI). The BI consisted of 2 counseling sessions based on principles of motivational interviewing and individualized written feedback conducted by psychologists with expertise in clinical treatment and research. Of the sample, 62% were women, the mean age was 55 years, and more than 56% misused opioids. At 3-month follow-up,

  • 52% of subjects in the BI group had a clinically significant reduction (25% or more from baseline) in daily PD dosage compared with 30% in the control group (p<0.02).
  • BI subjects tended toward greater reductions in PD use from baseline than controls (0.42 versus 0.12, respectively; p=0.08).
  • BI subjects tended to discontinue PD use more than controls (18% versus 9%, respectively; p=0.17).

Comments:

This study contributes to the scant literature on BI for drug-related disorders. BI among hospitalized patients might reduce PD misuse downstream, but the inclusion of patients who might have appropriately needed daily PD treatment raises concerns about whether BI might have lead to undertreatment of pain and anxiety disorders. Furthermore, this study used well-trained study staff who counseled patients for 30–45 minutes in the hospital and followed up 4 weeks later with a telephone call. Current funding mechanisms provide limited incentive for hospitals to hire staff for this purpose. It remains unclear whether regular hospital personnel preoccupied with multiple clinical responsibilities for sick inpatients could realize similar results. Peter D. Friedmann, MD, MPH

Reference:

Zahradnik A, Otto C, Crackau B, et al. Randomized controlled trial of a brief intervention for problematic prescription drug use in non-treatment-seeking patients. Addiction. 2009;104(1):109–117.

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