Brief Intervention for Drug Use Has No Efficacy in the Emergency Department

Screening, brief intervention, and referral to treatment (SBIRT) for drug use has been touted as an evidence-based practice, but methodologically sound trials suggest that it lacks efficacy in primary care settings. Now a multi-site trial finds it also lacks efficacy in emergency department patients. Investigators randomized 1285 adult patients reporting drug use and problems (≥3 on the Drug Abuse Screening Test) on screening at 6 academic emergency departments in the US to an information pamphlet, assessment and referral to treatment if indicated, or assessment and referral plus brief intervention with 2 telephone counseling sessions.

• Self-reported mean days use of the patient-defined primary drug was 16 days at study entry and 3 months later it was 10 days. However, there were no significant differences between groups.
• At 3 months, hair samples were more likely to be positive for the primary drug in the assessment and referral group than in the other two groups (95% versus 88–89%).

Comments:

SBIRT for drug use is not evidence-based. In fact, the weight of the evidence suggests that this approach lacks efficacy (as distinct from lack of evidence of efficacy). SBIRT advocates will likely point to trials without biological outcomes or in different contexts (e.g., help-seeking patients) that have found positive effects. They will also suggest that it might work in other populations (suburban, more severe, less severe). But this study and two recent large negative trials in primary care strongly suggest that we should not rely on SBIRT to address drug use and its consequences in general health settings.

Richard Saitz, MD, MPH

Reference:

Bogenschutz MP, Donovan DM, Mandler RN, et al. Brief intervention for patients with problematic drug use presenting in emergency departments: a randomized clinical trial. JAMA Intern Med. 2014;174(11):1736–1745.