Models of Screening, Brief Intervention With a Facilitated Referral to Treatment (SBIRT) for Opioid Patients in the Emergency Department

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.