Brief Intervention for Drug Misuse in the Emergency Department

Although screening, brief intervention, and referral to treatment (SBIRT) approaches are
effective in reducing alcohol misuse and its associated risk-taking behaviors and negative
consequences, there is little research demonstrating the effectiveness of SBIRT for illicit
and/or prescription drug misuse. Misusers of illicit and/or prescription drugs frequently
seek medical care in emergency departments (EDs), particularly for reasons related to their
misuse. As a result, the ED is well suited as a site to conduct an analysis of the
effectiveness of SBIRT for this population.

The Brief Intervention for Drug Misuse for the Emergency Department (BIDMED) study is a
randomized, controlled, trial that will include adult ED patients at a large, academic,
trauma center (Rhode Island Hospital) and a community hospital (The Miriam Hospital) who
have a subcritical illness or injury and whose screening indicates illicit and/or
prescription drug misuse. BIDMED participants will be randomized to receive screening only
(SO) or brief intervention (BI) with appropriate referral to treatment. Participants will
complete a battery of blinded baseline assessments using standardized instruments as well as
adapted instruments specific to the aims of this study. All participants will undergo
blinded follow-up assessments at three, six, and twelve months post-randomization. The
primary hypotheses addressed in the BIDMED study are that, compared to participants in the
SO arm, participants in the BI arm will show a significantly greater reduction in: (1) drug
misuse within the prior 30 days at three months post-randomization, (2) behaviors associated
with drug misuse at six months post-randomization; and (3) negative physical health,
psychosocial health, and socioeconomic consequences at twelve months post-randomization. As
a secondary aim, the impact of BI compared to SO will be assessed on participants
contacting, enrolling in, and completing a drug treatment program. In addition, the impact
of BI compared to SO on increasing uptake of HIV and hepatitis B/C screening will be
measured. A mechanisms of change model that addresses the expected mediators and moderators
of change to explain the effects of SBIRT in this setting will also be developed and tested.
Further, the epidemiology of illicit and/or prescription drug misuse will be assessed in a
random sample of ED patients.