Figuring out how to intercept and help patients with opioid addiction in medical settings is an urgent issue. There have been few promising leads in the last few years, a reality that becomes more unpalatable with each passing day. Because every single day in America, 78 people die from overdose and more than 1,500 people visit the emergency room as the result of heroin or prescription pain relievers. While we brainstorm effective responses to the opioid crisis, its effects rage on.
Screening, Brief Intervention and Referral to Treatment (SBIRT) would seem to be a good strategy to address opioid addiction in health settings. SBIRT has been shown to help patients reduce alcohol use in both primary care and emergency settings. But the evidence of SBIRT’s effectiveness at reducing drug-related harms has been spotty.
We got bad news in 2014. Even with well-trained staff delivering brief interventions using Motivational Interviewing with fidelity, researchers were not able to find evidence of reduced drug use, increased treatment engagement, or improved health in two studies of SBIRT for drug use in primary care. These results were discouraging not just because we might be barking up the wrong tree with SBIRT to prevent opioid harms, but because there weren’t a lot of other trees in sight.
JAMA study on SBIRT + buprenorphine published in 2015
In that context, the results of a 2015 study published in JAMA were particularly exciting because they showed a real reduction in opioid use and higher levels of treatment engagement. In fact, the study confirmed that SBIRT alone was not effective in reducing patients’ unhealthy opioid use, but that SBIRT coupled with an immediate prescription for buprenorphine in the emergency department can help patients commence a recovery process.
This is big news. Study authors Gail D’onofrio and Dave Fiellin won the Dan Anderson Research Award for their work.
Dr. Roger Weiss of Harvard Medical School said, “This paper is so important because far more people with substance use disorders are seen in general medical settings than in specialty addiction treatment programs. It is thus imperative that the field develops effective interventions in these settings.”
Scientific American published an article on the findings just last month in the wake of Prince’s death, commenting on the importance of reaching opioid users in emergency settings.
New on-demand presentation on SBIRT in emergency settings
On June 22, 2016 Gail D’onofrio presented a webinar titled “Closing the Gap: Addressing Substance Use in ERs, Adding Pieces to the Puzzle.” The webinar and accompanying slides are available on Youtube for anyone to view.
Closing the Gap: Addressing Substance Use Disorders in the ED (PowerPoint slides)