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Lack of efficacy in a randomised trial of a brief intervention to reduce drug use and increase drug treatment services utilisation among adult emergency department patients over a 12-month period
  1. Roland C Merchant1,2,
  2. Zhongli Zhang3,
  3. Zihao Zhang3,
  4. Tao Liu3,
  5. Janette R Baird1
  1. 1Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island, USA
  2. 2Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
  3. 3Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
  1. Correspondence to Dr Roland C Merchant, Department of Emergency Medicine, Rhode Island Hospital, Providence, RI 02903, USA; Roland_Merchant{at}brown.edu

Abstract

Objectives Assess the 12-month efficacy of a brief intervention (BI) on reducing drug use and increasing drug treatment services utilisation among adult emergency department (ED) patients.

Methods This randomised, controlled trial enrolled 18–64-year-old ED patients needing a drug use intervention. Treatment arm participants received a tailored BI while control arm participants only completed the study questionnaires. Self-reported past 3-month drug use and engagement in drug treatment services were compared by study arm at 3-month intervals over 1 year. Multiple imputations were performed to overcome loss-to-follow-up.

Results Of the 1030 participants, follow-up completion ranged 55%–64% over the four follow-ups. At 12 months, the two study arms were similar in regards to mean: (1) proportion reporting any drug use (treatment: 67.1% (61.6 to 72.6), control: 74.4% (69.4 to 79.4)); (2) drug use frequency on a five-point scale (treatment: 3.7 (3.3 to 4.2), control: 4.6 (4.0 to 5.2)); (3) total days of drug use (treatment: 28.3 (23.2 to 33.4), control: 33.4 (28.5 to 38.2)); (4) most number of times drugs used/day (treatment: 4.6 (3.6 to 5.5), control: 6.1 (4.8 to 7.3)) and (5) typical number of times drugs used/day (treatment: 3.3 (2.5 to 4.1), control: 5.1 (3.9 to 6.2)). Utilisation of drug treatment services also was similar by study arm. In multivariable regression analyses, patients who were homeless or had higher drug use at baseline continued to have greater drug use in follow-up.

Conclusions Among adult ED patients requiring a drug use intervention, this BI did not decrease drug use or increase drug treatment services utilisation over a 12-month period more than the control condition.

Trial registration number NCT01124591; Pre-trial.

  • drug abuse
  • mental health, drug abuse

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Footnotes

  • Contributors RCM was the principal investigator of the investigation and primary author of the manuscript. He was involved in all stages of the manuscript composition. ZhoZ and ZihZ were involved in the data analysis and manuscript composition. TL was a study co-investigator and supervised the data analysis and contributed to the manuscript. JRB was a study co-investigator and assisted in the study conduct and in the preparation of the analyses and the resultant manuscript.

  • Funding This research was supported by grants from the National Institute on Drug Abuse (R01 DA026066) and the Lifespan/Tufts/Brown Centers for AIDS Research (P30 AI042853). ClinicalTrials.gov identifier: NCT01124591.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Rhode Island Hospital Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data from the study are available from the study authors commensurate with appropriate data sharing uses and federal regulations.

  • Presented at Preliminary findings from this study were presented at the Society for Academic Emergency Medicine annual meeting in New Orleans, Louisiana on 12 May 2016.

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