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Absence of a quick fix does not mean ‘do nothing:’ time to address drug use in the ED
  1. Richard Saitz
  1. Correspondence to Dr Richard Saitz, Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; rsaitz{at}

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It is unsurprising that a brief counselling intervention for drug use has no effect on drug use or linkage to drug treatment. Although psychological interventions sometimes have delayed effects, the brief intervention studied by Merchant et al 1 had none at 3 months and still had none at 12 months. The study had some limitations as described by the authors, but it was null, just like prior studies in the ED and in primary care.2 3 Screening, brief intervention and referral to treatment (SBIRT in the USA), simply does not improve outcomes for unhealthy drug use.

Unhealthy substance use is not just one risk factor (eg, weekly cannabis use) or disease (eg, opioid use disorder) just as heart disease comprises many diseases all of which have specific treatments. A one-size-fits-all approach like SBIRT will not be effective; tailoring will be necessary.

No experienced clinician (or researcher familiar with relevant studies) would expect a patient not seeking help for an addiction consequence (eg, overdose) to cut down, quit or enter treatment based on brief advice. Some will enter treatment or change regardless of our advice (eg, the control group in Merchant et al 1); they are aware of the risks and want help. A few will have (1) low or …

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