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Addiction Science & Clinical Practice
Published in: Addiction Science & Clinical Practice 1/2018

Open Access 01-12-2018 | Review

Emergency department screening and interventions for substance use disorders

Authors: Kathryn Hawk, Gail D’Onofrio

Published in: Addiction Science & Clinical Practice | Issue 1/2018

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Abstract

The emergency department (ED) has long been recognized as providing critical access to the health care system for many, yet only in the past few decades has the ED visit been recognized as an opportunity to identify and link patients to care for substance use disorders (SUDs). This review explores the evidence for ED-based screening, psychosocial and pharmacological interventions, and linkage to treatment for the spectrum of SUDs including high risk alcohol use and alcohol, opioid, tobacco and other SUDs. Despite knowledge gaps, methodological challenges and some inconsistency across interventions studied, opportunities for EDs to improve the care of patients across the spectrum of SUDs are robust.
Literature
1.
Bernstein E, Edwards E, Dorfman D, Heeren T, Bliss C, Bernstein J. Screening and brief intervention to reduce marijuana use among youth and young adults in a pediatric emergency department. Acad Emerg Med. 2009;16(11):1174–85.CrossRefPubMedPubMedCentral
2.
Academic ED SBIRT Research Collaborative. The impact of screening, brief intervention, and referral for treatment on emergency department patients’ alcohol use. Ann Emerg Med. 2007;50(6):699–710.CrossRef
3.
D’Onofrio G, O’Connor PG, Pantalon MV, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313(16):1636–44.CrossRefPubMedPubMedCentral
4.
Samuels EA, Dwyer K, Mello MJ, Baird J, Kellogg A, Bernstein E. Emergency department-based opioid harm reduction: moving physicians from willing to doing. Acad Emerg Med. 2016;23(4):455–65.CrossRefPubMed
5.
6.
Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2017. https://​www.​samhsa.​gov/​data/​. Accessed 20 July 2018.
7.
Park-Lee E, Lipari RN, Hedden SL, Copello EAP, Kroutil LA. Receipt of services for substance use and mental health issues among adults: results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review; 2016. http://​www.​samhsa.​gov/​data/​. Accessed 20 July 2018.
8.
9.
Substance Abuse and Mental Health Services Administration (US), Office of the Surgeon General (US). Facing addiction in America: the Surgeon General’s report on alcohol, drugs, and health [Internet]. Washington (DC): US Department of Health and Human Services; 2016.
10.
Rockett IRH, Putnam SL, Jia H, Chang CF, Smith GS. Unmet substance abuse treatment need, health services utilization, and cost: a population-based emergency department study. Ann Emerg Med. 2005;45(2):118–27.CrossRefPubMed
11.
Konstantopoulos WLM, Dreifuss JA, Mcdermott KA, et al. Identifying patients with problematic drug use in the emergency department: results of a multisite study. Ann Emerg Med. 2014;64(5):516–25.CrossRefPubMedCentral
12.
Hall AJ, Logan JE, Toblin RL, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA. 2008;300(22):2613–20.CrossRefPubMed
13.
Florence CS, Zhou C, Luo F, Xu L. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016;54(10):901–6.CrossRefPubMedPubMedCentral
14.
Miller RWRS. Motivational interviewing: preparing people to change addictive behavior. New York: Guilford Press; 1991.
15.
D’Onofrio G, Bernstein E, Rollnick S. Case studies in emergency medicine and the health of the public. Boston: Jones and Bartlett; 1996.
16.
Bernstein E, Bernstein JA, Weiner SG, D’Onofrio G. Substance use disorders. In: Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM, editors. Tintinalli’s emergency medicine: a comprehensive study guide. 8th ed. New York: McGraw-Hill Education; 2016.
17.
D’Onofrio G, Fiellin DA, Pantalon MV, et al. A brief intervention reduces hazardous and harmful drinking in emergency department patients. Ann Emerg Med. 2012;60(2):181–92.CrossRefPubMed
18.
Havard A, Shakeshaft A, Sanson-Fisher R. Systematic review and meta-analyses of strategies targeting alcohol problems in emergency departments: interventions reduce alcohol-related injuries. Addiction. 2008;103(3):368–76.CrossRefPubMed
19.
Bernstein SL, D’Onofrio G. A promising approach for emergency departments to care for patients with substance use and behavioral disorders. Health Aff (Millwood). 2013;32(12):2122–8.CrossRef
20.
Simioni N, Rolland B, Cottencin O. Interventions for increasing alcohol treatment utilization among patients with alcohol use disorders from emergency departments: a systematic review. J Subst Abuse Treat. 2015;58:6–15.CrossRefPubMed
21.
Bernstein E, Bernstein J, Feldman J, et al. An evidence based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department (ED) providers improves skills and utilization. Subst Abus. 2007;28(4):79–92.CrossRefPubMedPubMedCentral
22.
Bogenschutz MP, Donovan DM, Mandler RN, et al. Brief intervention for patients with problematic drug use presenting in emergency departments: a randomized clinical trial. JAMA Intern Med. 2014;174(11):1736–45.CrossRefPubMedPubMedCentral
23.
Donovan DM, Bogenschutz MP, Perl H, et al. Study design to examine the potential role of assessment reactivity in the screening, motivational assessment, referral, and treatment in emergency departments (SMART-ED) protocol. Addict Sci Clin Pract. 2012;7(1):16.CrossRefPubMedPubMedCentral
24.
Pringle JL, Kelley DK, Kearney SM, et al. Screening, brief intervention, and referral to treatment in the emergency department. Med Care. 2018;56(2):146–52.CrossRefPubMed
25.
Miller WR, Rollnick S. The effectiveness and ineffectiveness of complex behavioral interventions: impact of treatment fidelity. Contemp Clin Trials. 2014;37(2):234–41.CrossRefPubMed
26.
27.
28.
Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory care quality improvement project (ACQUIP). Alcohol use disorders identification test. Arch Intern Med. 1998;158(16):1789–95.CrossRefPubMed
29.
Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG, World Health Organization, Dept. of Mental Health and Substance Dependence‎. AUDIT: the Alcohol Use Disorders Identification Test: guidelines for use in primary health care. 2nd ed. Geneva: World Health Organization; 2001. http://​www.​who.​int/​iris/​handle/​10665/​67205. Accessed 2 Feb 2018.
30.
31.
32.
33.
Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. Primary care validation of a single-question alcohol screening test. J Gen Intern Med. 2009;24(7):783–8.CrossRefPubMedPubMedCentral
34.
35.
Yudko E, Lozhkina O, Fouts A. A comprehensive review of the psychometric properties of the drug abuse screening test. J Subst Abuse Treat. 2007;32(2):189–98.CrossRefPubMed
36.
Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. A single-question screening test for drug use in primary care. Arch Intern Med. 2010;170(13):1155–60.CrossRefPubMedPubMedCentral
37.
Barata IA, Shandro JR, Montgomery M, et al. Effectiveness of SBIRT for alcohol use disorders in the emergency department: a systematic review. West J Emerg Med. 2017;18(6):1143–52.CrossRefPubMedPubMedCentral
38.
D’Onofrio G, Degutis LC. Integrating project ASSERT: a screening, intervention, and referral to treatment program for unhealthy alcohol and drug use into an urban emergency department. Acad Emerg Med. 2010;17(8):903–11.CrossRefPubMed
39.
40.
Ries R, Miller SC, Saitz R, Fiellin DA. The ASAM principles of addiction medicine. Philadelphia: Lippincott Williams & Wilkins; 2014.
41.
Bernstein E, Bernstein J, Levenson S. Project ASSERT: an ED-based intervention to increase access to primary care, preventive services, and the substance abuse treatment system. Ann Emerg Med. 1997;30(2):181–9.CrossRefPubMed
42.
D’Onofrio G, Pantalon MV, Degutis LC, et al. Brief intervention for hazardous and harmful drinkers in the emergency department. Ann Emerg Med. 2008;51(6):742–50.CrossRefPubMedPubMedCentral
43.
Estee S, Wickizer T, He L, Shah MF, Mancuso D. Evaluation of the Washington state screening, brief intervention, and referral to treatment project. Med Care. 2010;48(1):18–24.CrossRefPubMed
44.
Gentilello LM, Ebel BE, Wickizer TM, Salkever DS, Rivara FP. Alcohol interventions for trauma patients treated in emergency departments and hospitals: a cost benefit analysis. Ann Surg. 2005;241(4):541–50.CrossRefPubMedPubMedCentral
45.
Bohnert ASB, Bonar EE, Cunningham R, et al. A pilot randomized clinical trial of an intervention to reduce overdose risk behaviors among emergency department patients at risk for prescription opioid overdose. Drug Alcohol Depend. 2016;163:40–7.CrossRefPubMed
46.
Bernstein J, Bernstein E, Tassiopoulos K, Heeren T, Levenson S, Hingson R. Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug Alcohol Depend. 2005;77(1):49–59.CrossRefPubMed
47.
Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. 2009;99(1):280–95.CrossRefPubMed
48.
Blow FC, Walton MA, Murray R, et al. Intervention attendance among emergency department patients with alcohol-and drug-use disorders. J Stud Alcohol Drugs. 2010;71(5):713–9.CrossRefPubMedPubMedCentral
49.
Busch SH, Fiellin DA, Chawarski MC, et al. Cost-effectiveness of emergency department-initiated treatment for opioid dependence. Addiction. 2017;112(11):2002–10.CrossRefPubMedPubMedCentral
50.
Rubin R. As overdoses climb, emergency departments begin treating opioid use disorder. JAMA. 2018;319:2158–60.CrossRefPubMed
51.
Love JS, Perrone J, Nelson LS. Should buprenorphine be administered to patients with opioid withdrawal in the emergency department? Ann Emerg Med. 2018;72(1):26–8.CrossRefPubMed
52.
Walley AY, Xuan Z, Hackman HH, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ. 2013;346:f174.CrossRefPubMedPubMedCentral
53.
McDonald R, Strang J. Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria. Addiction. 2016;111(7):1177–87.CrossRefPubMedPubMedCentral
54.
Lagu T, Anderson BJ, Stein M. Overdoses among friends: drug users are willing to administer naloxone to others. J Subst Abuse Treat. 2006;30(2):129–33.CrossRefPubMed
55.
Hawk KF, Vaca FE, D’Onofrio G. Reducing fatal opioid overdose: prevention, treatment and harm reduction strategies. Yale J Biol Med. 2015;88(3):235.PubMedPubMedCentral
56.
Wheeler E, Jones TS, Gilbert MK, Davidson PJ. Centers for disease control and prevention (CDC). Opioid overdose prevention programs providing naloxone to laypersons—United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(23):631–5.PubMedPubMedCentral
57.
Seal KH, Thawley R, Gee L, et al. Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: a pilot intervention study. J Urban Health. 2005;82(2):303–11.CrossRefPubMedPubMedCentral
58.
Dwyer KH, Walley AY, Sorensen-Alawad A, et al. Opioid education and nasal naloxone rescue kit distribution in the emergency department. Ann Emerg Med. 2013;62(4):S123.CrossRef
59.
Kestler A, Buxton J, Meckling G, et al. Factors associated with participation in an emergency department-based take-home naloxone program for at-risk opioid users. Ann Emerg Med. 2017;69(3):340–6.CrossRefPubMed
60.
61.
Samuels E. Emergency department naloxone distribution: a Rhode Island department of health, recovery community, and emergency department partnership to reduce opioid overdose deaths. R I Med J. 2014;97(10):38–9.
62.
Rabe GL, Wellmann J, Bagos P, et al. Efficacy of emergency department-initiated tobacco control-systematic review and meta-analysis of randomized controlled trials. Nicot Tob Res. 2013;15(3):643–55.CrossRef
63.
Bernstein SL, Bijur P, Cooperman N, et al. A randomized trial of a multicomponent cessation strategy for emergency department smokers. Acad Emerg Med. 2011;18(6):575–83.CrossRefPubMedPubMedCentral
64.
Lemhoefer C, Rabe GL, Wellmann J, et al. Emergency department-initiated tobacco control: update of a systematic review and meta-analysis of randomized controlled trials. Prev Chronic Dis. 2017;14:160434.CrossRef
65.
66.
O’Connor PG, Sokol RJ, D’Onofrio G. Addiction medicine: the birth of a new discipline. JAMA Intern Med. 2014;174(11):1717–8.CrossRefPubMed
67.
68.
Metadata
Title
Emergency department screening and interventions for substance use disorders
Authors
Kathryn Hawk
Gail D’Onofrio
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2018
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/s13722-018-0117-1

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