Opiate abuse and overdose have surged in the past 15 years. Drug overdose, mostly from opiates, is now the US'second leading cause of accidental death. Most drug abuse treatment systems use passive approaches to link drug abusers to treatment, resulting in delayed entry into treatment, often subsequent to adverse impacts on health and society. Major structural and motivational barriers impede opiate abusers'engagement in treatment. Recent healthcare reform legislation presents opportunities to test proactive, public health approaches to identifying and linking drug abusers to treatment. While screening and brief intervention (BI) have shown effectiveness in addressing alcohol abuse in healthcare settings, research suggests that for those drug dependent, there is a need for enhanced BI and linkage to specialty treatment. Opiate abusers disproportionately use emergency medical services (EMS), as they do EDs, and our research suggests a significant number refuse transport to EDs. While EMS systems are in a prime position to intervene on drug abuse, few currently do so. Research suggests drug abusers may be motivated to engage in treatment at times of health emergencies, and that brief intervention (BI), free treatment, and incentives may further enhance treatment entry. In a prior study, EMS providers'discussing drug treatment with patients at times of overdose was associated with their entering treatment. Yet only 17% of EMS providers discussed treatment then, representing a missed opportunity for intervention. The proposed study tests the feasibility and effects on opiate abuse treatment entry of a novel EMS approach to drug abuse screening, and coordinated, enhanced BI to improve current linkage to treatment practices. All participants will be given vouchers for free treatment and active referral for on-demand treatment at any of the city's treatment facilities through the Baltimore City Health Department's (BCHD's) usual practice, a treatment information and referral (I&R) phone line. The half of participants randomized to the incentive arm will receive a nominal tangible incentive for treatment entry confirmed by record review. The study will compare outcomes across study arms and to a matched sample of I&R clients who (self-) refer using usual linkage to opiate abuse treatment practices. The study is enabled by electronic information systems seldom used in drug abuse treatment research. The academic-interagency collaboration builds on study team members'decades of successful relevant research with the study population. .
The study addresses the dearth of rigorous studies on universal screening and brief intervention to link drug abusers to drug treatment. The study uses a novel EMS approach and capitalizes on recent healthcare reform legislation, and early implementation at the study site, that expands funding streams and availability of drug abuse treatment. Findings will inform policymakers on a low cost, high impact model for linking acute care seeking opiate abusers to treatment, with implications to patient outcomes and healthcare costs.
