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Among patients receiving buprenorphine-naloxone in primary care for opioid dependence, the efficacy of brief weekly counseling and once-weekly medication dispensing did not differ significantly from that of extended weekly counseling and thrice-weekly dispensing. Strategies to improve buprenorphine-naloxone adherence are needed. (ClinicalTrials.gov number, NCT00023283 [ClinicalTrials.gov].).

BACKGROUND Brief interventions (BI) have been shown to reduce alcohol use and improve outcomes in Hazardous and Harmful (HH) drinkers but evidence to support their use in emergency department (ED) patients is limited. The use of research assessments in studies of BI may contribute to uncertainty about their effectiveness. METHODS We randomized 889 adult ED patients with HH drinking. A total of 740 received 1) an emergency practitioner (EP)-performed Brief Negotiation Interview (BNI, n=297), 2) BNI with a 1-month follow-up telephone booster (BNI with Booster), (n=295), or 3) standard care (SC, n=148). We also included a standard care with no assessments (SC-NA, n=149) group to examine the impact of assessments on drinking outcomes. Primary outcomes analyzed using mixed models procedures included past 7-day alcohol consumption and 28-day binge episodes at 6 and 12 months collected by Interactive Voice Response. Secondary outcomes included negative health behaviors and consequences collected by phone surveys. RESULTS The reduction in mean number of drinks in the past 7 days from baseline to 6 and 12 months was significantly greater in BNI with Booster: from 20.4 (95% confidence interval [CI], 18.8-22.0) to 11.6 (95% CI, 9.7-13.5) to 13.0 (95% CI, 10.5-15.5) and BNI: from 19.8 (95% CI, 18.3-21.4) to 12.7 (95% CI, 10.8-14.6), to 14.3 (95% CI, 11.9-16.8), than in SC: from 20.9 (95% CI, 18.7-23.2) to 14.2 (95% CI, 11.2-17.1), to 17.6 (95% CI, 14.1-21.2). The reduction in 28-day binge episodes was also greater in BNI with Booster: from 7.5 (95% CI, 6.8-8.2) to 4.4 (95% CI, 3.6-5.2) to 4.7 (95% CI, 3.9-5.6) and in BNI: from 7.2 (95% CI, 6.5-7.9) to 4.8 (95% CI, 4.0-5.6), to 5.1 (95% CI, 4.2-5.9), than in SC: from 7.2 (95% CI, 6.2-8.2) to 5.7 (95% CI, 4.5-6.9), to 5.8 (95% CI, 4.6-7.0). BNI with Booster offered no significant benefit over BNI. There were no differences in drinking outcomes between the SC and SC-NA groups. The reductions in rates of driving after drinking ≥ 3 drinks from baseline to 12 months were greater in the BNI (38% to 29%) and BNI with Booster (39% to 31%) groups than in the SC group (43% to 42%). CONCLUSIONS EP-performed brief interventions can reduce alcohol consumption and episodes of driving after drinking in HH drinkers. These results support the use of brief interventions in ED settings.

IMPORTANCE Treatment of opioid use disorder (OUD) with buprenorphine decreases opioid use and prevents morbidity and mortality. Emergency departments (EDs) are an important setting for buprenorphine initiation for patients with untreated OUD; however, readiness varies among ED clinicians. OBJECTIVE To characterize barriers and facilitators of readiness to initiate buprenorphine for the treatment of OUD in the ED and identify opportunities to promote readiness across multiple clinician types.

Study Objective-To determine efficacy of emergency practitioner performed brief intervention for hazardous/harmful drinkers in reducing alcohol consumption and negative consequences in an Emergency Department (ED) setting.Methods-A randomized clinical trial (Project ED Health) was conducted in an urban ED from 5/2002 to 11/2003 for hazardous/harmful drinkers. Patients ≥ 18 who screened above National Institute for Alcohol Abuse and Alcoholism guidelines for "low risk" drinking or presented with an injury in the setting of alcohol ingestion were eligible. The mean number of drinks per week and binge drinking episodes over the past 30 days were collected at 6 and 12-months; negative consequences and use of treatment services at 12-months. A Brief Negotiation Interview (BNI) performed by emergency practitioners was compared to scripted discharge instructions (DI).Results-A total of 494 hazardous/harmful drinkers were studied. The two groups were similar with respect to baseline characteristics. In the BNI group the mean number of drinks per week at 12 months was 3.8 less than the 13.6 reported at baseline. The DI group decreased 2.6 from 12.4 at baseline. Likewise, binge drinking episodes per month decreased by 2.0 from a baseline of 6.0 in the BNI group and 1.5 from 5.4 in the DI group. For each outcome the time effect was significant and the treatment effect was not. Conclusion: Among ED patients with hazardous/harmful drinking, we did not detect a difference in efficacy between emergency practitioner-performed BNI and DI. Further studies to test the efficacy of brief intervention in the ED are needed.

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ED-initiated buprenorphine was associated with increased engagement in addiction treatment and reduced illicit opioid use during the 2-month interval when buprenorphine was continued in primary care. Outcomes at 6 and 12 months were comparable across all groups.

To examine long-term outcomes with primary care office-based buprenorphine/naloxone treatment, we followed 53 opioid-dependent patients who had already demonstrated six months of documented clinical stability for 2-5 years. Primary outcomes were retention, illicit drug use, dose, satisfaction, serum transaminases, and adverse events. Thirty-eight percent of enrolled subjects were retained for two years. Ninety-one percent of urine samples had no evidence of opioid use, and patient satisfaction was high. Serum transaminases remained stable from baseline. No serious adverse events related to treatment occurred. We conclude that select opioid-dependent patients exhibit moderate levels of retention in primary care office-based treatment.