University of Utah
By Margaret Carlson
Clinical Research Coordinator
RA Program Director
Division of Emergency Medicine
Despite measures to reduce misuse of controlled substances, such as the Use Only As Directed Campaign, the Controlled Substance Database, and education outlined by the Utah Department of Health, opioid abuse continues to significantly affect Utahns, impacting individuals across all socioeconomic (SES) and education levels. Given the urgent need to address this public health epidemic, we proposed the practical approach of an emergency department (ED)-based SBIRT program. SBIRT is a comprehensive, evidence-based public health approach to early intervention and treatment for people at risk of developing a substance abuse disorder.
The EDtreats individuals from all SES backgrounds and reaches many individuals who do not otherwise have contract with the healthcare system. Additionally, patients typically spend several hours in an ED, thus providing ample time for screening and referral. Health providers have the unique opportunity to be able to address substance abuse early when patients come in for their treatment. Btw Mar2018-Apr2019, 7,101 patients participated. 5.8% screened moderate risk and 1.0% were high risk for substance use disorder. 17.6% of moderate risk and 34.4% of high risk patients screened positive for opioid use. 89.4% of ED providers caring for moderate or high risk patients had spoken with the patient prior to the SBIRT staff, but 51.1% of those providers were unaware of their patient’s substance abuse risk before being notified of the SBIRT findings. 60.8% strongly agreed or agreed that SBIRT improved the care of their patient and 93.7% strongly agreed or agreed that the SBIRT process didn’t interfere with clinical care provided in the ED.
Potential implication of SBIRT is the administration is billable by Medicare and Medicaid, and the large number of ED patients covered by these insurances may serve as additional motivation for EDs to implement SBIRT. Our site is looking into implementing this as our next step.
In conclusion, ED SBIRT may aid in addressing substance use disorders both through the direct intervention of the SBIRT process and provider awareness of patient risk.