Emergency Departments as Critical Intervention Hubs for Substance Use Disorders: Effectiveness, Barriers, and Opportunities for SBIRT Integration
Ahmed Ghanem Almukhlifi 1, Basim Othmn Naser Almarshad 1, Awwadh Saad Rashed Alshalawi 1, Saqer. Tawfiq Saeed M 1, Saleh Hulays Alharbi 1, Khalid Abdulmohsen Saad Alanazi 1, Zaid Kalaf T Alshammari 1, Sultan Mesfer Faraj Alsahmah 1, Tawfiq Saeed M Saqer 1, Jaber Abdullah M. Alanazi 1
Integrative Biomedical Research (Former Journal of Angiotherapy) 7(2) 1-6 https://doi.org/10.25163/angiotherapy.7210273
Submitted: 03 October 2023 Revised: 12 December 2023 Published: 15 December 2023
Abstract
Emergency Departments (EDs) play a critical role in addressing substance use disorders (SUDs) by serving as a key access point for intervention and treatment. They offer a unique environment for implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) strategies. This review evaluates the capacity of EDs to manage various SUDs—including alcohol use disorder, opioid use disorder, illicit drug use, and tobacco use disorder—through systematic reviews of both the clinical effectiveness and cost-effectiveness of SBIRT, while also examining barriers to its implementation. SBIRT combined with motivational interviewing has demonstrated significant success in reducing alcohol consumption and related harms, with an estimated return of $3.81 in savings for every $1 invested. For opioid use disorder, ED-initiated buprenorphine treatment significantly increases patient engagement in ongoing care, while naloxone distribution contributes meaningfully to harm reduction efforts. Interventions for illicit drug use have shown mixed results, often due to inconsistencies in implementation fidelity. Tobacco cessation efforts in EDs generally yield modest outcomes. Despite its potential, SBIRT implementation in EDs faces substantial challenges, including inadequate provider training, stigma toward patients with SUDs, and limited resources. Additional barriers include overreliance on automated screening tools and insufficient integration of policy and educational support for providers. Addressing these obstacles is essential for EDs to fulfill their potential as a pivotal component in bridging the treatment gap for SUDs and improving overall patient health outcomes.
Keywords: Emergency Department, Substance Use Disorders, SBIRT, Motivational Interviewing, Cost-Effectiveness
References
Academic ED SBIRT Collaborative. (2007). The impact of screening, brief intervention, and referral for treatment on emergency department patients’ alcohol use. Annals of Emergency Medicine, 50(6), 699–710.
Adams, J. M. (2018). Surgeon General’s advisory on naloxone and opioid overdose. Public Health Reports, 133(4), 347–348.
Barata, I. A., et al. (2017). Emergency department-based opioid harm reduction: A systematic review. American Journal of Emergency Medicine, 35(10), 1553–1560.
Bazargan-Hejazi, S., et al. (2019). Brief interventions for alcohol use in emergency departments: A systematic review. American Journal of Emergency Medicine, 37(8), 1501–1509.
Bernstein, E., et al. (2005). A brief motivational interview in a pediatric emergency department. Academic Emergency Medicine, 12(8), 688–695.
Bernstein, S. L., et al. (2011). The effect of smoking cessation interventions in the emergency department: A randomized controlled trial. Annals of Emergency Medicine, 58(5), 410–419.
Bernstein, S. L., et al. (2015). Tobacco control interventions in the emergency department: A randomized controlled trial. Addiction, 110(10), 1642–1651.
Bogenschutz, M. P., et al. (2014). Brief intervention for patients with problematic drug use presenting in emergency departments: A randomized clinical trial. JAMA Internal Medicine, 174(11), 1736–1745.
Bohnert, A. S., et al. (2016). Unintentional overdose and ED visits: A public health perspective. American Journal of Public Health, 106(6), 1035–1041.
Boudreaux, E. D., et al. (2016). The impact of direct versus indirect referral on treatment engagement. Drug and Alcohol Dependence, 160, 22–28.
Busch, S. H., et al. (2017). Cost-effectiveness of emergency department-initiated buprenorphine for opioid dependence. Addiction, 112(8), 1367–1375.
Cherpitel, C. J., & Ye, Y. (2015). Alcohol-attributable injuries in the emergency department. Alcohol Research: Current Reviews, 37(1), 83–92.
Cunningham, R. M., et al. (2018). Barriers to implementing SUD interventions in the ED. American Journal of Emergency Medicine, 36(7), 1302–1308.
D’Onofrio, G., et al. (2008). A brief intervention reduces hazardous drinking in the emergency department. Annals of Emergency Medicine, 51(6), 742–750.
D’Onofrio, G., et al. (2012). Screening, brief intervention, and referral to treatment (SBIRT) in the emergency department. Journal of Addiction Medicine, 6(4), 249–257.
D’Onofrio, G., et al. (2015). Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence. JAMA, 313(16), 1636–1644.
D’Onofrio, G., et al. (2018). Emergency department interventions for alcohol use disorders. Alcohol Research: Current Reviews, 39(2), 165–173.
Dwyer, K., et al. (2015). Naloxone distribution in the emergency department: A feasibility study. Academic Emergency Medicine, 22(7), 878–881.
Estee, S., et al. (2010). The impact of SBIRT on Medicaid costs. Medical Care, 48(10), 892–899.
Gentilello, L. M., et al. (2005). Alcohol interventions for trauma patients: A cost–benefit analysis. Journal of Trauma, 59(4), 802–811.
Havard, A., et al. (2008). Systematic review and meta-analyses of strategies targeting alcohol problems in emergency departments. Addiction, 103(3), 368–376.
Hawk, K., & D’Onofrio, G. (2018). Emergency department screening and interventions for substance use disorders. Addiction Science & Clinical Practice, 13(1), 18.
Larimer, M. E., et al. (2007). Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA, 297(13), 1429–1438.
Longabaugh, R., et al. (1997). Evaluating the effects of a brief motivational intervention for injured drinkers in the emergency department. Journal of Studies on Alcohol, 58(6), 628–635.
Madras, B. K., et al. (2009). Screening, brief interventions, referral to treatment for illicit drug use. Drug and Alcohol Dependence, 99(1–3), 29–38.
McCabe, C. T., et al. (2018). Cost-effectiveness of SBIRT in emergency departments. Journal of Substance Abuse Treatment, 93, 44–50.
Merchant, R. C., et al. (2015). Interactive voice response technology to reduce assessment reactivity in ED research. Academic Emergency Medicine, 22(6), 712–720.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.
Neighbors, C. J., et al. (2019). Cost-effectiveness of emergency department interventions for substance use disorders. Journal of Substance Abuse Treatment, 102, 39–47.
Pelletier, J. H., et al. (2010). Tobacco control interventions in the emergency department: A meta-analysis. Nicotine & Tobacco Research, 12(12), 1189–1197.
Rabe, G. L., et al. (2019). Updated meta-analysis of ED-initiated tobacco control interventions. Nicotine & Tobacco Research, 21(8), 1045–1052.
Saitz, R. (2010). Alcohol screening and brief intervention in the ED: Where are we now? Academic Emergency Medicine, 17(9), 965–967.
SAMHSA. (2017). National Survey on Drug Use and Health. SAMHSA.
SAMHSA. (2019). Enhancing addiction treatment in the emergency department. SAMHSA.
Samuels, E. A., et al. (2018). Peer navigation for opioid use disorder in the emergency department. Journal of Substance Abuse Treatment, 94, 82–89.
Schermer, C. R., et al. (2006). Trauma center brief interventions for alcohol disorders decrease subsequent driving under the influence arrests. Journal of Trauma, 60(1), 29–34.
Volkow, N. D., et al. (2018). The opioid crisis: A call for action. New England Journal of Medicine, 379(8), 696–698.
Weiss, A. J., et al. (2016). Trends in emergency department visits involving mental and substance use disorders. HCUP Statistical Brief #216. Agency for Healthcare Research and Quality.
Weiss, A. J., et al. (2017). Trends in ED visits for substance use disorders, 2006–2013. HCUP Statistical Brief #226. Agency for Healthcare Research and Quality.
View Dimensions
View Altmetric
Save
Citation
View
Share