Screening and brief intervention for low risk drug use in primary care: a pilot randomized trial

Abstract

Aims: Universal screening and brief intervention (SBI) for drug use among primary care (PC) patients lacks efficacy but the efficacy of SBI for low risk drug use is unknown. This 3-arm pilot study tested the efficacy of two brief interventions (BIs) for drug use compared to no BI in PC patients with low risk drug use identified by screening. Methods: We randomly assigned participants identified by screening with Alcohol Smoking and Substance Involvement Screening Test (ASSIST) drug specific scores of 2 or 3 (consistent with low risk drug use) to: no BI, a brief negotiated interview (BNI), or an adaptation of motivational interviewing (MOTIV). BNI was a 10-15 min structured interview conducted by health educators. MOTIV was 45 min with an optional booster conducted by trained master's-level counselors. Primary outcome was number of days use of self-identified main drug in the past 30 as determined by validated calendar method at 6 months. Analyses were performed using negative binomial regression adjusted for baseline use and main drug. Results: Of 142 eligible adults, 61(43%) consented and were randomized. Participant characteristics were: mean age 41; 54% male; 77% black. Main drug was marijuana 70%, prescription opioid 10%, cocaine 15%; 7% reported injection drug use and mean days use of main drug (of 30) was 3.4. At 6 months, 93% completed followup and adjusted mean days use of main drug were 6.4 (no BI) vs 2.1 (BNI) (incidence rate ratio (IRR 0.33, 95% CI 0.15-0.74) and 2.3 (MOTIV) (IRR 0.36, 95% CI 0.15-0.85). Conclusions: Brief intervention (both a brief negotiated interview and an adaptation of motivational interviewing) appears to have efficacy for preventing an increase in drug use in patients with low risk use identified by screening. These findings raise the possibility that low risk drug use in primary care may be uniquely amenable to brief intervention and warrant replication in a larger trial.