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Efficacy of Brief Intervention for Unhealthy Drug Use in Outpatient Medical Care: a Systematic Review and Meta-analysis

Abstract

Background

The efficacy of brief intervention (BI) for unhealthy drug use in outpatient medical care has not been sufficiently substantiated through meta-analysis despite its ongoing global delivery. This study aims to determine the efficacy of BI for unhealthy drug use and the expected length of effects, and describe subgroup analyses by outpatient setting.

Methods

Trials comparing BI with usual care controls were retrieved through four databases up to January 13, 2021. Two reviewers independently screened, selected, and extracted data. Primary outcomes included drug use frequency (days used) and severity on validated scales at 4–8 months and were analyzed using random-effects model meta-analysis.

Results

In total, 20 studies with 9182 randomized patients were included. There was insufficient evidence to support the efficacy of BI for unhealthy drug use among all outpatient medical care settings for use frequency (SMD = −0.07, 95% CI = −0.17, 0.02, p = 0.12, I2 = 37%, high certainty of evidence) and severity (SMD = −0.27, 95% CI = −0.78, 0.24, p = 0.30, I2 = 98%, low certainty of evidence). However, post hoc subgroup analyses uncovered significant effects for use frequency by setting (interaction p = 0.02), with significant small effects only in emergency departments (SMD = −0.15, 95% CI = −0.25, −0.04, p < 0.01). Primary care, student health, women’s health, and HIV primary care subgroups were nonsignificant. Primary care BI revealed nonsignificant greater average use in the treatment group compared to usual care.

Discussion

BI for unhealthy drug use lacks evidence of efficacy among all outpatient medical settings. However, small effects found in emergency departments may indicate incremental benefits for some patients. Clinical decisions for SBI or specialty treatment program referrals should be carefully considered accounting for these small effects in emergency departments.

Registration

PROSPERO (CRD42020157733)

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Funding

This research was supported through a fellowship grant (P19110) and grant-in-aid (19F19110) from the Japan Society for the Promotion of Science (JSPS).

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Contributions

ES and TAF conceived the study. ES, NW, and TAF provided substantial contribution to the design of the study during its development. ES has planned and conducted the search. ES, MS, RT, CH, KY, and YL conducted study selection, data extraction, and risk of bias assessments. ES conducted the statistical analysis. ES drafted the initial version, and all authors revised the manuscript for important intellectual content and contributed to its improvement. All authors gave the final approval to publish and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Ethan Sahker PhD.

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TAF reports personal fees from Mitsubishi-Tanabe, MSD and Shionogi, and a grant from Mitsubishi-Tanabe, outside the submitted work; TAF has a patent 2018-177688 pending. All the other authors report no competing interest.

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Sahker, E., Luo, Y., Sakata, M. et al. Efficacy of Brief Intervention for Unhealthy Drug Use in Outpatient Medical Care: a Systematic Review and Meta-analysis. J GEN INTERN MED 37, 2041–2049 (2022). https://doi.org/10.1007/s11606-022-07543-z

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KEY WORDS

  • screening
  • evidence-based treatment
  • primary care
  • emergency department
  • student health