Absence of a quick fix does not mean 'do nothing: time to address drug use in the ED

It is unsurprising that a brief counselling intervention for drug use has no effect on drug use or linkage to drug treatment. Although psychological interventions sometimes have delayed effects, the brief intervention studied by Merchant et al1 had none at 3 months and still had none at 12 months. The study had some limitations as described by the authors, but it was null, just like prior studies in the ED and in primary care.2 3 Screening, brief intervention and referral to treatment (SBIRT in the USA), simply does not improve outcomes for unhealthy drug use.

Unhealthy substance use is not just one risk factor (eg, weekly cannabis use) or disease (eg, opioid use disorder) just as heart disease comprises many diseases all of which have specific treatments. A one-size-fits-all approach like SBIRT will not be effective; tailoring will be necessary.

No experienced clinician (or researcher...

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