Interventions for Drug Use – Supplemental Report: A Systematic Review for the U.S. Preventive Services Task Force [Entered Retrospectively]

Project Summary Title and Description

Title
Interventions for Drug Use – Supplemental Report: A Systematic Review for the U.S. Preventive Services Task Force [Entered Retrospectively]
Description
Background: A U.S. Preventive Services Task Force (USPSTF) report found no consistent evidence that counseling interventions are effective at reducing drug use or improving other health outcomes in populations whose drug use was identified through primary care-based screening with questions about drug use or drug-related risks (i.e., “screen-detected populations”). Evidence from studies of persons seeking or referred for treatment for substance use or with clinical signs or symptoms of substance use (i.e., “treatment-seeking populations”) might also be useful for informing assessments regarding screening in primary care settings. Purpose: This report updates a 2008 USPSTF report on screening for illicit drug use and supplements an updated USPSTF report on screening for any drug use, focusing on the benefits and harms of pharmacotherapy and psychosocial interventions for persons whose drug use was identified when seeking substance use treatment, when presenting with signs or symptoms of drug use, when screened for drug use in primary care or other settings with questions about drug use or drug-related risks, or other means. Data Sources: The Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Ovid MEDLINE, Embase, and PsycINFO from inception to September 2018; surveillance for new literature was conducted through November 22, 2019. Study Selection: We included trials of Food and Drug Administration (FDA)-approved pharmacotherapies for opioid use disorder (methadone, buprenorphine, and naltrexone) and trials of psychosocial interventions for persons engaging in opioid, stimulant, cannabis, and mixed drug or polysubstance use. We also included trials of preemptive prescribing of naloxone in primary care settings as a rescue medication for opioid-related overdose. Trials compared included interventions against placebo, a minimal intervention, waitlist control, or usual care, and evaluated outcomes at >3 months for drug use or other risky behaviors; health, social, and legal consequences of drug use; or harms of treatment. Data Extraction: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. Data Synthesis (Results): We included a total of 71 trials, with 19 trials of pharmacotherapies and 52 trials of psychosocial interventions. All trials of pharmacotherapies and 25 trials of psychosocial interventions were conducted in treatment-seeking populations. Psychosocial interventions commonly incorporated cognitive-behavioral or motivational interventions and ranged from brief interventions consisting of one or two sessions of no more than one hour to multiple treatment sessions over weeks or months. In most pharmacotherapy trials, drug use counseling was provided to all patients. No study evaluated benefits or harms of preemptive naloxone prescribed in primary care settings versus placebo or no naloxone as a rescue medication for opioid-related overdose. In treatment-seeking populations with opioid use disorder, naltrexone (12 trials; relative risk [RR] 0.73, 95% confidence interval [CI] 0.62 to 0.85; number needed to treat [NNT] 5.3) and opioid agonist therapy with methadone or buprenorphine (4 trials; RR 0.75, 95% CI 0.59 to 0.82; NNT 2.9) were associated with decreased risk of drug use relapse compared with placebo or no pharmacotherapy. Naltrexone and methadone/buprenorphine therapy were also associated with increased likelihood of retention in substance use treatment (9 trials; RR 1.71, 95% CI 1.13 to 2.49; NNT 6.7 and 7 trials; RR 2.58, 95% CI 1.78 to 4.59; NNT 2.6; respectively). Evidence on harms of pharmacotherapies was limited, but indicated no increased risk of serious adverse events. Psychosocial interventions were associated with increased likelihood of abstinence from drug use versus control conditions at 3 to 4 months (15 trials, RR 1.60, 95% CI 1.24 to 2.13; NNT 11) and at 6 to 12 months (14 trials; RR 1.25, 95% CI 1.11 to 1.52; NNT 17), based on trials primarily conducted in treatment-seeking populations. Psychosocial interventions were also associated with a greater decrease versus control conditions in the number of drug use days (19 trials; mean difference -0.49 day in the last 7 days, 95% CI -0.85 to -0.13) and a small but statistically significant greater decrease in drug use severity (16 trials; standard mean difference -0.18, 95% CI -0.32 to -0.05) at 3- to 4-month followup. There was no difference between psychosocial interventions versus controls on drug use days or severity at longer (6 to 12 month) followup. Effects of psychosocial interventions were generally stronger in trials of treatment-seeking than screen-detected populations, trials that evaluated cannabis use than other types of drug use, and trials of more intensive than brief interventions. Few trials evaluated effects of psychosocial interventions for opioid or stimulant use, and estimates were imprecise. Limitations: Limitations included restriction to English-language articles, statistical heterogeneity in pooled analyses, and little evidence on drug-related health, social, or legal outcomes; most trials had methodological limitations. Evidence was lacking on effectiveness of treatments for opioid use disorder related to prescription drug use or stimulant use and evidence was limited for adolescents or pregnant persons. Conclusions: Pharmacotherapy and psychosocial interventions are effective at improving drug use outcomes, but evidence of effectiveness remains primarily derived from trials conducted in treatment-seeking populations. Although the applicability of data from such trials to persons whose drug use is identified through primary care-based screening is uncertain, intervention trials that enrolled patients based on screening identified a spectrum of drug use, ranging from mild drug use to more severe, untreated disease. The applicability of current evidence on drug use interventions to screening might be greater for the subset of patients screened in primary care settings with severe, untreated drug use who could utilize pharmacotherapies or more intensive psychosocial interventions.
Attribution
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Authors of Report
N/A
Methodology description
Study Selection: We included trials of Food and Drug Administration (FDA)-approved pharmacotherapies for opioid use disorder (methadone, buprenorphine, and naltrexone) and trials of psychosocial interventions for persons engaging in opioid, stimulant, cannabis, and mixed drug or polysubstance use. We also included trials of preemptive prescribing of naloxone in primary care settings as a rescue medication for opioid-related overdose. Trials compared included interventions against placebo, a minimal intervention, waitlist control, or usual care, and evaluated outcomes at >3 months for drug use or other risky behaviors; health, social, and legal consequences of drug use; or harms of treatment. Data Extraction: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. Data Synthesis (Results): We included a total of 71 trials, with 19 trials of pharmacotherapies and 52 trials of psychosocial interventions. All trials of pharmacotherapies and 25 trials of psychosocial interventions were conducted in treatment-seeking populations. Psychosocial interventions commonly incorporated cognitive-behavioral or motivational interventions and ranged from brief interventions consisting of one or two sessions of no more than one hour to multiple treatment sessions over weeks or months. In most pharmacotherapy trials, drug use counseling was provided to all patients. No study evaluated benefits or harms of preemptive naloxone prescribed in primary care settings versus placebo or no naloxone as a rescue medication for opioid-related overdose. In treatment-seeking populations with opioid use disorder, naltrexone (12 trials; relative risk [RR] 0.73, 95% confidence interval [CI] 0.62 to 0.85; number needed to treat [NNT] 5.3) and opioid agonist therapy with methadone or buprenorphine (4 trials; RR 0.75, 95% CI 0.59 to 0.82; NNT 2.9) were associated with decreased risk of drug use relapse compared with placebo or no pharmacotherapy. Naltrexone and methadone/buprenorphine therapy were also associated with increased likelihood of retention in substance use treatment (9 trials; RR 1.71, 95% CI 1.13 to 2.49; NNT 6.7 and 7 trials; RR 2.58, 95% CI 1.78 to 4.59; NNT 2.6; respectively). Evidence on harms of pharmacotherapies was limited, but indicated no increased risk of serious adverse events. Psychosocial interventions were associated with increased likelihood of abstinence from drug use versus control conditions at 3 to 4 months (15 trials, RR 1.60, 95% CI 1.24 to 2.13; NNT 11) and at 6 to 12 months (14 trials; RR 1.25, 95% CI 1.11 to 1.52; NNT 17), based on trials primarily conducted in treatment-seeking populations. Psychosocial interventions were also associated with a greater decrease versus control conditions in the number of drug use days (19 trials; mean difference -0.49 day in the last 7 days, 95% CI -0.85 to -0.13) and a small but statistically significant greater decrease in drug use severity (16 trials; standard mean difference -0.18, 95% CI -0.32 to -0.05) at 3- to 4-month followup. There was no difference between psychosocial interventions versus controls on drug use days or severity at longer (6 to 12 month) followup. Effects of psychosocial interventions were generally stronger in trials of treatment-seeking than screen-detected populations, trials that evaluated cannabis use than other types of drug use, and trials of more intensive than brief interventions. Few trials evaluated effects of psychosocial interventions for opioid or stimulant use, and estimates were imprecise.
PROSPERO
N/A
DOI
N/A
Notes
The following tables have been uploaded: Appendix 1. Naltrexone Trials – Study Characteristics Appendix 2. Naltrexone Trials – Intervention Characteristics Appendix 3. Naltrexone Trials – Results Appendix 4. Naltrexone Trials – Quality Assessment Appendix 5. Methadone and Buprenorphine Trials – Study Characteristics Appendix 6. Methadone and Buprenorphine Trials – Intervention Characteristics Appendix 7. Methadone and Buprenorphine Trials – Results Appendix 8. Methadone and Buprenorphine Trials – Quality Assessment Appendix 9. Psychosocial Trials – Study Characteristics Appendix 10. Psychosocial Trials – Intervention Characteristics Appendix 11. Psychosocial Trials – Results Appendix 12. Psychosocial Trials – Quality Assessment
Funding Source
This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2015-00007-I, Task Order No. 4)

Key Questions

1. Key Questions 4a and 4b. Do interventions to reduce drug use reduce drug use or improve other risky behaviors? Do interventions to reduce drug use reduce morbidity or mortality or improve other health, social, or legal outcomes?
2. Key Question 5. What are the harms of interventions to reduce drug use?
3. Key Questions 6 and 7. Does naloxone reduce morbidity or mortality, or improve other health outcomes in persons with opioid use disorder or misuse? What are the harms of naloxone in persons with opioid use disorder or misuse?
4. Key Question 1. Covered in Kaiser review
5. Key Question 2. Covered in Kaiser review
6. Key Question 3. Covered in Kaiser review

Associated Extraction Forms

Associated Studies (each link opens a new tab)

TitleAuthorsYear
Brief motivational interviewing intervention to reduce alcohol and marijuana use for at-risk adolescents in primary care.2018
Computer-delivered indirect screening and brief intervention for drug use in the perinatal period: A randomized trial.2018
Sexual HIV risk behavior outcomes of brief interventions for drug use in an inner-city emergency department: Secondary outcomes from a randomized controlled trial.2018
A randomized controlled trial of screening and brief interventions for substance misuse in reproductive health.2018
A Pilot Randomized Controlled Trial of a Computer-Delivered Brief Intervention for Substance Use and Risky Sex During Pregnancy.2018
Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care: The SUMMIT Randomized Clinical Trial.2017
A pilot replication of QUIT, a randomized controlled trial of a brief intervention for reducing risky drug use, among Latino primary care patients.2017
A randomized controlled trial of a brief intervention for alcohol and drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary health care in Chile.
A randomized controlled trial of brief interventions to reduce drug use among adults in a low-income urban emergency department: the HealthiER You study.2017
Peer Network Counseling as Brief Treatment for Urban Adolescent Heavy Cannabis Users.2017
Receipt of addiction treatment as a consequence of a brief intervention for drug use in primary care: a randomized trial.2017
Immediate Versus Delayed Computerized Brief Intervention for Illicit Drug Misuse.-- Not Found --
Anhedonia, depression, anxiety, and craving in opiate dependent patients stabilized on oral naltrexone or an extended release naltrexone implant.2016
Assessing the Efficacy of MOTI-4 for Reducing the Use of Cannabis Among Youth in the Netherlands: A Randomized Controlled Trial.2016
Project QUIT (Quit Using Drugs Intervention Trial): a randomized controlled trial of a primary care-based multi-component brief intervention to reduce risky drug use.2015
A Web-Based Self-Help Intervention With and Without Chat Counseling to Reduce Cannabis Use in Problematic Cannabis Users: Three-Arm Randomized Controlled Trial.
Brief intervention for daily marijuana users identified by screening in primary care: A subgroup analysis of the ASPIRE randomized clinical trial.-- Not Found --
Peer Network Counseling with Urban Adolescents: A Randomized Controlled Trial with Moderate Substance Users.2015
Six-month outcomes of a Web-based intervention for users of amphetamine-type stimulants: randomized controlled trial.2015
Brief intervention for patients with problematic drug use presenting in emergency departments: a randomized clinical trial.2014
Screening and brief intervention for drug use in primary care: the ASPIRE randomized clinical trial.
Brief intervention for problem drug use in safety-net primary care settings: a randomized clinical trial.2014
Effect of a primary care based brief intervention trial among risky drug users on health-related quality of life.2014
A randomized controlled trial of a brief motivational enhancement for non-treatment-seeking adolescent cannabis users.2014
Web-based screening and brief intervention for student marijuana use in a university health center: pilot study to examine the implementation of eCHECKUP TO GO in different contexts.2014
Computer-delivered screening and brief intervention (e-SBI) for postpartum drug use: a randomized trial.2014
Buprenorphine implants for treatment of opioid dependence: randomized comparison to placebo and sublingual buprenorphine/naloxone.2013
Indicated prevention for college student marijuana use: a randomized controlled trial.2013
Computer and therapist based brief interventions among cannabis-using adolescents presenting to primary care: one year outcomes.
Naltrexone with or without guanfacine for preventing relapse to opiate addiction in St.-Petersburg, Russia.2013
Effectiveness of a self-guided web-based cannabis treatment program: randomized controlled trial.2013
Project reduce: reducing alcohol and marijuana misuse: effects of a brief intervention in the emergency department.
Behavioral treatment for marijuana dependence: randomized trial of contingency management and self-efficacy enhancement.2013
Testing the effects of brief intervention in primary care for problem drug use in a randomized controlled trial: rationale, design, and methods.2012
Randomized trial of long-acting sustained-release naltrexone implant vs oral naltrexone or placebo for preventing relapse to opioid dependence.2012
Motivational enhancement therapy coupled with cognitive behavioral therapy versus brief advice: a randomized trial for treatment of hazardous substance use in pregnancy and after delivery.-- Not Found --
Randomized controlled trial of a novel cannabis use intervention delivered by telephone.2012
12-month follow-up of an exploratory 'brief intervention' for high-frequency cannabis users among Canadian university students.2012
Feasibility and impact of brief interventions for frequent cannabis users in Canada.2013
A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in clients recruited from primary health-care settings in four countries.2012
Motivational and mindfulness intervention for young adult female marijuana users.2012
Design of NIDA CTN Protocol 0047: screening, motivational assessment, referral, and treatment in emergency departments (SMART-ED).2011
Injectable extended-release naltrexone for opioid dependence: a double-blind, placebo-controlled, multicentre randomised trial.2011
A brief marijuana intervention for non-treatment-seeking young adult women.2011
Buprenorphine implants for treatment of opioid dependence: a randomized controlled trial.2010
A brief, web-based personalized feedback selective intervention for college student marijuana use: a randomized clinical trial.2010
Screening and brief intervention to reduce marijuana use among youth and young adults in a pediatric emergency department.2009
Brief intervention in general hospital for problematic prescription drug use: 12-month outcome.2009
Interim methadone treatment: impact on arrests.2009
Randomized controlled trial of a brief intervention for problematic prescription drug use in non-treatment-seeking patients.2009
Randomized controlled trial of motivational interviewing compared with drug information and advice for early intervention among young cannabis users.2008
Maintenance treatment with buprenorphine and naltrexone for heroin dependence in Malaysia: a randomised, double-blind, placebo-controlled trial.2008
Coping skills training and contingency management treatments for marijuana dependence: exploring mechanisms of behavior change.2008
A randomized trial of 6-month methadone maintenance with standard or minimal counseling versus 21-day methadone detoxification.2008
The adolescent cannabis check-up: randomized trial of a brief intervention for young cannabis users.2008
The Marijuana Check-up: promoting change in ambivalent marijuana users.2007
Computer-based brief intervention a randomized trial with postpartum women.2007
Naltrexone with or without fluoxetine for preventing relapse to heroin addiction in St. Petersburg, Russia.2006
Abstinence and moderate use goals in the treatment of marijuana dependence.2006
Abstinence rates following behavioral treatments for marijuana dependence.2007
A randomized controlled trial of interim methadone maintenance: 10-Month follow-up.2007
An evaluation of a brief motivational intervention among young ecstasy and cocaine users: no effect on substance and alcohol use outcomes.2006
Coping and self-efficacy in marijuana treatment: results from the marijuana treatment project.2005
A randomized controlled trial of interim methadone maintenance.2006
Reinforcement-based therapy: 12-month evaluation of an outpatient drug-free treatment for heroin abusers.2005
Naltrexone plus benzodiazepine aids abstinence in opioid-dependent patients.2005
Deterioration over time in effect of Motivational Interviewing in reducing drug consumption and related risk among young people.2005
Brief cognitive behavioural interventions for regular amphetamine users: a step in the right direction.2005
Brief motivational intervention at a clinic visit reduces cocaine and heroin use.2005
Brief treatments for cannabis dependence: findings from a randomized multisite trial.2004
Naltrexone for heroin dependence treatment in St. Petersburg, Russia.2004
The efficacy of single-session motivational interviewing in reducing drug consumption and perceptions of drug-related risk and harm among young people: results from a multi-site cluster randomized trial.2004
1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomised, placebo-controlled trial.2003
A placebo-controlled study of high dose buprenorphine in opiate dependents waiting for medication-assisted rehabilitation in Oslo, Norway.2002
Randomized controlled trial of brief cognitive-behavioural interventions among regular users of amphetamine.2001
A randomized controlled trial of brief cognitive-behavioral interventions for cannabis use disorder.2001
Clinical profile of participants in a brief intervention program for cannabis use disorder.2001
Comparison of extended versus brief treatments for marijuana use.2000
Naltrexone pharmacotherapy for opioid dependent federal probationers.-- Not Found --
The efficacy of naltrexone in preventing reabuse of heroin after detoxification.1994
Follow-up after a six-month maintenance period on naltrexone versus placebo in heroin addicts.1991
A naltrexone double blind placebo controlled study in Israel.1992
Clinical evaluation of naltrexone treatment of opiate-dependent individuals. Report of the National Research Council Committee on Clinical Evaluation of Narcotic Antagonists.1978
Randomized controlled pilot trial of naloxone-on-release to prevent post-prison opioid overdose deaths.2017
Nonrandomized Intervention Study of Naloxone Coprescription for Primary Care Patients Receiving Long-Term Opioid Therapy for Pain.2016
A motivational intervention trial to reduce cocaine use2009
Measuring Alcohol Consumption: Psychosocial and Biochemical Methods1992
Screening in Primary Care Settings for Illicit Drug Use: Staged Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 58, Part 1. (Prepared by the Oregon Evidence-based Practice Center under Contract No. 290-02-0024.) AHRQ Publication No. 08-05108-EF-s. Rockville, MD, Agency for Healthcare Research and Quality2008
Efficacy of naltrexone hydrochloride for preventing relapse among opiate-dependent patients after detoxification2001
Brief intervention impact on truant youths' marijuana use: eighteen-month follow-up2016
Characteristics of regular amphetamine users and implications for treatment2001

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