US-Mexico Binational Quit Using Drugs Intervention Trial (QUIT)

Introduction. The US-Mexico Binational Quit Using Drugs Intervention Trial (QUIT) aims to: (1) determine the feasibility of the self-administered electronic version of the WHO Alcohol Substance Involvement Screening Test (ASSIST); (2) estimate the rates of drug use in primary care clinic patients; and (3) conduct preliminary assessment of intervention effectiveness to prepare for a RCT of a primary care clinic-based brief intervention protocol for reducing the use of illicit drugs and the occurrences of drug-related harm in low-income patient populations at two 'safety-net' clinics in Tijuana and two in East LA. This proposal is responsive to calls from the 2011 Binational Mexico-US Drug Demand Reduction Meetings. Some drug users seek care within primary care settings but their drug use often goes undiagnosed because patients won’t report their drug use and their doctors don’t ask about it.

Methods. The objective is to adapt the US QUIT intervention for the East Los Angeles and Tijuana culture and conduct a “proof of concept” trial of the QUIT intervention approach. The mission is to develop brief, portable screening and intervention methods for use in primary care settings in both countries to address the complete range of ‘at risk’ drug use. ‘At risk’ drug use is defined as casual, frequent, or binge use without dependence. Specifically, ‘at risk’ illicit drug use and non-medical use of pharmaceuticals is defined by a score of 4 to 26 on the ASSIST. Subjects age 18 and older will be screened with the ASSIST (~1,000 in each country). Consented patients (~50, in each country) will be randomized to either (1) the QUIT intervention or (2) a control condition (care as usual). All data will be collected on EMMA, a system developed for the UCLA QUIT Study that utilizes touchscreen tablet PCs, a “talking touchscreen” to complete the self-administered screening tools.

The Binational QUIT includes brief (<5 minutes) clinician advice during the medical visit preceded by a computerized assessment of the patient's drug-use history in the clinic waiting room, followed by a post visit assessment and video doctor (providing a standardized brief clinician advice format), two post-visit telephone health educator drug-use counseling sessions at 2 and 6 weeks, and follow-up assessments at 3 months.

 

Results. The US and Mexico investigator team will present preliminary findings regarding the intervention, importance of primary care and the barriers to change, and discuss issues related to international collaboration, technology transfer, and research methodology.

Conclusions. The Binational QUIT Study meets key scientific and policy agendas for reducing drug demand at the borders by conducting drug abuse prevention activities with primary care clinicians and their patients.