Objective:To determine whether a brief (<5 minutes) Quit Using Drugs Intervention Trial (QUIT) delivered by primary care clinicians can reduce drug use days more in an intervention group compared to a control group of risky (nondependent) drug users.
Design:QUIT was a single-blind randomized controlled trial of patients enrolled from February 2011 to November 2012 with 3 month follow-up.
Setting: Primary care clinic waiting rooms of five large federally qualified health centers (FQHCs) in Los Angeles.
Participants:Adult patients were screened for drug use using the WHO ASSIST on an electronic Tablet. Subjects with “at risk” (4-26) scores were invited to participate based on their highest scoring risky drug (HSD).
Intervention(s):Intervention patients received brief clinician advice to quit/reduce their drug use and two drug-use health education/reinforcement telephone sessions (at 2 and 6 weeks, 20-30 minutes each). The control group received usual care, and information on cancer screening.
Main Outcome(s) and Measure(s):Reduction in past 30-day HSD use from baseline to follow-up.
Results:334 patients enrolled in the trial (171 intervention; 163 control condition). There were no group differences at baseline. The sample’s mean age was 41.7 years; 63% were male; 38% were white, 34% Latino, 23% African American. Patients had been using their HSD an average of 20.4 years. Three month follow-up surveys were completed by 261 patients (78%). The average reduction in HSD drug use days was 3.9 days higher (p < 0.001) in the intervention than in the control group, after adjustment for clinic, baseline HSD use, and time between assessments. The intervention effect was stronger in patients with high baseline HSD use (6.6 days greater reduction, P<.001) and also stronger with 2 than with 0-1 telephone reinforcement sessions (p<.001).
Conclusions and Relevance: QUIT is the first US study to demonstrate the efficacy of screening and brief intervention for risky drug use in the primary care setting. QUIT is timely, being the only existing model that addresses the Affordable Care Act’s urgent directive to FQHCs to integrate substance use treatment into primary care by January 2014.