Efficacy of Brief Interventions for Comorbid Substance Misuse in Patients on Opioid Agonist Treatment: A Systematic Review and Meta-analysis

Background and AimsMultiple substance use is a common but underrecognized problem in patients on opioid agonist treatment (OAT). Co-occurring substance misuse is associated with poor clinical and psychosocial outcomes. We aimed (a) to determine the effect of screening and brief intervention (SBI) for substance misuse in people on OAT and (b) to qualitatively summarize the implementation of SBI.MethodsWe performed a systematic review of clinical trials on the efficacy of SBI for alcohol and drug misuse in participants on OAT. We searched 5 electronic databases and included published studies and unpublished trials. We measured the standardized mean difference in substance risk scores before and after intervention. We also estimated the standardized mean difference in alcohol consumption per day before and after intervention.ResultsWe included a total of 8 studies; 5 of these were included in the meta-analysis, and all were reviewed for narrative synthesis. We observed a significant change in the pre-post brief intervention substance risk scores with a medium effect size (Hedges g = 0.752, 95% confidence interval, 0.405-1.099). Sensitivity analyses with different pretest-posttest correlations did not change our result. Modest effects of SBI were found in reducing both alcohol and illicit drug risk scores, and among the population on methadone and buprenorphine treatment. We also observed a significant decrease in alcohol consumption per day 3 months after SBI. Studies showed a limited and incomplete screening for substance misuse and delivery of brief intervention in OAT settings.ConclusionsScreening and brief intervention may be a potential treatment for co-occurring substance misuse among patients on OAT.

Automated summary

This study aimed to determine the efficacy of screening and brief intervention (SBI) for substance misuse in patients on opioid agonist treatment (OAT) and to summarize its implementation. The results showed that SBI can significantly reduce substance risk scores and have a modest effect on both alcohol and illicit drug risk scores. It is also effective among the population on methadone and buprenorphine treatment. Furthermore, there was a significant decrease in alcohol consumption per day 3 months after SBI. However, there were limitations in screening for substance misuse and delivering brief intervention in OAT settings.