By Leon Fooksman

HOW SBIRT TOOLKIT CAN HELP TACKLE DRUG OVERDOSE EPIDEMIC IN PALM BEACH COUNTY AND BEYOND

By Leon Fooksman

The numbers are heartbreaking: More than 20 million people in the United States have a substance use disorder (SUD). The rate of prescription overdose deaths has increased five-fold since 1999. And more than two-thirds of people who misused prescription opioids obtained them through prescriptions filled at a pharmacy for either themselves or a friend or family member.

One of the most-discussed approaches in medicine in addressing this problem is using a tool called Screening, Brief Intervention, and Referral to Treatment (SBIRT).

It’s been developed and used, for close to a decade, at primary care offices, emergency departments, workers’ compensation clinics, hospitals, criminal justice centers, and schools. Covered by most insurance, SBIRT is an evidence-based approach to identify people who use alcohol or other drugs in unhealthy ways but who do not necessarily have a substance use disorder (i.e., abuse, dependence).

The screening is a brief conversation between a clinician and patient using motivational interviewing techniques. Patients determined to have more severe symptoms may be referred to behavioral health treatment.

Sounds good, right? But like so much in medicine, there are challenges.

One is how to get physicians and medical providers to use SBIRT more frequently in their practices and clinical settings. The other is what to do when patients are found to have a “positive” response – in other words, how do providers get patients the help they need to overcome their substance disorder.

As part of the Palm Beach County Medical Society (PBCMS)’s Opioid Health Care Initiative, PBCMS asked John Hulick -- senior program manager for substance abuse at Palm Beach County Community Services Department -- for his thoughts on finding solutions.

“Palm Beach County has re-thought and focused its behavioral health system of care toward being more person-centered and recovery-oriented,” he said. “SBIRT represents a similar paradigm shift in substance use interventions in that, traditionally, these have focused on individuals who have severe substance use or those who meet criteria for substance use disorder.”

Hulick added: “My hope is to have a truly integrated and collaborative approach between the primary and behavioral sectors in order to address these concerns. SBIRT provides one path toward achieving this through implementing this effective strategy for earlier interventions before the need develops for more extensive or specialized treatment.”

As for encouraging more providers to use the SBIRT program model, he said: “I certainly recognize how busy doctor’s and their offices are. My hope is, as emphasis remains on caring for a patient’s health, that we continue to educate the profession that unhealthy alcohol and other drug use are among the most common causes of preventable morbidity and mortality.”

Since SBIRT is available through commercial and public insurance, that should, he said, “hopefully mitigate some cost concern in order to allow doctors and their staff to provide universal screening, early intervention, and timely referral to treatment for people who have SUDs.”

For another perspective on using SBIRT, PBCMS members Brent Schillinger, MD and Abby Strauss, MD spoke with Bertha Madras, MD, in a podcast called “Drug Use Screening SBIRT” in November 2020. (Dr. Madras,

a professor of psychobiology at Harvard Medical School, was deputy director for demand reduction in the White House Office of National Drug Control Policy.)

Asked how physicians should respond to positive screening using SBIRT, she said: “If you are going to screen, you have to be equipped to know what to do if you get a positive screen.” She added that providers either refer the patient to a treatment center or be “capable of handling the intervention and treatment yourself. But you cannot screen, get a positive and then do very little after that.”

One of the main reasons physicians are worried about the screening, Dr. Madras said, is they “don’t know what to do. There’s no medical education.” She added: “Physicians have been trained on tobacco screening, but few have been trained on how to give motivational interviewing and how to intervene.” She also said that medical schools and residency programs need to “mainstream this kind of training.” Dr. Madras will conduct a virtual presentation on SBIRT during an Opioid Educational Seminar for Physicians and Healthcare Providers on Friday, May 21st from 12-1pm; for more information go to www.pbcms.org.

Dr. Madras said studies as far back as the 1960s and 1970s showed that by physicians asking simple questions -- common now as part of the SBIRT toolkit -- they “changed behavior, even without an intervention, even without motivational form of interviewing.” She added: “So raising the question is important for many points of view.”

HERE IS THE LINK:

pbcms.org/opioid-addiction-treatment-resources.

YOU’LL FIND:

• Recommendations on screening approaches for alcohol and other drug use. • Steps for referring patients to substance use specialty care. • Suggested brief intervention script.

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