Preventing Drug Use in Low Income Clinic Populations

The Quit Using Drugs Intervention Trial (QUIT) will be the first randomized controlled trial in the U.S. that is powered to detect the effect of a primary care clinician delivered brief intervention protocol for reducing 'at risk' drug use and drug-related harm among low-income adult patients (ages 18 and older) at multiple safety net clinics in Los Angeles County. For this small trial, we will sample patients with 'at risk' use of drugs (marijuana, crack/cocaine, amphetamines/methamphetamines, inhalants, sedatives or sleeping pills, hallucinogens, and opiates), the most commonly used serious drugs among patients at our clinic sites. "At risk" drug use is defined in this study as current use (past 90 days) of drug measured as a self-reported total score of 4 to 26 on the WHO Alcohol Substance Involvement Screening Test (ASSIST). A total of 7,000-8,000 patients will be approached for screening to yield a 3-month effective sample size of 245 eligible patients per condition (1) an intervention condition involving drug use health education or (2) a control condition involving care as usual. In the intervention condition, very brief (less than 5 minutes) clinician advice regarding quitting drug use will be followed by two 2 and 6 week post-visit drug health education sessions on quitting drug use and cautioning against use of other 'at risk' substance use such as alcohol and tobacco. Patients assigned to the control condition will receive standard care for drug use at the baseline visit with their clinician. Follow-up assessments will be conducted at 3 month post-randomization. The framework for the QUIT project is the Social Action Theory, and the brief intervention protocol is based on NIDA's principles on prevention research and the utility of the 5 A's approach for assisting behavioral changes among patients (Ask, Advise, Assess, Assist, Arrange) in the clinic setting. If found to be effective in the community health center setting, this clinician and telephone drug-use health education program could become a model for health promotion activities. that would be expanded to all 'at risk' substance use and shared between community health centers.