The cost-effectiveness of brief intervention versus brief treatment of Screening, Brief Intervention and Referral to Treatment (SBIRT) in the United States

AIMS:To conduct a cost-effectiveness analysis (CEA) comparing the delivery of brief intervention (BI) with brief treatment (BT) within Screening, Brief Intervention and Referral to Treatment (SBIRT) programs. DESIGN:Quasi-experimental differences in observed baseline characteristics between BI and BT patients were adjusted using propensity score techniques. Incremental comparison of costs and health outcomes associated with BI and BT. SETTING:Health-care settings in four US states participating in Substance Abuse and Mental Health Services Administration SBIRT grant programs. PARTICIPANTS:Ninety patients who received BT and 878 who received BI. MEASUREMENTS:Per-patient cost of SBIRT, patient demographics and six measures of substance use: proportion using alcohol, proportion using alcohol to intoxication, days of alcohol use, days of alcohol use to intoxication, proportion using drugs and days using drugs. FINDINGS:BI and BT were associated with better outcomes. The cost of SBIRT was significantly higher for BT patients ($75.54 versus 16.32, 95% confidence interval,

Deaths Related to MDMA (Ecstasy/Molly): Prevalence, Root Causes, and Harm Reduction Interventions

Recent data show that MDMA (3,4 methylenedioxymethamphetamine) related deaths (MRDs) are on the rise in several countries. This rise in MRDs has caught the attention of public health officials and treatment practitioners. Although MDMA is not a new drug, misinformation regarding the root causes of MRDs is still widespread. For example, MRDs continue to be reported as “overdoses” in the media and by government. This erroneously gives the impression that these deaths are caused by ingesting too high a dose, when in fact MRDs are usually due to factors such as hyperthermia, dehydration, drug interactions, or hyponaetremia. When the real culprits behind MRDs are obscured, we are left with an inaccurate picture about the extent and nature of the risk of consuming the drug. This also inhibits the implementation of effective drug education and risk reduction messages. The purpose of this paper, therefore, is to explore MRDs further by: 1) providing a brief history of MDMA, 2) summarizing international prevalence rates of MRDs, 3) discussing factors that contribute to MRDs, and 4) identifying promising interventions to reduce MRDs. The information presented in this paper is particularly important given the international resurgence of recreational MDMA use (as molly) and the renewed interest in the drug’s therapeutic benefits