Chambers Laura C, Welwean Ralph A, Cho Daniel K, Langdon Kirsten J, Li Yu, Hallowell Benjamin D, Daly Mackenzie M, Marshall Brandon D L, Beaudoin Francesca L
Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.
Alpert Medical School of Brown University, Providence, Rhode Island.
Subst Use Misuse. 2025;60(3):381-392. doi: 10.1080/10826084.2024.2434003. Epub 2024 Dec 1.
Emergency department (ED) visits are an opportunity to provide prevention services to people at high risk of overdose. Considering patients' resources to initiate and sustain recovery ("recovery capital") may be useful for tailoring ED services, although its relevance in this population is unknown.
This secondary analysis used data from ED patients at high risk of opioid overdose enrolled in a randomized controlled trial in Rhode Island (2018-2021). We assessed baseline recovery capital using the Brief Assessment of Recovery Capital (BARC-10), dichotomized as a total score <47 versus ≥47. Post-discharge addiction treatment engagement within 30 days and non-fatal opioid overdose and fatal overdose within 18 months were assessed using statewide administrative data. We used modified Poisson regression and Cox proportional hazards models to estimate the association between recovery capital and (1) treatment engagement and (2) overdose risk, respectively, adjusting for potential confounders.
Among 543 participants, 32.2% had a baseline BARC-10 total score of ≥47, 32.6% engaged in treatment within 30 days, and 25.6% had a non-fatal opioid overdose and 4.2% had a fatal overdose within 18 months. BARC-10 total score was not associated with treatment engagement within 30 days (adjusted relative risk = 0.79, 95% confidence interval [CI] = 0.60-1.05) or non-fatal opioid overdose (adjusted hazard ratio [aHR] = 0.83, 95%CI = 0.57-1.20) or fatal overdose (aHR = 0.45, 95%CI = 0.14-1.40) within 18 months.
The majority of ED patients at high risk of opioid overdose had a BARC-10 total score of <47, suggesting low recovery capital. BARC-10 total score was not associated with post-discharge treatment engagement or overdose risk.
急诊科就诊是为药物过量高风险人群提供预防服务的契机。考虑患者启动和维持康复的资源（“康复资本”）可能有助于定制急诊科服务，尽管其在该人群中的相关性尚不清楚。
这项二次分析使用了罗德岛一项随机对照试验（2018 - 2021年）中纳入的阿片类药物过量高风险急诊科患者的数据。我们使用康复资本简要评估量表（BARC - 10）评估基线康复资本，将总分<47与≥47进行二分法划分。使用全州行政数据评估出院后30天内的成瘾治疗参与情况以及18个月内的非致命性阿片类药物过量和致命性过量情况。我们分别使用修正泊松回归和Cox比例风险模型来估计康复资本与（1）治疗参与情况和（2）过量风险之间的关联，并对潜在混杂因素进行调整。
在543名参与者中，32.2%的人BARC - 10总分≥47，32.6%的人在30天内参与了治疗，25.6%的人在18个月内发生了非致命性阿片类药物过量，4.2%的人发生了致命性过量。BARC - 10总分与30天内的治疗参与情况（调整后的相对风险 = 0.79，95%置信区间[CI]=0.60 - 1.05）、非致命性阿片类药物过量（调整后的风险比[aHR]=0.83，95%CI = 0.57 - 1.20）或18个月内的致命性过量（aHR = 0.45，95%CI = 0.14 - 1.40）均无关联。
大多数阿片类药物过量高风险的急诊科患者BARC - 10总分<47，表明康复资本较低。BARC - 10总分与出院后治疗参与情况或过量风险无关。
