Emergency Medicine Research Priorities for Early Intervention for Substance Use Disorders.

INTRODUCTION: Patients with substance use disorders (SUDs) frequently seek emergency care, and the emergency department (ED) may be their only point of contact with the healthcare system. While the ED visit has been increasingly recognized as providing opportunity for interventions around substance use, many questions remain. METHODS: In December 2016 the Coalition on Psychiatric Emergencies (CPE) convened the first Research Consensus Conference on Acute Mental Illness, which consisted of clinical researchers, clinicians from emergency medicine, emergency psychiatry, emergency psychology, representatives from governmental agencies and patient advocacy groups. Background literature review was conducted prior to the meeting, and questions were iteratively focused, revised, voted on and ranked by perceived importance using nominal group method. RESULTS: The main goal of the SUD workgroup was to identify research priorities and develop a research agenda to improve the early identification of and management of emergency department (ED) patients with SUDs with the goal of improving outcomes. This article is the product of a breakout session on "Special Populations: Substance Use Disorder." The workgroup identified with high consensus six research priorities for their importance related to the care of ED patients with SUDs in these overall domains: screening; ED interventions; the role of peer navigators; initiation of SUD management in the ED; specific patient populations that may impact the effectiveness of interventions including sociogenerational and cultural factors; and the management of the acutely intoxicated patient. CONCLUSION: Emergency providers are increasingly recognizing the important role of the ED in reducing adverse outcomes associated with untreated SUDs. Additional research is required to close identified knowledge gaps and improve care of ED patients with SUD.

Prenatal cocaine exposure and infant cognition.

The present study examined the relationship of prenatal cocaine exposure to infant information processing in the first year of life.In a prospective, longitudinal study of 177 cocaine-exposed and 175 non-exposed infants, the Fagan Test of Infant Intelligence (FTII) was used to measure attention, visual recognition memory and information processing speed at 6.5 and 12 months of age. Groups were compared over time using mixed linear model analyses.Prenatal cocaine exposure predicted poorer visual recognition memory at 12 months, with exposed infants obtaining lower mean scores and a higher percentage of scores in the risk range. Across exposure groups, information processing speed increased with age, demonstrating a developmental effect. Tobacco and marijuana exposures were related to faster looking times, which did not relate to visual recognition memory.Cognitive deficits and attentional problems noted in prior studies of cocaine-exposed children at later ages may be detectable in infancy.