Early Addiction Care Pathway After Acute Drug Intoxication in Emergency Departments

Condition(s) studied

Investigational drug(s) / intervention(s)

Structured early addiction care: The intervention consists of a structured early addiction care program initiated during hospitalization for acute psychoactive substance intoxication. It includes: * A standardized addiction consultation during the index hospitalization; * A protocolized follow-up schedule over 6 months, with 1-2 structured contacts per month (in-person or telephone); * Systematic harm reduction assessment and counseling at predefined visits; * Collection and structured feedback of toxicological results (urine, blood, and hair samples), including discussion of discrepancies between declared and detected substance use; * Reinforcement of linkage to addiction services and maintenance in the care pathway. The intervention aims to enhance patient engagement, insight into substance use patterns, and long-term retention in addiction care.

Not structured early addiction care: The intervention consists of a streamlined consultation with the implementation of addiction follow-up, possibly via video and telephone, and "treatment as usual" with routine toxicology tests typically used in most emergency departments. This program includes: * A standardized addiction consultation during initial hospitalization; * Addiction follow-up with random interviews and/or workshops, at least once a month, lasting 6 months or at the patient's request; * A systematic harm reduction assessment and support during pre-defined consultations, without taking into account the results of hair samples tests; * Collection of toxicology results (hair follicle), including a discussion of discrepancies between reported and detected substance use, at the end of the study at month 6.

Study summary

Acute intoxication with psychoactive substances represents a major public health issue and a frequent reason for emergency department (ED) visits. Beyond the acute medical management of intoxication, one of the main challenges remains the continuity of addiction care after discharge. Many patients disengage rapidly from follow-up services, leading to recurrent intoxication episodes, repeated ED admissions, and increased morbidity.

The IPAIS study (Interventions Précoces en Addictologie dans le cadre des urgences par Intoxications aiguës aux Stupéfiants) is a multicenter, randomized, parallel-group, open-label clinical trial designed to evaluate whether an enhanced early addiction care pathway improves retention in addiction treatment among patients admitted to emergency departments for acute intoxication involving at least one illicit psychoactive substance (excluding isolated alcohol intoxication).

All participants will receive an early addiction consultation within 24 to 72 hours following the acute event. In the experimental group, this consultation will be combined with a structured and standardized feedback session on toxicological analysis results and a proactive follow-up strategy including scheduled telephone contacts over a 6-month period. The control group will receive early addiction consultation according to usual care procedures, without the structured feedback and standardized follow-up program implemented in the experimental arm.

The primary objective of the study is to determine whether the enhanced intervention improves retention in the addiction care pathway at 6 months after inclusion. Retention is defined as sustained engagement in addiction care, operationalized as at least one addiction-related consultation per month and/or regular telephone-based addiction follow-up over the 6-month period.

Eligibility

Primary outcome measure(s)

• Retention in addiction care at 6 months — 6 months after randomization
  Proportion of randomized participants who are still actively engaged in a structured addiction care pathway 6 months after randomization. Retention is defined as attendance at ≥1 scheduled addiction care contact (in-person visit, structured psychological session, or protocol-defined telephone follow-up) within the predefined follow-up window around Month 6 (±30 days), without documented loss to follow-up or withdrawal from addiction care.

Trial sites (4)

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