162. Performance of the Screening to Brief Intervention (S2BI) Tool for Identifying Substance Misuse in Adolescents and Young Adults of Color in an Urban Adult Emergency Department

A screening, brief intervention, and referral to treatment (SBIRT) program for substance use disorder (SUD) was broadly implemented in an urban adult emergency department (ED) consisting of the validated AUDIT-C tool for alcohol and 1-item drug use questions for 18 types of drugs modified from the validated ASSIST tool. It is unclear how accurately these screening tools identify SUD in subgroups of ED patients, particularly adolescents and young adults (AYA) of color. The aim of this pilot study was to determine the utility of the addition of a validated substance use screening tool specifically for AYA (the S2BI) and compare the S2BI to that of the preexisting AUDIT-C/1-item drug use questions in ED AYA patients of color receiving care in an adult ED. This study was IRB-approved. From December 2021 – August 2022, 96 consented ED patients of color aged 18-24 years self-administered the S2BI on a touchscreen tablet platform. Responses to the ED SBIRT screening questions asked by nursing staff during that same ED visit were obtained from charts. Based on participant responses to the S2BI, patients were categorized as either “no risk”, “low risk”, “moderate risk”, or “high risk” for having a SUD. These classifications were compared with results of the preexisting SBIRT screening, which classified patients as either “negative/not currently” or “positive” for substance use. Types of substance misuse were compared between the two screening tools. Overall, 93 eligible ED patients were enrolled and completed the preexisting SBIRT screening. The majority were female, self-identified Black, and 22-24 years (63%, 89%, 59%, respectively). On the SBIRT screening, 48 (52%) screened positive for substance misuse including alcohol only (n=17), illicit drug only (n=13), and both (n=18). Of 31 patients who reported illicit drug use, cannabis use only was the leading substance (n=27), followed by cocaine (n=2), cannabis and opioids (n=2). Conversely, S2BI identified an additional 17 (39%) patients as at risk for SUD from the 45 patients who screened “negative/not currently” by SBIRT screening. Of those 17 additional patients, 16 reported using cannabis, 15 consuming alcohol, 5 smoking tobacco, 3 misused prescription drugs, and 1 used illegal drugs. Compared to the result of the SBIRT screening, S2BI identified 37 (77%) of 48 SBIRT-screened positive patients as at risk for SUD; importantly, S2BI captured all four youth who reported cocaine and opioid use, screening out only youth with cannabis or alcohol use. The addition of S2BI to the AUDIT-C and 1-item drug question SBIRT screening showed utility for identifying problematic substance use that would have otherwise been missed by the standard SBIRT screening, though some differences may be related to the different screening modalities (facilitated question vs self-administered). The S2BI may additionally be better able to distinguish between problematic and non-problematic cannabis and alcohol use among AYA of color who screen positive on standard SBIRT screening. Future research should be performed regarding the integration of AYA-specific screening tools to ensure accuracy in screening for SUD among AYA of color in adult ED settings.