Early Addiction Care Pathway After Acute Drug Intoxication in Emergency Departments (IPAIS)

実験的：Structured early addiction care

Participants randomized to the experimental arm receive a structured, protocol-based early addiction care pathway initiated during hospitalization for acute intoxication. The intervention includes a standardized addiction assessment, scheduled addiction follow-up visits (1-2 contacts per month) over a 6-month period, structured harm reduction evaluation, and systematic feedback of biological toxicology results, including hair analysis, at predefined timepoints (Month 1, Month 3, Month 4, and Month 6). Follow-up contacts may include in-person consultations and protocolized telephone interviews delivered by addiction specialists or trained psychologists.

行動：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.

他の：Not structured early addiction care

Participants randomized to the control group receive addiction follow-up with randomized interviews and/or workshops, at least once a month, for a duration of 6 months or as requested by the patient, and harm reduction assessments at months 1, 3, 4, and 6, disregarding toxicology results. Follow-up contacts may include in-person consultations and structured telephone interviews conducted by trained substance abusers or psychologists.

行動：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.

Retention in addiction care at 6 months

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.

Rate of recurrent acute intoxication episodes.

Proportion of randomized participants experiencing at least one new episode of acute intoxication requiring emergency department visit or hospitalization within 3 months and within 6 months after randomization. A recurrent acute intoxication episode is defined as a documented presentation to an emergency department or hospital admission for acute poisoning related to new psychoactive substances (NPS) or other psychoactive drugs occurring after the index episode that led to study inclusion. Data will be collected through hospital medical records review and structured follow-up interviews. Separate proportions will be calculated at 3 months and 6 months.

Change in Anxiety and depression score

Assenssment of Anxiety and depression using the HADS scale : Hospital Anxiety and Depression Scale, between baseline and 6 months.

Anxiety subscale from 0 to 21 Depression subscale from 0 to 21 A higher score indicates a more severe condition (worse result).

Change in health-related quality score

Assenssment of health-related quality usign the Short Form-36 (SF-36), between baseline and 6 months. SF-36 ranging from 0 to 100. A higher score indicates a better quality of life (better outcome)

Change in severity of sleep disorders score

Assessment of sleep disorders usign the Insomnia Severity Index scale (ISI) between baseline and 6 months, rangin from 0 to 28. A higher score indicates more severe insomnia.

Change in Need for thrills score

Assenssment of the need for thrills using the Sensation Seeking Scale (SSS),between baseline and 6 months, raging from 0 to 40 (for the short version).

A higher score indicates a more pronounced need for sensation.

Change in drug use practices : weekly Number of Drug Use Sessions

Evolution of individual weekly number of substance use sessions (sessions/week) - all substances combined or by substance, as reported by the participant -, between baseline and 6 months (at M1, M3, M4, and M6), using the CANDITOX questionnaire (Assessment of the infectious risks related to intravenous drug use) -not validated, but routinely used in clinical practice for evaluating patients with injection drug use -, administered at baseline (by day 7 at the latest). A decrease in the number of sessions may indicate an improvement.

Analyses will focus on within-participant change between baseline and Month 6, with intermediate assessments used to describe trajectories over follow-up.

Change in drug use practices : daily quantity consumed

Evolution in Daily Quantity of Drug Consumed (grams/day), between baseline and 6 months (at M1, M3, M4, and M6), using the CANDITOX questionnaire (Assessment of the infectious risks related to intravenous drug use) -not validated, but routinely used in clinical practice for evaluating patients with injection drug use -, administered at baseline (by day 7 at the latest). A decrease in the number of sessions may indicate an improvement.

Analyses will focus on within-participant change between baseline and Month 6, with intermediate assessments used to describe trajectories over follow-up.

Change in the frequency and/or occurrence of drug-related complications

Evolution of associated complications associated with drug use between baseline and 6 months (at M1, M3, M4, and M6), using the CANDITOX questionnaire ((Assessment of the infectious risks related to intravenous drug use) -not validated, but routinely used in clinical practice for evaluating patients with injection drug use -, administered at baseline (by day 7 at the latest).

A decrease in the total number of complications indicates an improvement.

Change in harm reduction knowledge and implementation score

Assessment of participants' knowledge and implementation of harm reduction strategies related to psychoactive substance use. Knowledge will be evaluated using a structured harm reduction questionnaire.

The primary metric will be the change in total knowledge score over time. Secondary analyses will assess the proportion of participants reporting implementation of harm reduction practices between assessments.

Number of Declarations Submitted to the Regional Health Agency (ARS)

Number of formal notifications and toxicological reports related to newly identified or atypical psychoactive substances generated by the study team during the 6-month study period.

Notifications are based on biological samples (urine, blood, hair) and/or powder analyses collected during the study and reported using the SINTES questionnaire framework.

The outcome will be reported as a cumulative count over the 6-month follow-up period.

Number of Addiction-Vigilance Notifications Transmitted to the French Addictovigilance Network (CEIP)

Number of Addiction-Vigilance Notifications Transmitted to the French Addictovigilance generated by the study team during the 6-month study period.

Notifications are based on biological samples (urine, blood, hair) and/or powder analyses collected during the study and reported using the SINTES questionnaire framework.

The outcome will be reported as a cumulative count over the 6-month follow-up period.

Number of Analytical Results Transmitted to the OFDT

Number of Analytical Results Transmitted to the French Monitoring Centre for Drugs and Drug Addiction (OFDT) specifically within the TREND-SINTES surveillance system (Île-de-France).

Notifications are based on biological samples (urine, blood, hair) and/or powder analyses collected during the study and reported using the SINTES questionnaire framework.

The outcome will be reported as a cumulative count over the 6-month follow-up period.