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Article Title

Single-Item Screens for Prescription and Illicit Drug Misuse Largely Identifies Primary Care Patients With Unrecognized Drug Use

Publication Date

4-30-2015

Keywords

drug misuse, preventive screening

Abstract

Background/Aims: The U.S. Preventive Services Task Force recommends depression and alcohol screening as part of routine primary care, but not drug screening because brief primary care counseling about drug use does not improved outcomes. However, drug screening might be helpful if it led to identification and treatment of patients with unrecognized substance use disorders. The objective was to describe the prevalence of positive drug and marijuana screens in a primary care population and whether patients who screened positive had previously recognized substance use disorders.

Methods: We conducted a 3-week feasibility test of universal depression and alcohol misuse screening in one primary care clinic as a prelude to behavioral health integration. Providers asked that we also screen for illicit drug and marijuana use (the latter was legal in Washington state). A total of 409 (61%) of 667 patients who were seen in the primary care clinic for a 3-week period completed a one-page behavioral health questionnaire that included brief depression (PHQ-2), alcohol misuse (AUDIT-C), drug (validated single-item) and marijuana screens. The latter was adapted from the single-item drug screen.

Results: Of 409 patients who completed screening (68% women; 10%, 17%, 43% and 31% age <30, 30–44, 45–64 and ≥65 years, respectively), 4% screened positive for past-year prescription or illicit drug use, 13% reported marijuana past-year use (3% daily or almost) and 16% screened positive for alcohol misuse. Among the 16 patients who screened positive for drug misuse, 4 (25%) reported daily drug misuse, and 7 (44%) screened positive for alcohol misuse. Only 1 (6%) of the 16 patients who screened positive for drug misuse had a prior diagnosis of a substance use disorders (but not in the past year). However, 38% had been prescribed opioids and 13% benzodiazepines in the past year (38% either). Providers found drug screening valuable as they had been previously unaware of most patients’ drug use.

Discussion: Most patients who screened positive for illicit or prescription drug misuse did not have recognized substance use disorders. Findings suggest that routine screening with single-item drug and marijuana screens provide important clinical information for primary care teams.

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