Screening patients in clinical settings can be a first step towards reducing unhealthy alcohol consumption. While there has been some interest in screening for unhealthy drug use, implementation in practice has been slow. Now, a new study co-authored by a Boston University School of Public Health (BUSPH) researcher has found that screening for unhealthy drug use can be rapidly implemented in some primary care settings.
The study, published in Substance Abuse, analyzed the electronic records of the VHA Medical Center in Bedford, Massachusetts, which in 2013 began piloting screening for drug use, requiring that clinicians in its primary care and outpatient mental health services complete an annual brief screening of all patients. The researchers found that, during the first year of implementation, 70 percent and 84 percent of patients were screened for unhealthy drug use and unhealthy alcohol consumption, respectively. Among those screened for drug use, a prior diagnosis of a drug use disorder was the strongest predictor of a positive screen.
“We found that drug use in primary care patients, while not common, can easily be screened for as long as the test is brief, though we also found that those who are most likely to be using drugs are not being tested,” says senior author Dr. Richard Saitz, professor of community health sciences at BUSPH. “We need to make it easier for clinicians to check for drug use just like they always check for allergies and ask about medications, including over-the-counter and complementary therapies.”
Overall, the screening level was not universal, which had been the goal. However, the authors argued that the results show that, in a clinical setting that has an electronic record and is prepared to improve care quality, very brief services such as a single-question screening test can be rapidly implemented.
“Screening in and of itself is not likely to change drug use, but it is useful to know if a patient is using drugs for safer prescribing, diagnosis, and treatment of just about any symptom and of illnesses,” Dr. Saitz says. “Further, it can help start a conversation that may lead to changes in drug use over time, and it lets the patient know that the doctor is interested in helping or considers it a health issue, so that the patient can reach out later if they wish.”