Rates of and Factors Associated With Patient-reported Illicit Drug Use Screening by Health Care Professionals in the United States From 2013 to 2015

Low-Burden Universal Substance Use Screening in a Primary Care Clinic to Lower Implementation Barriers

Universal substance use screening in primary care can proactively identify patients for intervention, though implementation is challenging. This project developed a strategy for universal low time- and labor-cost screening, brief intervention, and referral for treatment (SBIRT) in an HIV primary care clinic at an academic medical center in the Southeastern USA. Screening was implemented using a tablet computer that calculated results in real time and suggested motivational language for provider response. A brief intervention (BNI) was conducted by a trained professional as needed, preventing the need for all clinic providers to be competent in motivational interviewing (MI). More than 1868 patients were screened in 12 months, with an MI intervention conducted for 101 patients with higher risk use. Forty-four patients were referred for in-clinic treatment, compared to nine in the previous year. Computer-based, self-administered screening with real-time linkage to a BNI can allow recommended screening with low provider burden.

Associations of cannabis use frequency and cannabis use disorder with receiving a substance use screen and healthcare professional discussion of substance use

BACKGROUND AND OBJECTIVES

Screening, brief intervention, and referral to treatment (SBIRT) can reduce substance use, but receipt of these services by those who use cannabis frequently and have cannabis use disorder (CUD) remains unexplored. We examined cannabis use frequency and CUD's associations with the odds of receiving a substance use screening and a healthcare professional discussion among those who used healthcare services.

METHODS

Data came from the 2015-2019 National Survey on Drug Use and Health (N = 214,505 aged 18+). Among adults who used cannabis and attended healthcare settings in the past year (N = 36,374), multivariable logistic regression analysis was used to examine associations of cannabis use frequency and CUD with receiving a substance use screen and substance use discussion by a healthcare professional.

RESULTS

Cannabis use frequency was associated with higher odds of receiving a screen (adjusted odds ratio [AOR] = 1.27, 95% confidence interval [CI] = 1.14-1.41 for 300+ days of use) and a discussion among those screened (AOR = 1.83, 95% CI = 1.60-2.09 for 300+ days of use). CUD was not associated with receiving a screen, but it was positively associated with receiving a discussion among those screened (AOR = 1.22, 95% CI = 1.08-1.39). Nonmedical users were less likely to have a discussion among those screened and not screened.

DISCUSSION AND CONCLUSIONS

Findings indicate disparities in screening and discussion of substance use with patients, especially between medical and nonmedical users.

SCIENTIFIC SIGNIFICANCE

Study findings provide novel insight into differences in the reach of SBIRT services among adult cannabis users.

Discussing Drug Use With Health Care Providers Is Associated With Perceived Need and Receipt of Drug Treatment Among Adults in the United States: We Need to Talk

BACKGROUND

Drug treatment utilization is low despite a high public health burden of drug use disorders (DUDs). Engaging people at risk for DUDs across a broader range of health care settings may improve uptake of drug treatment.

OBJECTIVES

To estimate the prevalence of drug use screening/discussions between health care providers and individuals with past-year drug use, and to assess the associations between drug use screening/discussions and perceived need and use of drug treatment.

METHODS

We analyzed representative cross-sectional data from the 2015 to 2017 National Surveys on Drug Use and Health. The sample included adults aged 18 years and above reporting past-year drug use and ≥1 health care visit. We measured correlates of drug use screening/discussions using multinomial logistic regression. Overall and among adults meeting DUD criteria, we used logistic regression to estimate associations between drug use screening/discussions and (1) past-year drug treatment and (2) perceived need for treatment.

RESULTS

In the full sample (n=21,505), 34.50% reported no screening/discussions, 44.50% reported screening only, and 21.00% reported discussions with providers. Discussions were associated with significantly higher odds of receiving any drug treatment [adjusted odds ratio (aOR)=3.52 (2.66-4.65)], specialty drug treatment [aOR=4.13 (2.92-5.82)], and perceived treatment need [aOR=2.08 (1.21-3.59)]. Among people with DUD (n=3,834; 15.69%), discussions were associated with treatment use, but not with perceived need.

CONCLUSIONS

Discussing drug use with providers may impact people's perceptions of drug treatment need and use, indicating potential opportunities to engage people in addiction treatment. Addressing barriers to discussing drug use across care settings could increase treatment use, particularly among people with DUD.