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Simple drug screening tool proves effective for use in primary care

A new two-item screening tool for illicit drug use was found to be as accurate, if not more accurate, than currently used primary care screening tools, as well as less time consuming, according to recently published data in JAMA Internal Medicine.  

“The [Screen of Drug Use] appears to be a suitable screening instrument for both [illicit drug use disorder] and [negative consequences of drug use] in VA primary care settings. It is clear and brief. Its sensitivity and specificity are excellent for both criteria and sustained for diverse veteran patient groups,” Quyen Q. Tiet, PhD, Center for Innovation to Implementation and the National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, Calif., and colleagues wrote.

To develop the Screen of Drug Use (SoDU), researchers conducted signal detection analyses and examined current screening tools. The SoDU is comprised of two questions: “How many days in the past 12 months have you used drugs other than alcohol?”; and, “How many days in the past 12 months have you used drugs more than you meant to?”

Once developed, the researchers assessed the efficacy of the SoDU for illicit drug use disorder (DUD) and negative consequences of drug use (NCDU) in two primary care clinics at their northern California VA medical center.

In total, 1,283 participants, with a median age of 62.2 years, were included in the study. 

Using the Mini-International Diagnostic Interview as criterion for DUD, results demonstrated that the SoDU was 100% sensitive and 93.73% specific for DUDs.

The Inventory of Drug Consequences was used to determine criterion for NCDU, and results demonstrated that the SoDU was 93.18% sensitive and 96.03% specific for NCDU.

In a second analysis for accuracy, the SoDU showed 92.31% sensitivity and 92.87% specificity for DUD, and 83.17% sensitivity and 96.85% specificity for NCDU.

The researchers noted that not all patients who have NCDU will test positive for DUD, which could mean that individuals who experiment with drugs, but do not meet the DSM criteria for NCDU, may not get the early preventative interventions that could be beneficial to them.

“As a gateway to health care and provider continuity services, primary care is an ideal setting in which to screen for DUD and drug-related problems and to provide brief behavioral therapies and referral to treatment, especially since drug use often goes unrecognized in primary care settings. In the context of increased attention to psychosocial issues in VA primary care venues, it may be time to revisit the value of routinely screening for DUD,” the researchers concluded. – by Casey Hower

Disclosure: The researchers report no relevant financial disclosures.