Single-question drug screening urged

A single question can help primary care physicians identify patients who misuse drugs, according to a new Archives of Internal Medicine study: "How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?"

Participants, who were age 18 and older, were asked the single screening question. A positive result for drug use was defined as a patient response of at least one time.

Illicit drug use and nonmedical use of prescription drugs are underrecognized, the study said. Lead author Peter Smith, MD, said the new screening test is more efficient than standard multiquestion drug surveys.

Researchers examined the drug use of 286 patients at an outpatient clinic at Boston Medical Center between October 2006 and June 2007 for the study, published in the July 12 Archives of Internal Medicine (link).

Researchers gauged participants' level of drug use and dependence with several multiquestion screening tools, including the 10-item Drug Abuse Screening Test. Participants' oral fluid also was tested for the presence of opiates, benzodiazepines, cocaine, methamphetamines and tetrahydrocannabinol.

Of the 240 who consented to the oral test, 40% either reported that they used drugs (at least once in the past year) or they had a positive test result. Among these patients, 38% had a drug problem or drug disorder.

Researchers said the single-question screen detected 100% of the participants who had a drug use disorder, defined as abuse of or dependence on an illegal substance or prescription drug. The test was slightly less sensitive (92.9%) in identifying those who currently use drugs.

"The [findings] definitely show that universal screening [with the single-question test] in primary care is easy and doable. Whether it should be done for all patients depends on other factors," said Dr. Smith, who also is an instructor of medicine at Boston University School of Medicine and a staff physician at Boston Medical Center.

Dr. Smith encourages physicians who work in communities with a high prevalence of drug use to consider universal screening. He said targeted screening might be more practical in areas where rates are low.

When a patient responds that he or she took drugs in the past year, physicians, or their staffs, can follow up with a more comprehensive survey to determine the extent of the patient's use and what type of treatment is necessary.