Two Screening Questions Detect Drug Use Disorders in Primary Care

Screening questionnaires to detect substance use in primary care range from one to dozens of questions. Investigators have now validated a two-item tool* to detect drug use disorders. Of 3173 patients at two US Department of Veterans Affairs primary care sites, 41% agreed to the study and 1283 were enrolled. A diagnostic interview (Mini International Neuropsychiatric Interview) was used as a reference standard for DSM IV drug use disorder (10% met criteria), and the Inventory of Drug Use Consequences questionnaire for consequences (14% had at least one). Analyses were performed on two halves of the sample separately.

• In the replication sample, sensitivity and specificity for disorder (92% and 93%, respectively) and for consequences (83% and 97%, respectively) were high.

Comments:

This study found good diagnostic test characteristics for a two-item drug use disorder screening test. However, the participation rate was low, limiting generalizability, and more importantly, the test was studied to detect only disorders and consequences, and not the full spectrum of unhealthy use (which includes drug use). Therefore, the advantages of the tool over existing validated single-item tools and others that also detect unhealthy alcohol use are unclear. Nonetheless, given that drug use is often unrecognized in primary care settings, having another validated tool could provide—or at least inform—different ways to ask about drug use in primary care settings.

Richard Saitz, MD, MPH

Reference:

Tiet QQ, Leyva YE, Moos RH, et al. Screen of drug use: diagnostic accuracy of a new brief tool for primary care. JAMA Intern Med. 2015;175(8):1371–1377.