Recognizing illicit drug use in your patients

In 2006, 20.4 million Americans aged 12 years or older reported illicit drug use in the previous month. The drugs ranged from marijuana (14.8 million users), pain relievers, cocaine, hallucinogens, and methamphetamine to heroin (338,000 users).1 Nearly 4 million people met the criteria for dependence or abuse set forth in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition; fewer than one in four received treatment. The Clinical Advisor asked two specialists in substance dependence and abuse screening—Vicki Waters, MS, PA-C, assistant professor and assistant director for experiential learning in the physician assistant program at Baylor College of Medicine in Houston, and Kathleen L. Becker, MS, RN, CRNP, assistant professor and coordinator in the adult nurse practitioner program at Johns Hopkins University School of Nursing in Baltimore—for advice on how to identify and help these patients.

Q: Do primary-care practitioners (PCPs) routinely ask their patients about drug use?
Ms. Waters:
Often they do not, or they ask about it incorrectly. Research shows that health-care providers frequently lack the knowledge and skills to diagnose substance use disorder (SUD) with the same accuracy as they do other preventable illnesses. PCPs are often unprepared to treat the patient with a drug-related disorder because they feel less than competent in their ability to manage the disorder, dislike working with SUD patients, and consider the diagnosis of SUD peripheral to medical matters.2 The result is the underrecognition of SUD.
Ms. Becker: Patients should be universally screened for SUD. Early identification of those with risky or dependent behaviors often provides the PCP with a teachable moment to intervene and work with the patient to change his or her behavior.

Q: What is the profile of the patient who uses drugs?
Ms. Waters:
There is no profile. Drug use extends across genders and all ages, ethnicities, and socioeconomic groups. Some drugs may have a particular user profile at a particular time in a particular region, but these change.
Ms. Becker: Adolescent drug use dropped from 11.6% in 2002 to 9.8% in 2006. However, drug use in adults aged 50-54 years (the baby boomers) rose from 3.9% in 2003 to 6% in 2006.1 Providers need to screen this population more carefully. Others who warrant close screening include tobacco and alcohol users; people with mental health problems; and individuals with repeat emergency department visits attributable to trauma, falls, collapse, head injury, assault, nonspecific GI symptoms, psychological symptoms, and just feeling unwell.

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