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One question identifies drug abusers in primary care setting

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – According to a new report, primary care patients who may have a drug use disorder can be reliably identified with a single-question screening test: “How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?”

Writing in the July 12 issue of the Archive of Internal Medicine, Dr. Peter C. Smith and colleagues at Boston University School of Medicine and Boston University School of Public Health note that illicit drug use and nonmedical use of prescription drugs is common in primary care but often goes unrecognized. Since a single-question test is useful for detecting unhealthy alcohol use, they tested the same approach for screening for drug use.

More than 1700 patients waiting to be seen in an urban hospital-based clinic were approached to participate in the team’s study, and just under 400 were found eligible; 303 consented and 286 completed an interview. They were then asked to undergo oral fluid testing for common drugs of abuse, and 240 did so.

“Following the single drug screening question, but before the other assessments, the 10-item Drug Abuse Screening Test (DAST-10) was administered for comparison,” the authors explain. The participants were also assessed for current drug use disorder using the Composite International Diagnostic Interview.

Dr. Smith and colleagues found that for detection of current drug use disorder, the single screening question was 100% sensitive and 73.5% specific. This was similar to results obtained with DAST-10.

“If oral fluid test results were taken into account, the sensitivity for detecting current drug use was lower (84.7%),” the investigators report.

They conclude that the findings “support the use of this brief screen when identification of drug use is desired in primary care settings, which should, in turn, facilitate the implementation of screening and brief intervention programs in this setting.”


Arch Intern Med 2010;170:1155-1160.