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2015 HSR&D/QUERI National Conference Abstract

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1014 — Screen of Drug Use: Diagnostic Accuracy of a New Brief Tool for Primary Care

Tiet QQ, VA Palo Alto Health Care System; Leyva Y, VA Palo Alto Health Care System;

Objectives:
To develop and validate the Screen of Drug Use (SoDU) for VA Primary Care (PC)

Methods:
The Drug Screen for Primary Care Patients study approached 3,173 patients at two PC clinics at a VA health care system from 2012 to 2014. A total of 1,300 (41%) patients consented to the study, of whom 1,283 patients were eligible (mean age = 62.2; SD = 12.6); 10.4% met DSM-IV criteria for a drug use disorder (DUD). The sample was randomly divided to develop the measure (n = 643) and then to validate it (n = 640). The Mini International Neuropsychiatric Interview (MINI) was used as the criterion for DUDs, and the Inventory of Drug Use Consequences was used as the criterion for drug use negative consequences.

Results:
The SoDU has two items: "How many days in the past 12 months have you used drugs other than alcohol?" Patients meet criteria with a response of 7 or more days. The second question asks: "How many days in the past 12 months have you used drugs more than you meant to?" A response of 2 or more days meets criteria. In the validation sample, the SoDU was 92.3% sensitive (95% confidence interval, 83.2%-96.7%) and 92.9% specific (90.5%-94.7%) for DUD; for negative consequences of drug use, it was 83.2% sensitive (75.7%-89.2%) and 96.9% specific (95.0%-98.2%).

Implications:
The SoDU is a suitable screening instrument for both DUD and drug use negative consequences in VA PC. It is clear and brief, consisting of one or potentially two questions. Its sensitivity and specificity are excellent for both criteria, and sustained for diverse patient groups varying on gender, race/ethnicity, marital status, educational level, and PTSD status.

Impacts:
Illicit drug use is prevalent, and PC provides an ideal setting to screen for DUDs and drug-related problems. Comprehensive reviews have concluded that existing drug use screening instruments are not appropriate for routine use in PC. The newly developed SoDU would be a valuable addition to PC screening tools due to its excellent efficiency, and may have significant impact on how drug use is managed in the VA PC.