Illicit drug use is a serious public health problem
associated with significant co-occurring medical disorders, mental disorders,
and social problems. Yet most individuals with drug use disorders have never been
treated, though they often seek medical treatment in primary care. The purpose
of this study was to examine the baseline characteristics of people presenting
in primary care with a range of problem drug use severity to identify their
clinical needs.
We examined sociodemographic characteristics, medical and
psychiatric comorbidities, drug use severity, social and legal problems, and
service utilization for 868 patients with drug problems. These patients were
recruited from primary care clinics in a medical safety net setting. Based on
Drug Abuse Screening Test results, individuals were categorized as having low,
intermediate, or substantial/severe drug use severity.
Patients with substantial/severe drug use severity had
serious drug use (opiates, stimulants, sedatives, intravenous drugs); high
levels of homelessness (50%), psychiatric comorbidity (69%), and arrests for
serious crimes (24%); and frequent use of expensive emergency department and
inpatient hospitals. Patients with low drug use severity were primarily users
of marijuana, with little reported use of other drugs, less psychiatric
comorbidity, and more stable lifestyles. Patients with intermediate drug use
severity fell in between the substantial/severe and low drug use severity
subgroups on most variables.
Patients with the highest drug use severity are likely to
require specialized psychiatric and substance abuse care, in addition to
ongoing medical care that is equipped to address the consequences of
severe/substantial drug use, including intravenous drug use. Because of their
milder symptoms, patients with low drug use severity may benefit from a
collaborative care model that integrates psychiatric and substance abuse care
in the primary care setting. Patients with intermediate drug use severity may
benefit from selective application of interventions suggested for patients with
the highest and lowest drug use severity. Primary care safety net clinics are
in a key position to serve patients with problem drug use by developing a range
of responses that are locally effective and that may also inform national
efforts to establish patient-centered medical homes and to implement the
Affordable Care Act.
Full article at:
By:
- 1From the Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington at Harborview Medical Center, Seattle (AK, IIW, MCG, DCA, KB, DD, RR, PR-B); the Department of Health Services, University of Washington School of Public Health, Seattle (CM); and the Alcohol & Drug Abuse Institute, University of Washington, Seattle (DD). krupski@uw.edu.
- 2From the Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington at Harborview Medical Center, Seattle (AK, IIW, MCG, DCA, KB, DD, RR, PR-B); the Department of Health Services, University of Washington School of Public Health, Seattle (CM); and the Alcohol & Drug Abuse Institute, University of Washington, Seattle (DD).
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