Routine opioid use disorder screening fails to significantly increase new diagnosis rates
This may be due to the sensitivity of the screening instrument, compounded by the stigma of opioid use disorder; addressing the latter may increase the instrument's sensitivity, the authors suggest.
Routine screening for opioid use disorder (OUD) in a primary care setting did not significantly boost the rate of new diagnoses, a study found.
Researchers analyzed data from 20 primary care clinics to compare the percentage of patients who were newly diagnosed with OUD before and after implementation of a screening initiative. Screening began during the acute phase of the COVID-19 pandemic using questions from the National Institute on Drug Abuse's modified Alcohol, Smoking and Substance Involvement Screening Test and/or a two-item test developed for the study. Each clinic calculated the number and percentage of their existing patients who were newly diagnosed with OUD in the six months before or after implementation. The results were published Oct. 17 as a brief research report in Annals of Internal Medicine.
Among 167,710 patients with visits during the six-month postscreening period, 1,656 (0.99%) had OUD diagnoses, including 177 (0.11%) with new diagnoses. The median change in patients with a new OUD diagnosis was 0.03% (range, −0.08% to 0.38%). The median pre-post increase in the number of patients with a new OUD diagnosis was 1.5 patients per clinic (range, −4 to 17).
The study authors concluded that the percentage of patients with a new OUD diagnosis “did not increase in a clinically meaningful way after OUD screening in routine care.” Although screening coincided with the COVID-19 pandemic, anecdotal evidence suggests that postpandemic screening was no more effective, they noted.
The small change in the percentage of new OUD diagnoses after starting routine screening may result from multiple factors, including lower true prevalence of OUD in primary care, greater stigma, and greater delays in follow-up diagnostic assessments, the authors wrote. Stigma may decrease the sensitivity of OUD screening because patients may not be comfortable disclosing nonmedical opioid use.
“Although OUD screening is recommended in primary care if effective treatments are available, the resulting number of patients with new OUD diagnoses will depend on a clinic's underlying prevalence of OUD and level of stigma. Addressing stigma may increase the sensitivity of the screening instrument,” the authors wrote. “To address OUD in their communities, clinics may also want to conduct outreach activities and publicize their commitment to accepting new patients seeking care for OUD.”