New drug use screening tools for physicians

Apr 20 2009

The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, today unveiled its first comprehensive Physicians' Outreach Initiative, NIDAMED, which gives medical professionals tools and resources to screen their patients for tobacco, alcohol, illicit, and nonmedical prescription drug use.

The NIDAMED resources include an online screening tool, a companion quick reference guide, and a comprehensive resource guide for clinicians. The initiative stresses the importance of the patient-doctor relationship in identifying unhealthy behaviors before they evolve into life threatening conditions.

The NIDAMED tools - targeting primary care clinicians - were launched at a news conference at the National Press Club that featured NIDA Director Dr. Nora D. Volkow, Acting Director of the Office of National Drug Control Policy Ed Jurith, J.D., Sen. Carl Levin of Michigan, Acting Surgeon General Steven K. Galson, M.D., and representatives from the World Health Organization, the American Medical Association, and other organizations committed to helping patients who struggle with drug-related medical issues.

"Many patients do not discuss their drug use with their physicians, and do not receive treatment even when their drug abuse escalates," said Dr. Volkow. "NIDAMED enables physicians to be the first line of defense against substance abuse and addiction and to increase awareness of the impact of substance use on a patient's overall health."

In 2007, an estimated 19.9 million Americans aged 12 or older (around 8 percent of the population) were current (past month) users of illegal drugs - nearly 1 in 5 of those 18 to 25 years old - and many more are current tobacco or binge alcohol users. The consequences of this drug use can be far-reaching - playing a role in the cause and progression of many medical disorders, including addiction. Yet only a fraction of people who need addiction treatment receive it.

"I have long worked with NIDA to increase access to effective treatment in the battle against addiction," said Sen. Levin. "By encouraging physicians to consult with, screen and refer their patients who are in need of treatment, the NIDAMED initiative is a critical step towards achieving that goal. We must find ways to disseminate these important clinical tools, that can aid in mending lives and families, once torn asunder due to the scourge of addiction."

The NIDAMED tools were developed because doctors are in a unique position to discuss drug-taking behaviors with their patients before they lead to serious medical problems. Research shows that screening, brief intervention, and referral to treatment by clinicians in general medical settings, can promote significant reductions in alcohol and tobacco use.

A growing body of literature also suggests potential reductions in illegal and nonmedical prescription drug use. Yet many primary care physicians express concern that they do not have the experience or diagnostic tools to identify drug use in their patients.

"Not only will these tools potentially help clinicians identify the use of drugs such as cocaine and heroin, they can also identify patients who are misusing prescription medications," said Dr. Galson, a rear admiral in the U.S. Public Health Service. "In 2007, 16.3 million Americans age 12 and older had taken a prescription pain reliever, tranquilizer, stimulant, or sedative for nonmedical purposes at least once in the past year - behaviors that can lead to serious health problems, including addiction."

"My doctor literally saved my life," said Mink Rockmoore, a former Boston-area radio announcer who is a recovering heroin addict. "He worked hard to build my trust; he listened to my fears in a non-judgmental way; and he arranged for me to get both detox and treatment."

NIDAMED's screening tool was adapted from the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), developed, validated, and published by the World Health Organization (WHO) as an effective screening tool for identifying substance use. NIDA-modified ASSIST tools are specifically designed to fit into today's busy clinical practices. Doctors can access the new tools at www.drugabuse.gov by clicking on the NIDAMED icon.

The online screening tool is an interactive Web site that guides clinicians through a short series of questions and, based on the patient's responses, generates a substance involvement score that suggests the level of intervention needed. A physician can use this interactive tool during routine office visits. NIDAMED also includes an online resource guide with detailed instructions on how to implement the screening tool, discuss screening results, offer a brief intervention and make necessary referrals. In addition, a quick reference guide has been developed to serve as a prompt to medical professionals to initiate screening. This abbreviated guide provides a snapshot of the NIDA-modified ASSIST, briefly summarizing the questions, scoring and next steps.

Also included in the NIDAMED physician toolkit is a patient-tested postcard that encourages patients to "Tell Your Doctors About All the Drugs You Use" and offers Web links for further information. Doctors are encouraged to put the cards in their waiting rooms to be read by patients before their appointments.

NIDAMED was unveiled in conjunction with NIDA's recently updated Principles of Drug Abuse Treatment: A Research Based Guide. This publication summarizes the 13 evidence-based principles of effective treatment, answers common questions, and describes types of treatment, providing examples of scientifically based and tested treatment components. The principles are based on three decades of scientific research and clinical practice that have yielded a variety of effective approaches to drug addiction treatment.

More information on all NIDAMED products and the Principles of Drug Abuse Treatment: A Research Based Guide can be found at www.drugabuse.gov.

The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world's research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at www.drugabuse.gov. To order publications in English or Spanish, call NIDA's new DrugPubs research dissemination center at 1-877-NIDA-NIH or 240-645-0228 (TDD) or fax or email requests to 240-645-0227 or [email protected]. Online ordering is available at http://drugpubs.drugabuse.gov.

The National Institutes of Health (NIH) - The Nation's Medical Research Agency - includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.