title: Pilot Validation of a Brief Screen Tool for Substance Use Detection in Emergency Care.
abstract: BACKGROUND
  Screening and brief intervention for substance use in health care systems is recommended to identify and intervene with patients who abuse alcohol and other substances. However, there is limited research on the utility of short, single-item questions to identify illicit substance users.
  
  
  OBJECTIVE
  Pilot validation of two single-item screening questions to detect illicit substance use, one for marijuana and one for other illicit drugs. The goal was to identify sensitive, time-efficient screening questions that can be easily integrated into busy health care settings.
  
  
  METHODS
  A cross-sectional design was used. At intake, along with questions for tobacco and alcohol, nurses administered two brief screen questions to adult patients seen in designated areas in a large urban medical center. After patients were triaged to rooms, health educators (blind to brief screen responses) administered the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) as the reference standard.
  
  
  RESULTS
  On the ASSIST, 14% and 9% of participants reported risky marijuana and illicit (nonmarijuana) drug use, respectively. Sensitivity values for the marijuana and street drug questions were 72% (95% confidence interval [CI] 67% to 78%) and 40% (95% CI 32% to 48%), respectively. Specificity values for the marijuana and street drug questions were 96% (95% CI 95% to 97%) and 99% (95% CI 98% to 99%), respectively. Values differed minimally as a function of patient characteristics.
  
  
  CONCLUSIONS
  It is important to use validated questions to identify substance misuse so that individuals are not missed in the screening process. It is the possible that administration protocols play a role in detection rates. Future research is needed to identify easy-to-administer drug use screening questions.
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado.
authors.forename: Kerryann B
authors.initials: KB
authors.lastname: Broderick
authors.affiliation: OMNI Institute, 899 Logan St #600, Denver, Colorado 89203.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Richmond
authors.affiliation: OMNI Institute, 899 Logan St #600, Denver, Colorado 89203.
authors.forename: Jesse
authors.initials: J
authors.lastname: Fagan
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado.
authors.forename: Alison Wojciak
authors.initials: AW
authors.lastname: Long
mesh_terms: D003120:Colorado; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009730:Nursing Assessment; D010865:Pilot Projects; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D019966:Substance-Related Disorders / Q000175:diagnosis*; D011795:Surveys and Questionnaires
keywords: SBIRT; brief screen; harm reduction; risky substance use; screening and brief intervention; screening for illicit drug use; universal substance screening