Clinical Needs of Patients with Problem Drug Use.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
From 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.
Antoinette
A
Krupski
From 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).
Imara I
II
West
From 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).
Meredith C
MC
Graves
From 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).
David C
DC
Atkins
From 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).
Charles
C
Maynard
From 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).
Kristin
K
Bumgardner
From 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).
Dennis
D
Donovan
From 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).
Richard
R
Ries
From 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).
Peter
P
Roy-Byrne
D019033:Delivery of Health Care, Integrated / Q000379:methods*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000379:methods*; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000379:methods*; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000628:therapy; D016896:Treatment Outcome
Comorbidity; Delivery of Health Care; Drug Abuse; Health Care Costs; Integrated; Primary Health Care