February 25th: Drinking in people who also use other illicit drugs causes serious problems. Their doctors and health professionals can ask about alcohol, provide advice or refer the person to a specialist if the problem is too big. We had a look into medical notes of 200 people screened for an alcohol use disorder in a primary care clinic and another 200 people screened in an opioid treatment program over a two year period.
Chart reviews suggested that most people with opioid dependence (95%) seen in a federally qualified health center completed a routine annual alcohol screening; elevated scores in the Alcohol Use Disorders Identification Test were recorded for six people (3% of those screened) and brief interventions were completed with five of those people.
“When you know of … people who are using heroin, there’s a chance they’re using it IV, and if they’re using IV there’s a chance they’re accessing blood …, so if there’s people we have coming with Hep C that have been drinking there’s a whole other level of medical risk associated and it’s hard to stabilize anyone, so people are coming in ill or they have other doctors’ appointments or they’re just not physically able to engage in programs.” Physicians worried about opening up this complex issue and felt the system was not prepared.
The methadone program, in comparison, diagnosed alcohol abuse or dependence at admission in 27% (n = 54) of the patient records reviewed. People treated in the methadone program appeared to have higher rates of serious alcohol use disorders than those who received buprenorphine in the primary care clinic:
“It’s a lot easier to fly under the radar with alcohol than with other drugs.” Focus group participants recognized limitations of screening.
Practitioner focus groups were completed in the with four primary care physicians and eleven counsellors from the opioid treatment program to assess experience with and attitudes towards screening opioid agonist people for alcohol use disorders.
Focus groups suggested organizational, structural, provider, patient and community variables hindered or fostered alcohol screening.
A primary care physician noted, “When people are in the more severe category and you run out of time and you can hand them a list of AA meetings around the town, but it’s just so unlikely that they are going to access it if they haven’t already. That warm hand off process is huge.”
Alcohol screening is feasible among opioid agonist people:
“Having a consistent way that we treat specific conditions, like alcoholism with this background and this level of care would be great. So that we can develop patterns and know how to treat them as they go.”
Effective implementation, however, requires physician training and systematic changes in workflow.
A counselor stated, “Engagement is key; how we treat our patient has a lot to do with what they tell us, so if the people feel not judged, if they feel safe, they’re going to be more likely to engage in the treatment process.”
To read the full article, go to the website of the Journal of Psychoactive Drugs: http://www.tandfonline.com/doi/full/10.1080/02791072.2014.991859#abstract