Assessment may offer another option for substance abuse screening
A screening tool has high sensitivity and specificity for identifying use of illicit drugs and prescription medications, which might be useful to address an opioid epidemic and high rates of overdose deaths across the U.S.
A brief screening assessment may be able to accurately identify unhealthy substance use in primary care patients and may provide another option for rapid triage, a study found.
The Tobacco, Alcohol, Prescription Medication, and Other Substance use (TAPS) tool is a combined two-part screening and brief assessment. The tool's first-stage screening component, TAPS-1, asks about past 12-month use in four substance categories: tobacco, alcohol, illicit drugs, and nonmedical use of prescription medications. Response options are never, less than monthly, monthly, weekly, and daily or almost daily.
To validate TAPS-1 in primary care patients, 2,000 consecutive adults were approached in the waiting areas of five primary care clinics and invited to complete an anonymous screening for a health study. Participants were paid $20 for completing the assessment, after which they were asked to provide an oral fluid cheek swab specimen for a drug test. Those who provided the specimen were paid an additional $10.
Patients completed the TAPS tool in self- and interviewer-administered formats, in random order. In a secondary analysis, the TAPS-1 was evaluated against DSM-5 substance use disorder criteria to determine optimal cut-points for identifying unhealthy substance use at three severity levels (problem use, mild substance use disorder, and moderate-to-severe substance use disorder).
Results were published online May 26 by the Journal of General Internal Medicine.
Optimal frequency-of-use cut-points on the self-administered TAPS-1 for identifying substance use disorders were at least monthly use for tobacco and alcohol (sensitivity, 0.92 and 0.71; specificity, 0.80 and 0.85; area under the curve, 0.86 and 0.78, respectively) and any reported use for illicit drugs and prescription medication misuse (sensitivity, 0.93 and 0.89; specificity, 0.85 and 0.91; area under the curve, 0.89 and 0.90, respectively).
The performance of the interviewer-administered format was similar. When administered first, the self-administered format yielded higher disclosure rates for past 12-month alcohol use, illicit drug use, and prescription medication misuse. Among those who did not report drug use on the TAPS-1, fewer than 4% had a drug-positive biomarker.
The researchers noted that the screening tool has high sensitivity and specificity for identifying use of illicit drugs and prescription medications, which is particularly important because of the opioid epidemic and high rates of overdose deaths across the U.S.
The authors wrote, “Disclosure of substance use at low levels can identify patients with problem use and [substance use disorders] with a high level of accuracy. No screening tool should be considered an end unto itself, but rather a means to triage patients and inform a more detailed clinical assessment. To that end, the TAPS-1 succeeds.”