ObjeCtiveTo study the association between benzodiazepine prescribing patterns including dose, type, and dosing schedule and the risk of death from drug overdose among US veterans receiving opioid analgesics.

BACKGROUND Drug use (illicit drug use and nonmedical use of prescription drugs) is common but under-recognized in primary care settings. We validated a single-question screening test for drug use and drug use disorders in primary care. METHODS Adult patients recruited from primary care waiting rooms were asked the single screening question, “How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?” A response of ≥1 was considered positive. They were also asked the 10-item Drug Abuse Screening Test (DAST). The reference standard was the presence or absence of current (past year) drug use or a drug use disorder (abuse or dependence) as determined by a standardized diagnostic interview. Drug use was also determined by oral fluid testing for common drugs of abuse. RESULTS Of 394 eligible primary care patients, 286 (73%) completed the interview. The single screening question was 100% sensitive (95% CI 90.6% to 100%) and 73.5% specific (95% CI 67.7% to 78.6%) for the detection of a drug use disorder. It was less sensitive for the detection of self-reported current drug use (92.9%, 95% CI 86.1% to 96.5%) and drug use detected by oral fluid testing or self-report (81.8%, 95% CI 72.5% to 88.5%). Test characteristics were similar to that of the DAST, and were affected very little by subject demographic characteristics. CONCLUSIONS The single screening question accurately identified drug use in this sample of primary care patients, supporting the utility of this brief screen in primary care.

BACKGROUNDUnhealthy alcohol use is prevalent but under-diagnosed in primary care settings.OBJECTIVETo validate, in primary care, a single-item screening test for unhealthy alcohol use recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).DESIGNCross-sectional study.PARTICIPANTSAdult English-speaking patients recruited from primary care waiting rooms.MEASUREMENTSParticipants were asked the single screening question, “How many times in the past year have you had X or more drinks in a day?”, where X is 5 for men and 4 for women, and a response of >1 is considered positive. Unhealthy alcohol use was defined as the presence of an alcohol use disorder, as determined by a standardized diagnostic interview, or risky consumption, as determined using a validated 30-day calendar method.MAIN RESULTSOf 394 eligible primary care patients, 286 (73%) completed the interview. The single-question screen was 81.8% sensitive (95% confidence interval (CI) 72.5% to 88.5%) and 79.3% specific (95% CI 73.1% to 84.4%) for the detection of unhealthy alcohol use. It was slightly more sensitive (87.9%, 95% CI 72.7% to 95.2%) but was less specific (66.8%, 95% CI 60.8% to 72.3%) for the detection of a current alcohol use disorder. Test characteristics were similar to that of a commonly used three-item screen, and were affected very little by subject demographic characteristics.CONCLUSIONSThe single screening question recommended by the NIAAA accurately identified unhealthy alcohol use in this sample of primary care patients. These findings support the use of this brief screen in primary care.

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.