Screening and Treatment for Alcohol, Tobacco and Opioid Use Disorders: A Survey of Family Physicians across Ontario

Abstract

IntroductionAs a primary point of contact within the health care system, family physicians are able to play a vital role in identifying individuals with substance use disorders and connecting them to the appropriate treatment. However, there is very little data available on whether family physicians are actively screening for and treating substance use disorders. The objective of the current survey was to assess whether family physicians in Ontario are screening for alcohol, opioid and tobacco use disorders, using validated tools and providing treatment.MethodsAn online survey consisting of a series of 38 primarily close-ended questions was circulated to family physicians in Ontario. Rates of screening for alcohol, opioid and tobacco dependence, use of validated tools for screening, providing treatment for dependent individuals and the current barriers to the prescription of pharmacotherapies for these drug dependences were assessed.ResultsThe use of validated screening tools was limited for all three substances. Screening by family physicians for the substance use disorders among adolescents was much lower than screening among adults. Pharmacotherapy was more commonly used as an intervention for tobacco dependence than for alcohol and opioid dependence. This was explained by the lack of knowledge among family physicians on the pharmacotherapies for alcohol and opioid dependence.ConclusionsFindings from the current study suggest there is a need for family physicians to integrate screening for substance use disorders using validated tools into their standard medical practice. Furthermore, there is a need for increased knowledge on pharmacotherapies for alcohol and opioid use disorders. It is important to note that the low response rate is a major limitation to this study. One possible reason for this low response rate may be a lack of interest and awareness among family physicians on the importance of screening and treatment of substance use disorders in Ontario.

Multicomorbidity of chronic diseases and substance use disorders and their association with hospitalization: Results from electronic health records data

“…Team-based chronic care approaches have been advocated to improve health care and outcomes for SUDs (McLellan et al, 2014). However, providers in general medical settings generally have inadequate support or training to provide alcohol/drug use disorder treatment, or are uncomfortable or unwilling to do so (CASA Columbia, 2000; Loheswaran et al, 2015; Wakeman et al, 2016). We found that at least one-fifth of patients with ≥1 chronic condition had at least one SUD recorded in their EHR data, and SUD (tobacco, alcohol, and drug use disorders) was particularly prevalent among those with hepatitis, COPD, ischemic heart disease, or chronic kidney disease.…”

DSM-5 substance use disorders among adult primary care patients: Results from a multisite study

“…To improve integration of SUD assessment and treatment into primary care, research is needed to inform primary care physicians’ willingness to use validated tools for screening substance misuse, identify effective approaches for addressing SUDs in medical settings, and engage patients into SUD treatment (Kim et al, 2016; Loheswaran et al, 2015; Saitz et al, 2014). …”

What does it mean when people say that they have received expressions of concern about their drinking or advice to cut down on the AUDIT scale?

“…For health professionals, this lack of difference between risk groups could reflect that all at risk and high risk drinkers deserve intervention. However, it is also notable that the majority of participants did not report receiving expressions of concern about their drinking from a health professional, even among the high risk group [ 15 , 16 ].…”