Schedule:
Tuesday, May 26, 2015
Columbia A/B (Hyatt Regency Washington)
* noted as presenting author
Melvin Rico, BS, Research Coordinator, University of California, Los Angeles, Los Angeles, CA
Mani Vahidi, BS, Fieldwork Director, University of California, Los Angeles, Los Angeles, CA
Ietza Bojorquez, PhD, Professor, El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico
Miriam Arroyo, MSc, Research assistant, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
Ronald M. Andersen, PhD, Wasserman Professor Emeritus, University of California, Los Angeles, Los Angeles, CA
Julia Yacenda-Murphy, BA, Project Manager, University of California, Los Angeles, Los Angeles, CA
Guillermina Natera, MSc, Director of Epidemiological and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
Mario González, Dr, Assistant Director of Intersectoral Operations in Public Health, National Commission Against Addictions, Mexico City, Mexico
Introduction: Illicit drug use has physical and psychological consequences; it can exacerbate pre-existing conditions or become the catalyst for other chronic communicable conditions. As a result, drug users might seek care within primary care settings to address these health concerns, yet their drug use often goes undiagnosed since there is no standard drug screening protocol in primary care. Using a self-administered touchscreen Tablet PC version of the WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), we obtained rates of drug use in primary care clinic patients during the
Quit
Using
Drugs
Intervention
Trial (Binational-QUIT). We also evaluate whether the WHO ASSIST screening yields sufficient numbers of risky, untreated drug users to warrant the implementation of a clinic wide physician brief intervention of QUIT in Los Angeles and Tijuana.
Methods: Pre-visit screening of all eligible low-income adult patients (ages 18 and older) in 2 community health centers (CHCs) in East Los Angeles (LA) and 6 CHCs in Tijuana, Mexico (MX) was conducted with a self-administered version of the WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) using a touchscreen Tablet PC in English and Spanish. “Risky” drug use was defined as casual, frequent, or binge use without the manifestations of dependence (ASSIST 4-26). High risk for dependence was defined by an ASSIST score of 27+.
Results: 5397 patients were found eligible for the screening during the study period (LA 2507, MX 2890). Of those, 2282 (91%) in LA, and 2808 (97%) in Tijuana, completed the ASSIST questionnaire. Illicit drug use rates were higher in LA compared to MX patients: lifetime use 45% vs. 15% and past 3 month use 19% vs. 4%. Levels of drug use based on ASSIST scores were also higher in LA than MX: low or no use (ASSIST 0-3) 81% vs 94%, moderate use of at least one drug (ASSIST 4-26) 16% vs 5%, and high use of at least one drug, indicating possible dependence (ASSIST 27+) 3% vs. 1%. The most commonly used illicit drugs in both countries were marijuana and stimulants (cocaine and methamphetamine / amphetamines type stimulants).
Conclusions: The Binational-QUIT study demonstrates the feasibility of integrating screening for drug use in CHCs of LA and Tijuana using self-administered touchscreen tablet PCs. Drug misuse rates among patients of CHCs are higher than expected from household: in LA 10% and MX 6%. Our data suggest the imperative to conduct broad screening of all patients for drug use in CHCs in both Los Angeles and Tijuana.
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