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August 6, 2014

Screening and Brief Intervention and Referral to Treatment for Drug Use in Primary Care: Back to the Drawing Board

Author Affiliations
  • 1Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
  • 2National Institute on Drug Abuse, Rockville, Maryland
JAMA. 2014;312(5):488-489. doi:10.1001/jama.2014.7863

The use of drugs other than alcohol is a leading cause of fatal injury in the United States, accounting for more than 40 000 deaths per year.1 Increases in the rate of drug-attributable deaths over the past 2 decades have been fueled by overdoses of illicitly used prescription drugs (such as opioids and sedatives, sometimes in combination with alcohol). In 2011, an estimated 1 280 134 hospitalizations were related to drug overdoses nationwide, of which 1 021 563 (80%) involved drugs only and 258 571 (20%) involved drugs in combination with alcohol.2 National roadside research surveys have detected more drivers on roads after using drugs than alcohol,3 and several meta-analyses indicate that fatal traffic crash risks of drivers who have simultaneously used drugs and alcohol exceed the fatal crash risk of driving after either alone.4,5 In addition, marijuana use has increased in the past decade,6,7 perhaps accelerated by legalization of medical marijuana in 22 states and Washington, DC, and legalization of recreational use by Colorado and Washington State. These public health trends underscore the need for continuing research to develop effective interventions for unhealthy drug use, and the emphasis on primary care in health care system reforms suggests that approaches to identify and effectively intervene with patients exhibiting risky patterns of drug use should be evaluated in a variety of clinical settings.