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Comment & Response
December 2015

Appropriate Screening for Substance Use vs Disorder

Author Affiliations
  • 1Department of Population Health, New York University School of Medicine, New York, New York
  • 2Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
  • 3Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
JAMA Intern Med. 2015;175(12):1997-1998. doi:10.1001/jamainternmed.2015.6517

To the Editor We appreciated the rigorous validation study of a new drug screening instrument by Tiet et al.1 However, the Screen of Drug Use (SoDU) may not be the appropriate tool for primary care. The SoDU performed well for detection of drug use disorders (Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition, Text Revision] abuse or dependence) and negative consequences of drug use. Yet primary care clinicians need to also be concerned with drug use that does not rise to this level of severity but still poses significant health risks. These risks include drug-medication interactions, overdose, drug use–associated risk behavior (eg, driving under the influence, sexual exposures), and progression to more frequent use. Furthermore, knowing about drug use is critical for proper diagnosis and management of myriad symptoms common in primary care settings (ie, chronic pain, anxiety, insomnia, and hypertension) that may occur even with occasional use.

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