142nd APHA Annual Meeting and Exposition

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Prevalence of Illicit Drug Use Among Patients of Community Health Centers (CHCs) in East Los Angeles and Tijuana

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Mani Vahidi , Family Medicine, University of California, Los Angeles, Los Angeles, CA
Lillian Gelberg, MD, MSPH , Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA
Guillermina Natera , Instituto de Psiquiatría, Ramón de la Fuente Muñiz, Mexico City, Mexico
Ronald M. Andersen, PhD , Department of Health Services, UCLA School of Public Health, Los Angeles, CA
Ietza Bojorquez, PhD , Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico
Julia Yacenda , Family Medicine, University of California, Los Angeles, Los Angeles, CA
Miriam Arroyo Belmonte, MSc , Epidemiological and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
Lisa Arangua, MPP , Department of Family Medicine, UCLA, Los Angeles, CA
Mario Gonzalez Zavala, MD , National Commission Against Addictions, Mexico City, Mexico
Nell Baldwin , Department of Family Medicine, UCLA, Los Angeles, CA
Background: 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 goes undiagnosed since there is no standard drug screening protocol in primary care.

Methods: Pre-visit screening of all eligible adult patients in the waiting rooms of CHCs in Los Angeles (LA) and in Tijuana (TJ) was conducted with a computerized, self-administered version of the WHO ASSIST in English and Spanish. Risky drug use was defined as frequent use without the manifestations of dependence (ASSIST 4-26). High risk for dependence was defined as ASSIST 27+.

Results: 5397 patients were found eligible for the screening during the study period (LA 2507, TJ 2890). Of those, 2282 (91%) in LA, and 2808 (97%) in Tijuana, completed the ASSIST. Illicit drug use rates were higher in LA than TJ: lifetime use 45% vs. 15% and past 3 month use 19% vs. 4%. Levels of drug use based on ASSIST scores were: low or no use (ASSIST 0-3) 81% vs 94%; moderate use (ASSIST 4-26) 16% vs 5%) and high risk of dependence for at least one drug (ASSIST 27+) 3% vs 1%).

Conclusions: CHC patients have higher than expected rates of drug use: LA 10% and TJ 6%. Binational-QUIT demonstrates the feasibility of integrating screening for drug use in CHCs of LA and TJ using self-administered touchscreen tablet PCs.

Learning Areas:

Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
Evaluate whether ASSIST screening yields sufficient numbers of risky, untreated drug users to warrant the implementation of a clinic wide physician brief intervention of Quit Using Drugs Intervention Trial (QUIT) based on screening done during the Binational-QUIT.

Keyword(s): Community Health Centers, Drug Abuse Prevention and Safety

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the Fieldwork Director and Data Manager of two federally funded grants focusing on the prevention of drug dependence in primary care clinics. Among my scientific interests has been the development of an effective and efficient protocol that primary care providers can use as they begin offering more integrated and patient­centered care under the Affordable Care Act (ACA).
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4176.0: Screening for Substance Abuse in Medical Settings