OPQRST(U): Integrating substance use disorders or “Use” into the medical history

Abstract

Substance use disorders (SUDs) are pervasive in the United States, with 20.1 million cases in 2016, of which only 19% receive treatment. SUDs permeate all medical specialties and should be considered in the differential diagnosis of every chief complaint. Acknowledging the salience of SUDs provides a unique opportunity for early identification and intervention. Thus, SUDs should be reflected prominently in the history of the present illness rather than in the social history. To this effect, we propose the inclusion of Use (U) in the history of present illness and incorporating “U” into the pedagogical mnemonic of OPQRST that is commonly used in medical training. Obtaining this history will help determine if and which abused substances may be contributing to the chief complaint. We also suggest the incorporation of an additional acronym, SORTED, to account for the various domains of Use, including Street (illicit drugs), OTCs (over-the-counter medications), Rx (prescriptions, including nonmedicinal use of pharmaceutical drugs), Tobacco (including e-cigarettes), EtOH (alcohol), and Dietary (caffeine, vitamins, and herbal supplements) agents. We discuss how utilizing OPQRSTU will help reshape the way medical students think about SUDs and will facilitate detection and diagnosis of all domains of SUDs.

Keywords:

• Substance use disorder
• medical education
• history of present illness
• social history

Acknowledgements

We thank Gail Basch, MD, for her helpful discussions on this topic. We also thank Corinne Miller, MLIS, for the invaluable assistance in procuring relevant literature citations.

Disclosures statement

Dr. T. Celeste Napier serves as a scientific advisor/board member for the Robert Crown Center for Health Education, Hinsdale, Illinois, the Epworth Village Foundation, York, Nebraska, the Ponce Research Institute, Ponce, Puerto Rico, and the Society for NeuroImmune Pharmacology.

Funding

Dr. T. Celeste Napier receives funding from the National Institutes of Health for biomedical research. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author contributions

Mr. Eloge assisted with literature review and preparation of the manuscript. Dr. Napier assisted with preparation of the manuscript. Dr. Dantz assisted with preparation of the manuscript.