Alcohol Screening among Opioid Agonist Patients in a Primary Care Clinic and an Opioid Treatment Program

Abstract

Problem alcohol use is associated with adverse health and economic outcomes, especially among people in opioid agonist treatment. Screening, brief intervention, and referral to treatment (SBIRT) are effective in reducing alcohol use; however, issues involved in SBIRT implementation among opioid agonist patients are unknown. To assess identification and treatment of alcohol use disorders, we reviewed clinical records of opioid agonist patients screened for an alcohol use disorder in a primary care clinic (n = 208) and in an opioid treatment program (n = 204) over a two-year period. In the primary care clinic, 193 (93%) buprenorphine patients completed an annual alcohol screening and six (3%) had elevated AUDIT scores. In the opioid treatment program, an alcohol abuse or dependence diagnosis was recorded for 54 (27%) methadone patients. Practitioner focus groups were completed in the primary care (n = 4 physicians) and the opioid treatment program (n = 11 counselors) to assess experience with and attitudes towards screening opioid agonist patients for alcohol use disorders. Focus groups suggested that organizational, structural, provider, patient, and community variables hindered or fostered alcohol screening. Alcohol screening is feasible among opioid agonist patients. Effective implementation, however, requires physician training and systematic changes in workflow.

Keywords:

• agonist treatment
• alcohol
• family medicine
• implementation
• opioids
• SBIRT

Additional information

Funding

An INVEST Fellowship from the National Institute on Drug Abuse supported this analysis. Additional support was provided through the Western States Node of the National Drug Abuse Treatment Clinical Trial Network (U10 DA015815), an award from the Substance Abuse and Mental Health Services Administration for SBIRT Oregon (TI020272), and from the ELEVATE: Irish Research Council International Career Development Fellowship—co-funded by Marie Cure Actions (ELEVATEPD/2014/6). The authors report no additional potential conflicts.