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Gastroenterologists can use single-item tools like the National Institute on Drug Abuse Quick Screen to assess substance use in patients with Crohn’s disease.
Patients with Crohn’s disease (CD) appear to experience higher substance use than the general population, according to findings published in Gastro Hep Advances.
In a retrospective cohort study of 37,323 Medicaid recipients with incident CD, Po-Hung (Victor) Chen, MD, PhD, and colleagues used diagnostic codes to identify patients who had newly diagnosed CD and had used alcohol, opioids, cocaine, amphetamine, or cannabis. The researchers used multivariable logistic regression to analyze associations between CD-related interventions and substance use after CD diagnosis.
Findings showed that 6,091 of Medicaid enrollees with incident CD (16.3%) had ever used substances. Alcohol and opioid use, at 8% each, were more frequent than previously reported for the general US population (6% and 4%, respectively, in 2019). Cannabis use was reported in 4.3%, cocaine in 2.3%, and amphetamine use in 1.3%.
In the second of this two-part series, Dr. Chen talked with Physician’s Weekly (PW) about the gastroenterologist’s role in managing substance misuse in patients with CD.
Are gastroenterologists asking patients with CD about substance abuse?
I have not seen studies on substance abuse screening practices of US gastroenterologists. When asked, my academic colleagues who specialize in IBD have offered mixed responses on whether they regularly screen for substance use in their clinical practices.
Those who screen prefer the ease of single-item screening questions such as the National Institute on Drug Abuse Quick Screen, tools which are more feasible in busy clinics. Gastroenterologists who desire more in-depth risk stratification may opt for longer, more time-consuming instruments like the Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool.
What strategies can gastroenterologists use to educate patients about substance use?
I encourage gastroenterologists to take advantage of existing educational resources for themselves and their patients from the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism, which are all federal agencies, that promote service delivery efforts and research for mental health and substance misuse. The American Society of Addiction Medicine is another good resource.
However, disease-specific context may be relevant when addressing substance use disorders. Most available resources from addiction-related organizations have not been specifically tailored for patients with IBD, who may have physical ailments that are very different from most patients. More research is needed to identify the most effective substance use communication strategies for these patients.
What role do gastroenterologists have in managing substance use?
The SBIRT—Screening, Brief Intervention, and Referral to Treatment—is a well-described approach to delivering early intervention and treatment services for substance use disorders. I recommend that all gastroenterologists perform substance use screening and feel comfortable delivering brief interventions, often using motivational interviewing principles. Patients with moderate or severe substance use disorders will likely benefit from referrals to specialized addiction treatment services.
However, each gastroenterologist’s familiarity with managing substance use disorders will ultimately dictate the timing of referral. I recommend using a resource from SAMHSA to help patients find the right treatment programs.
What further related research are you planning?
More research is needed to understand the best ways to communicate about substance use and to perform early detection and treatment of misuse among patients with IBD. We also need more data on possible interactions between substance-related organ injuries, such as chronic liver disease, pancreatitis, and gastrointestinal malignancies, and IBD and their joint impact on health outcomes.
Is there anything else you would like to mention?
I recommend adopting a universal substance use screening process in your clinical practice to reduce provider bias that may occur with targeted screening. One option is embedding these questions into the intake process, perhaps in the EMR, before each clinic visit. Also, plan for how your practice will address positive screening results. If you choose to use substance biomarkers such as cotinine for nicotine or phosphatidylethanol for alcohol, consider about how your practice will approach potentially discordant results between biomarkers and self-reporting.
Click here to read part 1 of Dr. Chen’s conversation.
