An overlooked tool for chipping away at the opioid crisis
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Too few states are assessing residents for substance use disorders, a practice that one expert says could get drug users into treatment earlier.
Tackling a challenge as large and amorphous as opioid abuse requires reliable, standardized data. Beyond basic measures for tracking opioid use disorders like the number of individuals already diagnosed with an OUD, states may be overlooking other baseline metrics such as the number of available providers and treatment programs or the percentage of patients who initiate treatment, one expert says.
An under-utilized “starting point for evaluating care is measuring what portion of the population is diagnosed with OUD. Knowing this information will help policymakers understand how well treatment systems are identifying people with OUD, which is the first step in getting them needed care,” said Alexandra Duncan, project director of Pew’s substance use prevention and treatment initiative.
Unfortunately, many states are not doing enough OUD screening to effectively identify how many residents need help, she added.
“[W]idespread SUD screening is lacking across settings even though identifying people with a SUD who need treatment is a crucial first step to improving treatment systems,” Duncan said. “State officials should prioritize implementing SUD screening across health care settings and allocate resources to support that effort.”
A recent analysis from the Pew Charitable Trusts found only two states—Indiana and West Virginia—reported screening patients for substance use disorders, or SUDs, using a standardized assessment tool as part of the federal 1115 SUD waiver or interactive state dashboards, she added.
Assessing patients for SUDs can help states proactively identify residents with the condition, she said, and gauge how effective they are at recognizing people in need of treatment. Those data insights can inform improvements to the screening process, such as identifying gaps in implementation across the state, to ensure harm reduction services and programming reach those in need.
Indiana and West Virginia have leveraged the Screening, Brief Intervention and Referral to Treatment, or SBIRT, model, an evidence-based approach for talking with patients about use and misuse of drugs and alcohol. It helps health care providers flag concerning substance use behaviors in Medicaid patients and intervene with necessary resources and services to aid patient prevention or treatment and recovery of SUDs.
Under the SBIRT model, individuals’ current level and frequency of substance use are assessed to gauge their severity. Health care providers can then intervene by educating patients on the dangers of continued or abusive use to encourage safer substance use practices. Providers can also link patients to treatment and recovery resources to ensure those with more severe behaviors can leverage specialty care.
The Indiana SBIRT program, a 2014 initiative developed by the Indiana University School of Public Health and the Indiana Prevention Resource Center, for instance, encourages health care providers to implement various screening procedures to identify potential substance use disorders, including opioid use disorders.
Suggested screening tools include the Alcohol Use Disorder Identification Test-10, the Drug Abuse Screening Test-10 and the CRAFFT tool, which helps identify substance use and associated behaviors in youth and adolescents, among others. The SBIRT model has been expanded for use at community health centers, federally qualified health centers and rural health centers in Indiana.
In West Virginia, health officials completed 80,971 SBIRT assessments from October 2020 to August 2021. Nearly 7,500 individuals screened positive for a substance use disorder, with 753 patients referred to treatment and 564 linkages to treatment. In 2022, the West Virginia Department of Health and Human Resources requested an expansion of its Section 1115 waiver demonstration project to continue SBIRT screenings.
SBIRT initiatives have also cropped up in other states such as Minnesota and Colorado.
“State officials must provide strong leadership support and resources, such as funding for staff to work on measurement initiatives, if they want to effectively collect, report and ultimately make improvements as a result of the data,” Duncan said.
“These data will provide states with crucial information on how to allocate scarce resources more effectively, whether through increasing SUD screening or other data-driven treatment system improvements,” she added.
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