Lab Soft News: MGH to Screen All Patients for Substance Abuse

MGH will question all patients admitted to the hospital about substance abuse (see: MGH to screen all patients for substance abuse). There are at least two reasons for screening all hospital inpatients for substance abuse. The first is that such information is important when working-up a patient. Of course, problems related to alcohol abuse such as cirrhosis will become apparent as soon as the lab values come back. The second reason, as noted below, is that substance abuse patients often have various chronic illnesses and higher readmission rates:

Patients at Massachusetts General Hospital will soon be asked questions about their alcohol and illegal drug use, no matter why they’re at the hospital. The program scheduled to start this fall is part of a broader plan to improve addiction treatment at the Boston hospital and its community health centers. Caregivers will ask patients how often they have had six or more drinks on one occasion, and whether they have used an illegal drug in the past year, according to a report in The Boston Globe. If the questioning reveals a possible addiction, doctors can summon a team to conduct a ‘‘bedside intervention’’ and, if needed, arrange treatment. Some hospitals already ask emergency room patients about alcohol and drug use, and the American College of Surgeons has required hospitals to ask all trauma patients about their alcohol use since 2006. But standardized hospital-wide substance-abuse screening of all patients is not tracked. MGH officials say the practice will reduce costs and improve care. The hospital recently studied more than 2,500 patients with identified substance abuse disorders who were in the hospital for various medical problems and found they had longer stays and higher readmission rates. The cost of...[the care for patients with substance abuse problems] averaged 40 to 50 percent higher than the cost of treating patients with other chronic conditions. Substance abuse can affect other medical issues, doctors said. Dr. Timothy Wilens, director of addiction medicine at MGH, said a patient with high blood pressure who reports drinking four bourbons a night, for example, may not think alcohol use is an issue.‘‘I would say, ‘Let me tell you that when you drink at that level, it starts to affect you liver and cardiovascular health,'’’ Wilens said.

Here's more details about the MGH screening program (see: Massachusetts Hospital To Begin Mandatory Drug Screening For Patients):

Caregivers at the hospital will ask patients four specific questions about their drug and alcohol use, including whether or not they’ve used an illegal substance in the past year or how often they have more than six drinks in a night....Although the hospital routinely asks patients about their drinking and drug use, it has never been done in all cases and specific mandatory questions were not part of the protocol.

The first problem that come to mind about broad substance abuse screening is how it affects patient privacy and confidentiality. I am sure that many patients would not like such problems coming to light. Of course, given that the screening process at MGH will be oral queries rather than drug screening, the patient can always answer in the negative if he or she does not want to divulge the information.

I believe that one of the reasons that MGH is initiating this policy now is to try to reduce patient care costs. Having a history of substance abuse also allows physicians to be proactive and perhaps reduce length-of-stay and the readmission rate for such patients. Knowing such a history, as noted in the excerpt above, will also allow "bedside interventions" to facilitate treatment of an addiction. Note that the hospital screening program stops short of broad lab screening for drugs and alcohol which would definitely raise privacy concerns.