Primary care settings are critical entry points for addressing the growing opioid use disorder (OUD) crisis. To effectively manage OUD within primary care, reliable and efficient diagnostic tools are essential. The Substance Use Symptom Checklist has emerged as a promising instrument for assessing DSM-5 substance use disorder (SUD) symptoms in this context. This checklist offers a structured approach to identify individuals who may be struggling with OUD or are at risk due to long-term opioid therapy (LTOT).
The effectiveness of the Substance Use Symptom Checklist was evaluated in a recent study conducted within Kaiser Permanente Washington (KPWA). This observational study focused on primary care patients with documented OUD or those undergoing LTOT. The research aimed to determine the psychometric properties of the checklist, ensuring its reliability and validity in this specific patient population. Electronic health records were analyzed for adult primary care patients who completed the Checklist between March 2015 and August 2020.
The Checklist comprises 11 items that align with the DSM-5 criteria for SUD. The study assessed the prevalence of at least two SUD symptoms reported on the checklist, which is indicative of a mild to severe DSM-5 SUD. The analysis included an overall patient sample and two distinct subgroups: patients with clinically-recognized OUD and those on LTOT only. Out of 2007 eligible patients, a significant 39.9% reported two or more SUD symptoms. Notably, this rate was much higher (74.3%) in the clinically-recognized OUD group compared to the LTOT only group (13.1%).
Item response theory (IRT) analysis confirmed that the 11 checklist items effectively measure a single, unidimensional construct of SUD symptoms. The checklist demonstrated excellent fit (comparative fit index = 0.998) and high item discrimination across the entire sample and within both subgroups. While differential item functioning (DIF) was observed for single items related to age, race, ethnicity, and treatment, these had minimal impact on the overall symptom scoring.
The findings of this study underscore the Substance Use Symptom Checklist as a robust tool for measuring SUD symptoms, consistent with DSM-5 guidelines, in primary care patients with OUD and LTOT. Its consistent measurement properties across various demographic subgroups further validate its broad applicability. This Primary Care Diagnosis Checklist can be instrumental in supporting symptom assessment for patients with OUD and facilitating diagnosis, particularly among individuals receiving long-term opioid therapy. The checklist offers a practical and psychometrically sound method for primary care providers to screen and monitor patients for potential substance use disorders, enabling timely intervention and care.
