Just under one-third of depressed primary care patients misuse drugs or alcohol. Problem drinking, marijuana use, and the misuse of prescription sedatives and opioids (synthetic narcotics) are particularly common, according to a study supported in part by the Agency for Healthcare Research and Quality (HS08349). Clinicians should broadly screen all depressed patients for substance misuse, including patients with only a few depressive symptoms who do not meet the criteria for depressive disorder, concludes Kenneth B. Wells, M.D., M.P.H., of RAND. Dr. Wells and his colleagues screened patients with depressive symptoms or disorders seen in rural, suburban, and urban primary care clinics of six managed care organizations.
Among 1,187 demographically diverse depressed patients, 44 percent had depressive symptoms only, 56 percent had depressive disorders, and 44 percent also had coexisting anxiety disorders. Twenty-seven percent of the patients said they had used at least one illicit drug or misused a prescription drug in the past 6 months. Problem use of prescription drugs, mostly sedatives and tranquilizers, was more common (19 percent) than use of illicit drugs (12 percent), mostly marijuana and hashish. Eleven percent of the group had a pattern of hazardous drinking; 6 percent had both hazardous drinking and used at least one illicit drug, and 9 percent used multiple drugs. In these patients, hazardous drinking increased the odds of marijuana use; prescription opioid misuse and hazardous drinking increased the odds of sedative misuse; and sedative misuse increased the odds of opiate misuse.
These findings suggest that problem substance use is common among patients with either depressive symptoms or depressive disorders in community-based managed primary care clinics. Problem drinking, marijuana use, and the misuse of prescription sedatives and opioids are particularly common and occur across different clinical and demographic groups of primary care patients, often contrary to expectations based on community surveys. The researchers conclude, therefore, that primary care physicians should go beyond current practice recommendations to screen patients for substance misuse in the presence of depressive symptoms or disorder.
See "Problem substance use among depressed patients in managed primary care," by Carol A. Roeloffs, M.D., M.S.H.S., Dr. Wells, Douglas Ziedonis, M.D., M.P.H., and others, in the September 2002 Psychosomatics 43(5), pp. 405-412.