Identification of substance use and dependence among patients with viral hepatitis

BackgroundAs drug abuse and addiction have been shown to decrease adherence to treatment of hepatitis C virus (HCV) or HIV, screening for substance use should be standard clinical practice in those undergoing an evaluation for these diseases.AimsTo assess the effectiveness of the Kreek–McHugh–Schluger–Kellogg (KMSK) scale to quantify substance use and dependence among patients with viral hepatitis.MethodsThe KMSK scale, a validated instrument that quantifies lifetime use of alcohol, cocaine, heroin, and tobacco, was distributed to 161 consecutive patients referred to a hepatology clinic at an academic, tertiary-care center over a 1-year period.ResultsOf the 159 patients who returned the KMSK scale, 62% reported illicit drug use and 30% met defined criteria for lifetime dependence on cocaine or heroin. We found that 15% of our population at some time had been co-dependent on cocaine and heroin. The KMSK scale identified significantly more cocaine, heroin, and alcohol use than that detected through the medical record (χ2 = 7.61, p < 0.01, χ2 = 9.66, p < 0.002, respectively). Cocaine dependence was significantly higher among HCV/HIV co-infected than among mono-infected patients (χ2 = 5.46, p < 0.02).ConclusionsThe KMSK scale may be useful to diagnose drug and alcohol use and dependence among patients undergoing evaluation for treatment of viral hepatitis.