All patients should be screened routinely (i.e., at least annually) for substance use. Introducing substance use screening tools in a non-judgmental, conversational manner can foster trust and, in turn, improve the accuracy of self-report. Seeking the patient’s consent and providing context prior to asking screening questions may also aid in building rapport. Establishing trust and safety in these initial conversations is particularly important for patients who may otherwise tend to underreport substance use, such as pregnant people, adolescents, older adults, and patients with co-occurring substance use disorders or mental health conditions.103-105

Regardless of the screening tool used, it is emphasized that screening alone does not improve outcomes. Provider and staff education, training, and the development of clinical pathways and processes that support early intervention among individuals who use opioids are also needed, along with a plan for any necessary diagnostic follow-up and treatment for individuals who are diagnosed with an opioid use disorder.