Rural and Urban Cocaine Users’ Discussions about Drug Use with Medical Care Providers: An Opportunity for Promoting Substance Use Treatment in Primary Care

Borders TF, Booth BM, Curran GM, Cheney AM. Rural and Urban Cocaine Users’ Discussions about Drug Use with Medical Care Providers: An Opportunity for Promoting Substance Use Treatment in Primary Care. Paper presented at: National Rural Health Association Annual Meeting; 2013 May 7; Louisville, KY.

This presentation examined how rural residence, drug use severity, and physical and mental health status are associated with illicit drug users' 1) comfort talking with a medical care provider about personal drug use and 2) historical likelihood of actually talking about drug use with a medical care provider. Data were collected as part of a population-based study of 400 African American cocaine users who were not currently receiving any substance use treatment. The 2 dependent variables were self-reported comfort talking to a doctor about drug use and a past history of actually discussing drug use with a doctor. Independent variables were rural/urban residence, age, marital status, educational status, past 12 month diagnosis of a cocaine use disorder, past 30 day use of crack and powder cocaine, a global severity index of psychiatric distress, and the physical component score from the SF-12. Multivariate logistic regression analyses were conducted to model the odds of each dependent variable. Contrary to our hypotheses, 39% of urban and 53% of rural users were comfortable talking about drug use with a doctor. 25% and 26% of rural and urban users had talked with a doctor about drug use in the past. Rural residence, male gender, having health insurance, using crack cocaine on 15 or more days in the past 30 days, higher (worse) psychiatric distress, and higher (better) SF-12 PCS scores were associated with higher odds of being comfortable talking with a doctor about drug use. Age and health insurance were associated with higher odds whereas having less than a high school degree was associated with lower odds of a history of talking with a doctor about drug use. Many rural African American cocaine users expressed comfort in potentially discussing their illicit drug use with a physician, but a relatively lower percentage had actually ever engaged in such discussion. These findings suggest that primary medical care providers, especially in rural areas where formal substance abuse services are often scarce, could play a more active role in screening, referring, and perhaps even treating patients using illicit drugs.