Physician unawareness of serious substance abuse

FRANÇAIS :
Une étude a été réalisée auprès de personnes désirant entreprendre un traitement de leur toxicomanie dans le secteur public et ayant un médecin traitant. 45% des patients présentant un usage de drogues suffisamment important pour nécessiter une prise en charge, déclarent que leur médecin traitant ignore leur toxicomanie. Ce constat est dautant plus marqué chez les patients qui ne bénéficient pas dune assurance maladie, qui nont pas dantécédent médical et qui nont pas suivi de traitement pour leur abus de drogue ou pour des troubles mentaux
ENGLISH :
Purpose: To describe and assess the prevalence of perceived physician unawareness of serious substance abuse. Patients and methods: We report an observational study with validation of multivariable results of data collected by interview from persons presenting for addictions treatment in the public system who reported having a physician. Results: Of 3,253 patients interviewed, 87% (2,943) responded to the question about having a physician. Of 1,440 patients who stated that they had physicians, 45% (651) reported that the physician who cared for them was unaware of their substance abuse. In multivariable logistic regressions adjusting for sociodemographics, health status, and substance abuse histories, the following patient characteristics were found to be independently associated with physician unawareness of substance abuse and were confirmed in a validation analysis (OR = Odds Ratio, CI = 95% Confidence Interval): no prior episodic medical illness (OR = 1.98, CI = 1.35-2.92), no health insurance (OR = 1.89, Cl = 1.33-2.70), no prior mental health treatment (OR = 1.75, CI = 1.06-2.88), no chronic medical illness (OR = 1.69, CI = 1.18-2.40), no prior substance abuse treatment (OR 1.64, CI 1.17-2.31), and no prior detoxification (OR = 1.54, Cl = 1.14-2.22). Conclusions. Forty-five percent of patients with substance abuse serious enough to prompt a presentation for treatment stated that the physician who cared for them was unaware of their substance abuse. Patients without health insurance, a history of medical illness, or prior substance abuse or mental health treatment were more likely to have reported physician unawareness. Even among substance abusing patients requesting addiction treatment, many perceive that their physicians do not recognize their substance abuse. (Author' s abstract)