IMPORTANCE: Despite decreasing substance use by adolescents in recent years, overdose rates continue to rise. Morbidity and mortality from substance use is preventable if detected; however, screening practices among youth-serving clinicians are unknown. OBJECTIVE: To describe youth-serving clinicians' screening, brief intervention, and referral to treatment practices for substance use disorders (SUDs) among adolescents. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used DocStyles data from September 5 to October 12, 2023, on clinical practice settings in the US. Responding clinicians included family physicians, internal medicine physicians, pediatricians, nurse practitioners, and physician assistants. EXPOSURE: Delivery of services to youths aged 17 years or younger. MAIN OUTCOMES AND MEASURES: Screening, brief intervention, and referral to treatment practices, including screening frequency and type of screening tool used, and screening at every well visit using a screening tool were assessed using descriptive statistics and multivariable logistic regression. RESULTS: Of 1047 youth-serving clinicians (mean [SD] age, 45.3 [11.4] years; 555 male [53.0%]), 467 (44.6%) were family physicians, 250 (23.9%) were pediatricians, 132 (12.6%) were internal medicine physicians, 107 (10.2%) were nurse practitioners, and 91 (8.7%) were physician assistants (survey response rate, 57%). Median years in practice was 13 (IQR, 7-23 years). Most clinicians (634 [60.6%]) reported that skills in SUD diagnosis were relevant to their practice, and 800 (76.4%) reported seeing at least 1 adolescent with an SUD monthly. A majority of clinicians (596 [56.9%]) reported screening for SUDs at every well visit, with a high proportion of pediatricians reporting screening at every well visit (173 of 250 [69.2%]). Clinicians who screened at every well visit were more likely to use a screening tool (odds ratio, 1.87 [95% CI, 1.44-2.44]). Only 411 clinicians (39.3%) reported screening at every well visit using a screening tool; 321 clinicians (30.7%) offered all components of screening, brief intervention, and referral to treatment practice. Clinicians who reported seeing 5 or more adolescents with an SUD per month had a higher odds of screening with a standardized tool at every annual well visit (adjusted odds ratio, 2.19 [95% CI, 1.30-3.71]). CONCLUSIONS AND RELEVANCE: These findings suggest that while most clinicians report screening youths for SUDs at least sometimes, a substantial proportion screened only intermittently. Efforts to improve screening rates through education and systems-based practice changes may facilitate offering anticipatory guidance and SUD treatment in all youth-serving clinical settings.

Introduction: In 2016, the Centers for Disease Control and Prevention released the Guideline for Prescribing Opioids for Chronic Pain (2016 Centers for Disease Control and Prevention Guideline) to improve opioid prescribing while minimizing associated risks. This analysis sought to understand guideline-concordant knowledge and self-reported practices among primary care physicians. Methods: Data from Spring DocStyles 2020, a cross-sectional, web-based survey of practicing U.S. physicians, were analyzed in 2022 and 2023. Demographic, knowledge, and practice characteristics of primary care physicians overall (N=1,007) and among specific subsets—(1) primary care physicians who provided care for patients with chronic pain (n=600), (2) primary care physicians who did not provide care for patients with chronic pain (n=337), and (3) primary care physicians who reported not obtaining or seeking a buprenorphine waiver (n=624)—were examined. Results: A majority of physicians (72.6%) were unable to select a series of options consistent with diagnostic criteria for opioid use disorder; of those physicians, almost half (47.9%) reported treating at least 1 patient with medications for opioid use disorder. A minority of physicians (17.5%) reported having a buprenorphine prescribing waiver. Among physicians who prescribed opioids for chronic pain (88.5%), 54.4% concurrently prescribed benzodiazepines. About one third (33.5%) reported not taking patients with chronic pain. Conclusions: There were critical practice gaps among primary care physicians related to 2016 Centers for Disease Control and Prevention Guideline topics. Increasing knowledge of the Centers for Disease Control and Prevention's opioid prescribing recommendations can benefit physician practice, patient outcomes, and public health strategies in addressing the opioid overdose crisis and implementing safer and more effective pain care. © 2024