What are the recommended screening tools for assessing opioid dependence in primary care?

In primary care settings, the recommended approach to assessing opioid dependence involves a comprehensive clinical assessment rather than reliance on a single formal screening tool. Healthcare professionals should take a detailed history of drug and alcohol misuse, including previous treatment attempts, and review current and past physical and mental health problems along with any treatments received. Clinical assessment of signs of opioid withdrawal is important, and the use of formal rating scales may be considered as an adjunct but not as a substitute for clinical judgment. Biological testing such as urinalysis, oral fluid, or breath testing can aid identification of opioid use but should not be the sole method of diagnosis. Confirmatory laboratory tests are recommended when dependence or tolerance is uncertain, especially in complex cases or young people presenting for detoxification. The assessment should also consider social and personal circumstances, risks of self-harm, and the impact on family members. This comprehensive, multi-dimensional assessment approach is advised over specific screening tools in primary care to establish the presence and severity of opioid dependence and to inform treatment planning.