Patients often lie about drug use. Part of practicing emergency medicine is using skill in communication to get through those communication pitfalls.
To get patients to tell the truth on drug use, start with low stakes questions. Don’t ask “do you use drugs?” I don’t even use the word “drugs” at all, as some take the word pejoratively or do not consider certain substances to be drugs.
Ask “did you try amphetamines when you were younger?” If they answer affirmatively then can expand to “when was the last time?”
If you have doubts about their denial, you can say “It is crucial for your health that I have objective data. I would like to test your urine for drugs and confirm.”
TAKE HOME POINTS
-Ask about past drug use first
-Then ask about recent drug use
-Be candid about your desire for objective information from a drug screen