Prevalence of Substance Use Disorders Across Five Community Health Centers in Boston, Massachusetts

Understanding the prevalence and demographic distribution of substance use disorders (SUDs) among patients in the primary care setting is essential for informing service delivery and resource allocation.

To estimate the prevalence of SUDs and examine demographic variation among adult patients receiving care at hospital-licensed community health centers (CHCs).

Retrospective cohort study using electronic health record data.

Individuals aged ≥ 17 years who were considered active patients at five hospital-licensed CHCs that are part of a large academic healthcare system in Boston, Massachusetts, between 2021 and 2023.

Prevalence of SUDs, overall and by major substance type (alcohol, opioid, cannabis, cocaine, non-cocaine stimulant, and sedative use disorders). We further stratified SUD prevalence by age, gender, and race/ethnicity.

Among 54,288 health center patients, 14.1% had a documented SUD diagnosis. Alcohol use disorder was the most prevalent (8.8%), followed by opioid (4.4%) and cannabis (2.6%) use disorders. Overall SUD prevalence was highest among individuals aged 45-64 years, males, and non-Hispanic White patients. These demographic patterns were consistent across most major substance types, except cannabis use disorder, which was most prevalent among individuals aged 18-24 years and non-Hispanic Black patients.

In this large cohort of patients receiving care in academically affiliated, hospital-licensed CHCs, SUD prevalence varied substantially by substance type and demographic subgroup. These findings highlight the need for targeted prevention, screening, and treatment strategies in primary care settings serving historically marginalized populations.