What are some of the best practices for implementing universal screening for substance use disorders or should we be implementing universal screenings for substance use disorders? I think at this stage most of us are saying yes. Right. Screen everyone. Why would you screen everyone? I think you have to screen everyone multiple times because at some point, they might be open and honest with you. Because you can't look at someone and say they're not using alcohol, they're not using cocaine. So just assume that people are going to be honest and when you ask, they'll say. So also would be destigmatizing to some extent if everyone expected it and didn't see it as somehow an assessment of their competency or their self-worth. It just is. I ask everyone. Now as long as you have a unified easy way to ask people, then it makes it easy. But if you have to ask 15 questions to get at whether a patient's using substances that makes, it really challenging. So making it universal, making it easy, and just implementing it into your workflow, whether that's through an electronic health reminder or having other members of your team be the screeners. Thinking about ways in your system to make sure that universal screening is happening. How close are we to that? Let me ask you guys as patients. Were you asked about your substance use the last time you went to your general practitioner for your annual physical? I wasn't. I always get asked about smoking and I get asked about heavy drinking. I don't get asked about other substances. I got asked, "You don't drink, do you?" Sometimes it's asked in that way. I mean they knew what I do for a living so that might have been part of it. But I said, "Actually I do." We've talked about we agree that universal screening. But in which settings is this most appropriate? I ask all my patients in my private practice. At least when they start treatment with me and ask them fairly often afterwards, though not every time I see them and depending on the patient. Some patients I might ask every time I see them. I really was trying to think of a place where this wouldn't be appropriate. I mean it's even appropriate for physical therapy, it's appropriate pre-surgery, it's appropriate for inpatients, it's appropriate for outpatients. It seems like it's absolutely essential. Emergency rooms. I couldn't really come up with a place, and so it just really reiterated that universal screening is no matter what field you go into, you're going to have patients who use substances, and we should be screening. You may do things that could increase their risk if they're using substances. That's right. So dentists, really any health care system. That's not to say that it has to happen with every contact point. But you have to have a flow of how you're going to get that information. Again, I think if we want to be agents of culture change, if we make it universal and people expect it when they come in, we start taking away at that stigma that I think it's been such a prominent feature of every module in this course that we talk about a huge barrier for our patients. So we really do need to create culture change and that's one way to do it. For other problems like HIV and hepatitis C, we've created an algorithm to decide how often people should be tested. It's high risk, its every year for people who are in certain age groups, it's at least once and then once every five years or people in other groups it's once ever. Do we have a similar algorithm for screening for substance use disorders? Or should we need to develop one as a community? I think it would be useful to develop one. I think with where we are with the opioid epidemic, I think everyone's on heightened awareness. You won't be faulted for asking at this point. But I certainly think that it's something we need to consider if it is too much of a burden on the healthcare system to be asking, that we should have guidelines developed on how to do it. Are you asking about asking or are you asking about screening? Asking about how often we should screen. Screen, like through urine? No. Every year or so or every evaluation. Asking about it. I don't mean testing people to make sure that. I'm opposed for obvious reasons to any kind of coerced testing of people's bodily fluids. Yes. You're saying we should do that in primary care? No.