{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T09:07:54Z","timestamp":1779440874965,"version":"3.53.1"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Drug and Alcohol Review"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>People who inject drugs (PWID) face a high risk for serious infections, yet International Classification of Diseases (ICD) codes fail to identify this population. Large language models (LLM) offer a promising alternative by extracting information from unstructured clinical text. This study evaluated the diagnostic performance of off\u2010the\u2010shelf LLMs in identifying PWID and related attributes from hospital discharge summaries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross\u2010sectional study, discharge summaries from the Infectious Diseases service at St Vincent's Public Hospital, Sydney, between 2018 and 2022 were reviewed. A single reviewer manually annotated each de\u2010identified summary for PWID status, drugs reported, injection recency and opioid agonist therapy. Eight LLMs (Gemma3, Llama 3.3, Mistral, Phi4, hippomistral, llama3\u2010med [8B and 70B] and OpenBioLLM) were compared using prevalence\u2010weighted average\u2010F1 scores. Diagnostic metrics with bootstrapped 95% confidence intervals were calculated for each annotated category.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 859 first admissions, manual review identified 149 (17.1%) PWID. ICD codes showed low sensitivity (\u2264\u20090.32) but high specificity (\u2265\u20090.97) for identifying PWID. The best\u2010performing model (Llama 3.3) achieved a prevalence\u2010weighted average\u2010F1 of 0.845 (0.733, 0.927). For injecting drug use, sensitivity was 0.819 (95% CI 0.753, 0.879) and specificity 0.999 (0.996, 1.00). Identification of heroin, methamphetamine, cannabis and methadone was near perfect (F1\u2009&gt;\u20090.973), while illicit prescription opioid and benzodiazepine use were identified less accurately (F1\u2009=\u20090.400 and 0.606).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and Conclusions<\/jats:title>\n                    <jats:p>LLMs accurately identify PWID from discharge summaries, outperforming ICD codes. Challenges remain for certain substances, underscoring the need for task\u2010specific tuning, external validation and integration with structured data to enhance surveillance and interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dar.70169","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T03:11:08Z","timestamp":1778814668000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Large Language Models Accurately Identify People Who Inject Drugs From Infectious Diseases Discharge Summaries in an Australian Hospital"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9382-3564","authenticated-orcid":false,"given":"David","family":"Goodman\u2010Meza","sequence":"first","affiliation":[{"name":"St Vincent's Hospital  Sydney Australia"},{"name":"Kirby Institute UNSW Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9444-0186","authenticated-orcid":false,"given":"Marianne","family":"Martinello","sequence":"additional","affiliation":[{"name":"Kirby Institute UNSW Sydney  Sydney Australia"},{"name":"Prince of Wales Hospital  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Masters","sequence":"additional","affiliation":[{"name":"Kirby Institute UNSW Sydney  Sydney Australia"},{"name":"Royal Prince Alfred Hospital  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6770-3099","authenticated-orcid":false,"given":"Danielle","family":"Russell","sequence":"additional","affiliation":[{"name":"Kirby Institute UNSW Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5910-853X","authenticated-orcid":false,"given":"Brendan","family":"Jacka","sequence":"additional","affiliation":[{"name":"Kirby Institute UNSW Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail V.","family":"Matthews","sequence":"additional","affiliation":[{"name":"St Vincent's Hospital  Sydney Australia"},{"name":"Kirby Institute UNSW Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4741-2622","authenticated-orcid":false,"given":"Gregory J.","family":"Dore","sequence":"additional","affiliation":[{"name":"St Vincent's Hospital  Sydney Australia"},{"name":"Kirby Institute UNSW Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2021.08.006"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1128\/cmr.00162-23"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-024-09143-0"},{"key":"e_1_2_10_5_1","volume-title":"Experiences of Alcohol and Other Drugs Among People Who Inject Drugs","author":"Health AIo, Welfare","year":"2025"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/dar.13471"},{"issue":"5","key":"e_1_2_10_7_1","article-title":"Incidence, Patient\u2010Directed Discharge, Readmission, and Mortality Among People Hospitalized With Injecting\u2010Related Infection: A Population\u2010Based Linkage Study. Open Forum","volume":"12","author":"Masters J.","year":"2025","journal-title":"Infectious Diseases"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000838"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.107906"},{"issue":"10","key":"e_1_2_10_10_1","article-title":"Use of ICD\u201010 Codes for Identification of Injection Drug Use\u2010Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder. Open Forum","volume":"7","author":"Marks L. R.","year":"2020","journal-title":"Infectious Diseases"},{"issue":"2","key":"e_1_2_10_11_1","article-title":"Impact of Potential Case Misclassification by Administrative Diagnostic Codes on Outcome Assessment of Observational Study for People Who Inject Drugs. Open Forum","volume":"11","author":"Goodman\u2010Meza D.","year":"2024","journal-title":"Infectious Diseases"},{"issue":"9","key":"e_1_2_10_12_1","article-title":"Natural Language Processing and Machine Learning to Identify People Who Inject Drugs in Electronic Health Records. Open Forum","volume":"9","author":"Goodman\u2010Meza D.","year":"2022","journal-title":"Infectious Diseases"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.14217"},{"key":"e_1_2_10_14_1","unstructured":"T. B.Brown B.Mann N.Ryder et\u00a0al. \u201cLanguage Models Are Few\u2010Shot Learners \u201d2020 arXiv preprint arXiv:2005.14165."},{"key":"e_1_2_10_15_1","unstructured":"A.Grattafiori A.Dubey A.Jauhri et\u00a0al. \u201cThe Llama 3 Herd of Models \u201d2024 arXiv preprint arXiv:2407.21783."},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2025.112888"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-03425-5"},{"key":"e_1_2_10_18_1","unstructured":"J. B.GruberandM.Weber \u201cRollama: An R Package for Using Generative Large Language Models Through Ollama \u201d2024 arXiv preprint arXiv:2404.07654."},{"key":"e_1_2_10_19_1","volume-title":"Ollama: Run Large Language Models Locally","author":"Ollama I.","year":"2024"},{"key":"e_1_2_10_20_1","unstructured":"A.Pal P.Minervini A. G.Motzfeldt andB.Alex \u201copenlifescienceai\/open_medical_llm_leaderboard \u201d2024."},{"key":"e_1_2_10_21_1","unstructured":"S.Quan J.Yang B.Yu et\u00a0al. \u201cCodeElo: Benchmarking Competition\u2010level Code Generation of LLMs with Human\u2010comparable Elo Ratings \u201d2025."},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-023-00918-4"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-07939-1"},{"key":"e_1_2_10_24_1","first-page":"259","volume-title":"Certifying and Removing Disparate Impact. Proceedings of the 21th ACM SIGKDD International Conference on Knowledge Discovery and Data Mining","author":"Feldman M.","year":"2015"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.16338"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.25919"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.josat.2024.209392"},{"key":"e_1_2_10_28_1","volume-title":"Australian Needle Syringe Program Survey: National Data Report 2019\u20132023","author":"The Kirby I","year":"2024"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(17)30375-3"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-025-04076-0"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14176169"},{"key":"e_1_2_10_32_1","unstructured":"M.Garg S.Raza S.Rayana X.Liu andS.Sohn \u201cThe Rise of Small Language Models in Healthcare: A Comprehensive Survey \u201d2025April 01 2025:[arXiv:2504.17119] https:\/\/ui.adsabs.harvard.edu\/abs\/2025arXiv250417119G."},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40264-024-01483-9"}],"container-title":["Drug and Alcohol Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dar.70169","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/dar.70169","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dar.70169","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T08:46:49Z","timestamp":1779439609000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dar.70169"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":32,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1111\/dar.70169"],"URL":"https:\/\/doi.org\/10.1111\/dar.70169","archive":["Portico"],"relation":{},"ISSN":["0959-5236","1465-3362"],"issn-type":[{"value":"0959-5236","type":"print"},{"value":"1465-3362","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"2025-11-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70169"}}