Doctors urged to screen all adults for illegal drug use

August 15, 2019

An expert task force says screening is justified by evidence and can help patients

The U.S. Preventative Services Task Force (USPSTF) has released a draft recommendation that physicians screen all adults age 18 years or older for illicit drug use when treatment and care can be provided or referred.                                           

The task force is an independent, volunteer panel of national experts in prevention and evidence-based medicine.

According to the task force, in 2017, an estimated 11.5 percent of Americans age 18 years or older reported current illicit drug use in a national survey. The draft recommendation states that, “The USPSTF concludes with moderate certainty that screening for illicit drug use in adults has moderate net benefit when services for accurate diagnosis of unhealthy drug use or drug use disorders, effective treatment, and appropriate care can be offered or referred.” It also noted that there isn’t enough evidence to recommend drug screening for those under 18.

Screenings would include pregnant and postpartum patients and would not be based on risk factors-all patients would be tested each time they seek medical services, except those who have a currently diagnosed drug use disorder or are undergoing drug treatment. The task force says primary care physicians could use either the six-question Brief Screener for Tobacco, Alcohol and Other Drugs tool or the eight-item Alcohol, Smoking and Substance Involvement Screening Test.

The tools are not meant to diagnose drug dependence, abuse, addiction or use disorders. Patients with positive screening results would be referred for diagnostic assessment.

The USPSTF states that the rationale for early detection, intervention and treatment of illicit drug use are as follows:

·      The availability of three FDA-approved pharmacotherapy agents have moderate benefits for reducing relapse and increasing retention in treatment in adults with opioid use disorders.

·      Psychosocial interventions have moderate benefits for increasing abstinence from or reducing illicit drug use; effects may be greater for intensive psychosocial interventions and for cannabis use.

·      The magnitude of benefits is moderate for screening for and treating illicit drug use based on moderate benefits of pharmacotherapy in adults with opioid use disorders and some intensive psychosocial interventions in adults using some types of illicit drugs.

The USPSTF is soliciting public input on its draft recommendation by 8 p.m. ET, September 9, before it is finalized.