August 14, 2019

The U.S. Preventive Services Task Force (USPSTF) on Tuesday issued a draft recommendation that providers screen all adult patients for illicit drug use, marking the first time the task force has proposed such a recommendation.

How to help your patients struggling with substance abuse

According to STAT News, the draft recommendation is intended to help combat the U.S. opioid epidemic. A federal survey in 2017 found one in 10 U.S. residents older than age 18 reported using drugs or prescription drugs illicitly, and other research has shown more than 70,000 U.S. residents in 2017 died from a drug overdose, STAT News reports.

USPSTF in 2008 had concluded that there was insufficient evidence to recommend that providers screen all adult patients for illicit drug use.

Draft recommendation details

However, based on new evidence, USPSTF on Tuesday proposed that providers screen all patients ages 18 and older for illicit drug use if the providers can offer or refer patients to services to accurately diagnose and effectively treat substance use disorders. USPSTF in the draft recommendation defined illicit drug use as the use of illicit drugs or prescription drugs in amounts and for durations or frequencies other than prescribed.

According to the draft recommendation, USPSTF found new evidence showing screening tools can allow providers to detect whether a patient is using drugs illicitly and whether a patient might need to be assessed further. However, Karina Davidson, co-chair of USPSTF, noted that the task force is not recommending providers use drug tests to screen their patients. Instead, USPTF said providers could ask their patients a series of questions to determine whether they are using drugs illicitly.

USPSTF also found psychosocial interventions such as behavioral therapy can help adults with a substance use disorder avoid or limit their use of illicit drugs, particularly cannabis. The task force also noted that there are three FDA-approved mediation-assisted treatments—buprenorphine, methadone, and naltrexone—to treat adult patients with opioid use disorders.

Based on the evidence, USPSTF concluded "with moderate certainty" that screening adult patients for illicit drug use has a moderate net benefit when providers can offer or refer patients to services to diagnose and treat substance use disorders. USPSTF did not endorse a particular screening tool or treatment, which means providers who follow the recommendations can decide how they will screen and treat their patients.

USPSTF gave a "B" grade to the draft recommendation. Under the Affordable Care Act, insurers are required to cover preventive services that receive a "B" grade or higher from USPSTF without cost sharing.

Draft recommendation does not apply to teens

USPSTF did not extend the draft recommendation to adolescent patients between the ages of 12 and 17. The task force said there was insufficient evidence to determine whether screening tools and treatments are safe and effective for adolescents.

According to STAT News, the long-term effects of certain treatments on the developing brains of adolescents are unknown, which is why treatments such as buprenorphine are approved only for use among patients 16 and older. USPSTF in the draft recommendation called for additional research on screening tools and treatments for adolescents who use drugs illicitly.

Carol Mangione, a member of the task force and chief of general internal medicine at the David Geffen School of Medicine at University of California-Los Angeles, said providers should not interpret this as a recommendation against screening adolescent patients for illicit drug use.

USPSTF is accepting comments on the draft recommendation through Sept. 9.

Discussion

Mangione said, "I think in the context of the opioid epidemic, most primary care providers would welcome the recommendation." She added, "We have a pretty high prevalence of adults using illicit drugs and we're seeing harms every day from that. This is a big change that we're really excited about. Effective treatment is where we will finally begin to move the needle on the epidemic."

Mangione noted that the draft recommendation stipulates providers screen adult patients when the provider can offer or refer patients to treatment services because providers "haven't helped [their patients] much" if they "have no ability to get them to treatment."

Gary LeRoy, president-elect of the American Academy of Family Physicians (AAFP), agreed, saying it is crucial for providers to have substance use disorder care available on site, because there is a possibility patients will not receive appropriate care if they leave the providers' facility. LeRoy noted many providers likely already are screening patients for illicit drug use, though they might not be using a specific assessment tool. "We may not be checking boxes on a screen, but we're mentally checking boxes saying something is wrong," he said.

AAFP and the American College of Physicians did not directly comment on the draft recommendation, STAT News reports.

Michael Carome, director of Public Citizen Health Research Group, said it already is common practice for providers to screen their patients for illicit drug use. As such, he said, "This recommendation, when accurate diagnosis, effective treatment, and appropriate care can be offered or referred, seems reasonable to me"  (Burton, Wall Street Journal, 8/13; Owens, "Vitals," Axios, 8/14; Hoffman, New York Times, 8/13; Flaherty, STAT News, 8/12).

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