As new ways to identify and treat people who use opioids and other drugs emerge, an independent panel of experts is recommending that health care providers screen their adult patients for illicit drug use.

The U.S. Preventive Services Task Force has determined, for the first time, that there is enough evidence to state with “moderate certainty” that screening adults for illicit substance use is overall beneficial.

What the panel means by “screening” means a physician asking a patient a series of questions. The answers can indicate who might need to be offered or referred support. It does not include drug testing. “Screening tools are not meant to diagnose drug dependence, abuse, addiction, or use disorders,” the members of the task force wrote in their report.

advertisement

“We have a pretty high prevalence of adults using illicit drugs and we’re seeing harms every day from that,” said task force member Dr. Carol Mangione, the chief of general internal medicine at the David Geffen School of Medicine at UCLA. “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.”

Currently in draft form, the new recommendation will be posted for public comment through Sept. 9. After the task force reviews comments, it will issue a final recommendation.

The task force defined illicit drug use as both taking illicit drugs and using prescription drugs for nonmedical purposes — meaning for reasons, durations, frequencies, or in amounts other than prescribed.

In 2008, the task force, which advises the federal government and makes recommendations for primary care providers, concluded that there was not enough evidence to recommend for or against screening in adults or adolescents. But after reviewing recent studies, it determined there are adequate tools available and sufficient care systems in place to recommend screening in adults, which can help doctors identify patients who may need support.

The availability of new studies, tools, and treatments is due in part to recognition of the need for ways to address the opioid epidemic, said Dr. Gary LeRoy, president-elect of the American Academy of Family Physicians (AAFP).

“As we move forward as a society, we are learning more,” he said. “Since 2008, opioid and substance use disorders have become a national epidemic. It’s on everybody’s consciousness right now as health care professionals.”

In 2017, more than 70,000 Americans died from drug overdoses.

In terms of treatment, it found that three drugs approved by the Food and Drug Administration — naltrexone, buprenorphine, and methadone — can help adults with opioid use disorder reduce relapses and stick with treatment. The task force also found that psychosocial interventions like behavioral therapy can help adults avoid or reduce their use of illicit drugs, particularly cannabis.

The recommendation does not extend to adolescents aged 12 to 17 years. Mangione said this should not be confused as a recommendation against screening in this age group; rather the panel did not have enough information to assess whether screening tools and interventions are effective and safe for teenagers. Due to concerns about the effects of long-term buprenorphine use on the developing brain, this drug, for example, is approved only for ages 16 years or older. The panel called for more studies to fill this research gap.

The recommendation is not mandatory for clinicians, nor does it endorse one particular screening tool or intervention. It is up to primary care providers, hospital systems, and medical organizations to decide whether and how to implement drug screening, Mangione said.

Some medical organizations, like the American College of Physicians, which represents internists, and the AAFP have their own recommendations about clinical care. While neither would comment directly on the draft recommendations, LeRoy said many physicians are likely already on the lookout for signs of drug use, but may not always be using a particular tool.

“We may not be checking boxes on a screen, but we’re mentally checking boxes saying something is wrong,” he said.

LeRoy said continuity of care and understanding family dynamics sometimes help family physicians and other providers clue into changes that could indicate illicit drug use.

“For some of these folks, we have literally watched them grow up,” he said. “So we’ve watched how they behaved and how they did in school as an adolescent. And then it’s just like, OK, something’s wrong. Let’s have a discussion here.”

One challenge, he added, is that there are many constraints on physicians’ time and many topics to cover in visits.

“Primary care providers are very, very busy individuals,” he said. “It would be nice in a perfect world to sit down and do all the screens for everything under the sun on our patients. But you find what you what works within your practice.”

Dr. Holly Biola, chief of family medicine at the Lincoln Community Health Center in Durham, N.C., said there could be cultural and language barriers to using some tools, noting that it’s not uncommon for her to encounter six different languages in a single day.

“That is not to say we shouldn’t be screening all adults for illicit substances. I think we should,” Biola said. “I just worry about the logistics of it and about finding the right tool for my patients.”

The draft statement does stipulate that screening is recommended “when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred.” In some clinics and health centers, Mangione said, there aren’t sufficient services available to diagnose and treat patients after screening indicates they need help.

“If you offer screening and find people with serious problems but you have no ability to get them to treatment, then you haven’t helped them much,” she said.

LeRoy agreed, noting that access to resources, financial challenges, and transportation to health care services can all present hurdles. He also said it’s important to have care on site if possible because when people leave, “sometimes you don’t see them back. They just disappear.”

Despite potential challenges in implementation, the new recommendation is important given current substance use issues across the country, Mangione said. “I think in the context of the opioid epidemic, most primary care providers would welcome the recommendation.”

Editor’s note: This article was updated to clarify that screening does not include testing patients for drug use.

Leave a Comment

Please enter your name.
Please enter a comment.

  • ‘Big Brother’ always knows what is best for you. This committee is out of touch. Addicts never recover until they decide they are ready. It doesn’t matter what substance they abuse, take that away and they find another. There are plenty of resources available now. Is the government going to force addicts into these programs?!

  • “Just say no.” When I was a child, my father — who was a master marksman — taught me that you never tell anyone else that you own a gun. If my doctor asked me if I have a gun, I would say “no.” It’s none of his business, and the question is intrusive and irrelevant to any problem I would bring to a doctor.

    Same issue here. If a doctor asked me if I use illicit drugs — which I do not and never have — I would say “no” regardless of whether I did or not. Why? Because unless whatever ails me that brought me to the doctor could be caused by drug use, it’s none of his business, irrelevant and intrusive. Additionally, I would never tell a doctor anything that could end up in records shared with insurance companies or Medicare if it would stigmatize me or put me at some disadvantage.

    And yes, Jonathon, I have read the article. 😉

  • Go to a doctor for help with pain your a drug addict might as well have a big stamp drug addict . I have lost faith in doctors ever since they allowed the Government to dictate what they are allowed give someone, that is in pain. It is a bunch of crap all progress has stopped no new non-addictive pain drugs. even though they have drugs like oxycodone with naloxone witch have no high doctors say it won’t work but it does. there is a small high but not enough to make you want to keep going and going after a while you feel no high at all just the high of walking with out pain. give the doctors the ability to treat there patients again not punish people that have to look out side of the box for their pain meds. just the way I see It dammit .

    • Most doctors are all about money. Often when they are working for a corporation they are under pressure to avoid lawsuits at any cost. Even if that cost is by listening to marketing consultants and lawyers who train them to use lies to make money from adverse regulations. I discussed my medications with my primary care doctor once and all she did was say “that’s too much medication” three times and never asked me the reason for my pain. Doctors have forgotten to treat the patient or, rather the disease. Medical moral is at an all-time low.

  • Randomly screening all adults without a court order is unconstitutional. There has to be an arrest made first. In fact allowing companies to randomly screen it’s employees is not only borderline illegal, it is also ineffective. Most Drug Addicts cheat their tests anyway and are almost impossible to remove from a company unless they steal or assault another employee, which they often do.

    • While I agree that it would be unconstitutional if someone were to attempt this, I think it bears pointing out that the “screenings” in question comprise the practice of merely asking patients if they use drugs, something almost all doctors already do. No one is suggesting forcibly drawing blood from Americans.

      This should have been clear to you if you had read the article, which had its share of issues without the need to imagine any additional ones.

    • If you are applying for a job in a sensitive area, such as aviation, military or government work, you are the one that’s wanting that job. You need to comply with the rules laid out by the company/government agency that you’ve applied to. That being said, it’s NOT unconstitutional for you to submit to a drug test/questions. It’s voluntary.

  • This is absolutely ridiculous. The government needs to stay out of people’s personal lives when they can’t even figure out how to keep people healthy with the socialist welfare programs they’ve already implemented and the middle class is paying for. The American Heart Association says that roughly 800000 people die annually from cardiovascular disease and the CDC says that roughly 10% of the American populace has diabetes, that’s 30 million people. The screwed-up thing is that I just saw in the gas station that EBT can now be used on Reese’s Snickers Butterfingers a place known as a Krispy krunchy Chicken accepts EBT. So so they now have all these people caught in this negative feedback loop of disease in the guise of support yet they’re going to tell people they can’t consume a substance they deem illegal and unhealthy. It’s just laughable, the hypocrisy of it all. If some grown adults want to snort some Coke or take some pills who in the hell is the government to say they can’t when in all actuality the government played a huge role in creating the opioid crisis. Anyways if you can’t tell I don’t support big government telling grown adults what they can and can’t do and their personal lives.

    • You didn’t read the article. Did you?

      It is a recommendation that doctors simply ask patients if they use illicit drugs. That’s the “screen”. It’s not drug testing.

      Which you would know. If you read the article.

  • Doctors already ask enough questions without throwing in nosy, judgmental questions. Asking about family history of disease and allergies is reasonable. Asking about gun ownership (yes, 2 in 10 doctors do this) and recreational drug use is not reasonable. There is virtually no possibility that an adult who is using a substance has never been told it is bad for them. We hear it in school, we hear it on TV, we read it in articles. $300,000/year doctors need to do a little better than regurgitate factoids my 5th graders know by heart. We should get more for our 50 buck co-pays than that, they owe it to us.

    Being honest with your doctor when it comes to substance use is almost always a bad move. For one thing, they will be less likely to go give 100% effort in treating someone they look down upon. Secondly, being a substance user (as they call it) means you will be behind non-users on the organ transplant list.

    I don’t know about you, but my choice to imbibe a legal substance should not be a death sentence when it comes time to replace the old liver.

  • Submit to the tests or you’ll be denied coverage. How long before the nanny state states punishing folks for doing something to their own bodies? In every place they have decriminalized drugs, the overall use goes down. Those that were on the fringes because society decided what “proper” citizens should do, all of a sudden were no long pariahs. Those robbing and turning tricks for drugs no longer needed to resort to crime. Unemployment dropped, crime dropped, and the associated health crises went away. But, as long as big pharma, the state, the ama have any say, they will continue to make 1984 a reality, rather than a dystopian cautionary tale.

    This society places far too much power in the hands of seemingly anybody and everybody except the individual themselves. Not certain about everybody else, but I for one feel I am most qualified to run my life, and you, best suited to run yours. But, hey. What do I know. Right?

    • You didn’t read the article. Did you?

      It is a recommendation that doctors simply ask patients if they use illicit drugs. That’s the “screen”. It’s not drug testing.

      Which you would know. If you read the article.

  • In a failed health system, the U.S. panel recommends screening for drug use when the opioid crisis started in the medical system? From the National Pain Center, “Don’t blame opioids for the opioid crisis—doctors must become better at pain management. – “https://qz.com/1136393/opioid-crisis-dont-blame-opioids-doctors-must-become-better-at-pain-management/ … it seems to me that the health system in government still does not know what it is doing.

    Coming from the THE PRESIDENT’S COMMISSION ON COMBATING DRUG ADDICTION AND THE OPIOID CRISIS – “Medical education: Medical education has been deficient in pain management, opioid prescribing, screening for, and treating addictions. 31 During the 1990’s, the pain movement should have alerted medical education institutions and creators of continuing medical education courses to address this issue. In some medical schools and some specialties, it remains inadequate to this day. 32 One strategy promoted 10 years ago to stratify patients’ risk for opioid misuse and overdose was the screening of patients for substance use disorders (SUDs), especially pain patients. 33 Implementation of Screening, Brief Interventions, and Referral to Treatment (SBIRT) in healthcare systems was incentivized with billing codes. 34 SBIRT was mainstreamed into health care reform, but has yet to be incorporated nationally into medical curricula, or applied as routine care. Nor do core curricula necessarily address addictions, treatment options, or stress the need to screen for substance use and mental health. – https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-1-2017.pdf

    This U.S. Panel is doing a great injustice to our system, and the FDA is the agency that approved the opioid medications based on science. What is the FDA doing about that?

    Also, read about the Flexner Report to understand how the the current medical system started in America – The Flexner Report ― 100 Years Later – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178858/

    The root of the problem is how the practice of medicine is conducted. There are medical education problems that are funded by Big Pharma – The Pharmaceutical Industry’s Role in U.S. Medical Education – https://in-training.org/drugged-greed-pharmaceutical-industrys-role-us-medical-education-10639

    These type of U.S. panels are a cancer on the backs of patients that need help. Instead of trying to pass honorable policy, they make the circumstances worse for patients and tend to distract from addressing root problems, whether it is physical, mental or emotional , or all three.

  • I’d also like to say that screenings in general are the biggest joke in the world, at least in the USA. The media puts it out there that screenings are a panacea and everyone repeats the lie for fear of sounding less than progressive. In cases where “screenings” (sounds like something WWF guys used to do to each other) might actually do some good, blood pressure testing for example, all the screener can do is tell the person, “High blood pressure is bad, mmmKay?” The odds are overwhelming that any person who submits to the testing offered by the timid old women in the ShopRite either has perfectly normal blood pressure, and will consequently walk away with a false sense of security about their health and believe seeing a doctor is entirely unnecessary, or they will learn for the first time they have high blood pressure (but remember, they wouldn’t be using a free screening if they could afford to follow up with a doctor,) and now you’ve basically given them and anxiety disorder as well, which can only drive their blood pressure higher.

    Most Americans cannot afford their co-pays and their doctors are incompetent to boot. Screenings are promoted by the media to make money for the people who sell the tests.

A roundup of STAT’s top stories of the day in science and medicine

Privacy Policy