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.
“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.
Not everyone does drugs and for people to feel they need to take on a big brother approach is an invasion of privacy. Going too d…far.
Most commentaries are yelling “leave me alone, don’t touch my freedom”. That seems to indicate protection of their drug use. This article on the contrary underlines that Doctors Do Care – as is conform their Oath. I really don’t see the problem with MD’s more interested in their patients’ well-being by asking questions (no tests as per article). It seems logical to conclude that those having a problem with that don’t have a regular doctor, or don’t want to be helped. To be included in the next OD death numbers??
Sorry, but you are way off the mark. Most of the comments mention privacy concerns, use or no use. The pain management business borders on predatory. I am in pain management and the law says that a doctor can see a patient up to every three months, so does the Board of Medicine, AMA, CDC, DEA, and all the other guidance. However, doctors insist on getting paid 12 times a year stable patient or not. When will insurance companies step in and say hold it! Do really need to see our insured 12 times a year? Are we overpaying? As for being professional doctors lie to my face and say seeing me every month is the law; when I challenge that they say the Board of Medicine guidelines say to see me every month. Meanwhile, I have not seen a pain doctor in almost three years. I always see a nurse. Is the doctor even there? With such dishonesty in the medical profession, how can I trust them to handle screenings without concocting a way to charge me or invade my privacy?
If I were to be screened for illicit drug use for no apparent reason I would terminate my relationship with that provider
Thank you Dr. Takala. What we really need are more physician advocates , if possible, before things get way out of hand. Maybe some physicians can brainstorm and create a new medical association that will emphasize the physician-patient interrelationship? Who is the doctor in the room anyway?
I find this idea of mass screening an invasion of privacy and a bit too big brother for my taste.
I think we need to do monthly drug testing of politicians and any that have retired including past POTUS that receive govt pensions . Better yet there ought to be means testing to wheth they should receive a pension at all . Need term limits to help prevent so much corruption in govt .
Mr. Curl, how about the pharmaceutical companies executives? We already know they are living the high life.
More invasion of privacy!!! Get lost. More socialists!! If your a Doc you should know and talk to your patients. But all of you do one thing.Pass your patients of to the specialists. When i was young my family DOCTOR did it all. And when you are im paim you have to beg. All because others abuse stuff. My right to PRIVACY ended in 1977 everytime i go to a RANDOM ITS LIKE BEING RAPED!!! And then the famous well if you dont have nothing to hide. Ok. Lets go through your house every drawer!!! Every closet!! Same thing. Invasion of PRIVACY!!! The PRIVACY act pf 1974 took OUR PRIVACY. WE HAD PRIVACY. UNLESS you have a dam good reason.
I think you mean Communism, not Socialism. Under Socialism, depending on the country we might all have health coverage and doctors that don’t have expectations of becoming very wealthy.
Methadone is an effective treatment… The dawn is easily as bad as heroin but with methadone the state gets to be paid for your usage of it and keeping you on it and keeping you controlled in your drug abuse. I have worked with many people who are going through drug abuse methadone has never been the answer to save them only to deprive them from ever getting better.
Not to mention how dangerous it is. Thousands die a year from Methadone. Its highly addictive and very dangerous but hey.. big Pharma loves it. So does Big Rehab .. these laws are being written by special interest lobbys. If not they would be screaming to arrest the pharma companies who pushed 3 million doses on a town of 3000 in one years. These are the drug dealers that have threatened my well being since I am a chronic pain patient. You want to know why the sudden increase in heroin and street drugs and overdoses? Yanking people who are suffering from doctor care and pain management for rulings that will NEVER stop addicts from being addicts but leaving those who suffer two choices. Suicide or street drugs.
Seriously the fucked up government has ZERO business in our medical care. If they want to implement laws than do the job and start jailing these Pharma execs and sales people for mass murder. Use the fines to open mental and addiction centers for all. Find shelter for the homeless. End the income inequality that has forced an entire generation and all to come into slavery for shelter.
Fix the fucking real issues and stay out of my medical care.
Suboxone is the drug of choice now in the medical profession. Same thing, but supposed to be easier to quit once moved over. Methadone was becoming a drug of abuse and it was killing people. Helping people who have no pain quit opioids requires a multi-layered approach, both chemical and mental. Even if a person is in pain after a while hates being a prisoner to prescriptions, because of the stigma and the way doctors treat you when they know they have you over a barrel.
That’s because my dad died when I was in 6th grade I had to quit school and go to work help support Mt family
This is what America needs! More panels, more intrusion into your “free” lives. You were born free, live free. Live your life as you see fit, only you can save yourselves. Only you can steer your lives in the direction of your choice. You decide your fate, your destiny, it should never be an entity that dictates your life.
Under care of a pain management specialist given urinalysis monthly. Leave us alone, another way to take more of the meds we need to function away from patients in need. Concentrate on the heroin/fentanyl crisis at hand caused by Gov getting involved in health care. Treatment you say not enough treatment centers and to expensive as it is now. Check my documentation, walk a few steps in our shoe see how it is. All you communistic ideology.
You are dead right. But, what do you do to stop physical pain that is constant? Opium has been around thousands of years and it meant for the short term. Pharma can’t get it right. NSAID medications eventually tear your guts into shreds. Even the VA cut back on pumping 800mg of Ibuprofen into soldiers and went back to the Real Mccoy. Non-abusers can handle pain maintenance with narcotics. The people who steal patient medications are screwed up. If the government would stop with its knee jerk reactions, doctors could lighten up a bit and pain patients would not feel so trapped.
Stupid and a HUGE waste of time… 70,000? Woopteedoo! Lets look up the number of people killed by alcohol… car accidents, overdose, violence… opioids are “not ok” but booze! No problems… smh