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.
When you sign up at any doctors office the questionnaire asks for all your medications. Anything else is none of their business unless something in your presentation during the examination prompts a need to know.
Ten year pilot plan with welfare recipients as the pool and then we’ll talk.
88,000 people die from alcohol every year. Why is our government or medical community not concerned about this? The 70,000 figure for opioid deaths includes any & all opioids in the system at TOD, prescribed or not.
If doctors were any good at screening, we never would have such severe addiction issues. But with 15 minutes to see a patient, they’re not going to catch things. Not to mention, as others have said, doctors are low on the trustworthy scale. For good reason, in my experience.
If rehab is so great, why doesn’t it work until the 17th time?
Why the hell give opioid addicts another opioid for ‘treatment ‘??!!
Chronic pain patients, who do not get high on their meds, can’t get opioids but addicts can. WTF?
This is a slippery slope that could certainly lead to involuntary UAs.
Stay healthy. Avoid doctors. Avoid meds-especially generics made in India. (Read Bottle of Lies by Katherine Eban)
Because everything revolves around money.
The pharmaceutical companies have dividends to pay. By law they must make money for their stakeholders. So the logic for health to be traded on the stock market is sinister, inadvertently, or not. It is good for people to advocate for change, but until the stock markets discontinue to make money off peoples suffering, nothing will change. And since physician organizations have been unable to mitigate the core problems, the government intervenes with corporate lobbyists, and they do not care if it is blood money or not. As long as their stakeholders are receiving dividends, nothing will change.
I agree with u on all but one thing. It’s a big thing that makes u sound extremely ignorant and im not trying to be mean. Opiate addicts may NEED a opiod(different from opiate) like methadone to get clean due to the fact that withdraw is so intense that the only true way to manage it is with another opiate or opiod. The difference is ur getting a dose that’s not too much or too little that u take in front of a RN. Plus it’s not cut with god-knows-what like heroin is. Methadone has saved my life. I was addicted to pain killers for over a dozen years and to heroin for 3 years. Methadone is something ive been on for 3 years and not only have i completely stopped heroin but ive also stopped all other drugs i was addicted to. Plus methadone doesnt get me hi, if u think that u really kno nothing about this topic and shouldnt be commenting.
Talk about packing it on.
This may be the back end story of what is going on and if you have more to say, I would like to hear it. After relentlessly pursuing the “truths”, I have also discovered that some people (in general) seem to avoid truth.
The front end is there is a problem with the delivery of care for pain patients. The April article on STAT News:
“No more ‘shortcuts’ in prescribing opioids for chronic pain. Millions of Americans need nuanced care.” – https://www.statnews.com/2019/04/26/no-shortcuts-prescribing-opioids-chronic-pain/
“Don’t blame opioids for the opioid crisis—doctors must become better at pain management”. – Dr. Jay Joshi, MD, National Pain Center
Still barking at the wrong tree, and also trying to make us believe that this is an effort to help. Not true. This is a well planned scheme to go further into invading our freedom. Do you really think my family doctor wont realize that something is wrong right off the bat as soon as I walk into the room? This guys treat patients all they and can sppt a drug user a mile away in a night with no stars. Please! Use your brains! Don’t be so gullible to swallow this b.s. up without thinking it over for a second.
There is still a big crowd of people that need prescription meds to be able to have somewhat a close to normal life. All this is only infusing unnecessary paranoia, prejudice and also taking away from the ones who have a real need for meds.
I am not a user, and I would be seriously offended if someone came to me screening me for drug abuse. Under what pretext. Again start by trating the ones that are in need and are looking actively for help.
Freedom also means that if someone chooses to die in a certain way he also has the right to do so, if it pleases him. This concept might be a bit too progressive for many. But ultimately who is anybody to push anyone else to do something against their will? If you are not hurting anyone else, go for it!
Set up centres and a federal budget to REALLY help the ones that want and seek help. How many people are out there crying for help and don’t have the resources to get it?
This society and the way is set up is churning out people in need of help by the second. The greed and lack of empathy are appaling. Rehab centres can cost the price of a house. There is no real help, only business and money making schemes all around.
This country has a very real drug problem and “screening” schemes, more privacyinvasion, bogus referrals to money pits on highly charged treatments are certainly not the solution. Maybe following the money trail and cut the problem at the real root coild be a good beginning.
Comments are closed.