PCPs should ask adults about drug use, USPSTF says

For the first time, the U.S. Preventive Services Task Force recommended that primary care physicians ask adults about drug use and connect those with a drug use problem to resources for treatment.

However, the USPSTF maintained its previous position on screening teenagers for drug use, saying there is insufficient evidence to recommend that PCPs do so.

The task force’s statements, based on 99 studies that included a total of 84,206 participants, were published in JAMA.

Karina Davidson

“It’s important to note that screening [of adults] should be implemented when services for accurate diagnosis, effective treatment and appropriate care can be offered or referred,” task force vice chair Karina Davidson, PhD, MASc, told Healio Primary Care.

Regarding drug use in teens, she said that “clinicians should be prepared to address the concerns of patients or caregivers and provide the appropriate care.”

Davidson, who is also senior vice president of research and the head of a new center focused on behavioral and cardiovascular health research at the Feinstein Institutes for Medical Research at Northwell Health in New York, said there are several areas in need of research before recommendations in youth can be made, including:

• the effectiveness of screening and interventions for teens;
• the development of adequate screening tools for detecting nonmedical use of prescription drugs; and
• ways to improve access to behavioral interventions and medication for drug use disorders.

Richard Saitz, MD, MPH, FACP, DFASAM, professor of community health sciences at Boston University School of Public Health, noted in a related editorial that the task force based its recommendation for screening on studies that included patients with known drug use or those who were seeking treatment, rather than “evidence of benefits and harms of preventive care services for ‘people who have no signs or symptoms of the specific disease or condition under evaluation.’”

Using studies about drug treatment to steer recommendations on screening is “akin to considering studies of chemotherapy for patients seeking care for breast cancer or thrombolysis for symptomatic myocardial infarction as relevant to questions of cancer and cardiovascular disease screening efficacy,” Saitz wrote. He further cautioned that participants who are screened in studies are often protected by confidentiality and thus, may respond differently than they would if their identities were not hidden.

“These observations should serve as an important call for the development and study of new strategies to identify and address drug use in ways that can reduce related harms of such use,” Saitz concluded.

References:

• Patnode CD, et al. JAMA. 2020;doi:10.1001/jama.2019.21381.
• Saitz R. JAMA. 2020;doi:10.1001/jama.2019.20152.