Proposal to screen all US adult patients for substance use

Abstract

On Aug 13, the US Preventive Services Task Force (USPSTF) published a draft recommendation on screening for illicit drugs, including the non-medical use of prescription drugs. The announcement comes amid the opioid crisis in the USA and is motivated by the need for early identification of people at risk for drug use. The task force draws on data from a 2017 national survey in which 11·5% of Americans reported illicit drug use with more than 700 000 overdoses. In contrast to the 2008 recommendation against drug screening in both adults and adolescents because of insufficient evidence, for the first time, USPSTF is now advising physicians to screen all adult patients for illicit drug use without biological drug testing. However, potential harms associated with such screening and evidence for best practice first needs to be considered in greater detail. USPSTF notes that the recommendation is non-binding for physicians and carries two limiting caveats. First, the screening should be implemented when appropriate and affordable access to care can be offered to patients. Second, physicians should be made aware of any legal requirements for mandatory screening and reporting of results to state authorities and should understand the implications of reporting, such as stigmatisation. Experts in addiction research, Wayne Hall and Louisa Degenhardt contacted by The Lancet, raised further concerns about the quality of research behind the recommendation. Notably, the summary of the USPSTF review found no direct evidence that addresses the benefits and harms of screening for drug use. Furthermore, the evidence for the accuracy of screening questionnaires is scarce, particularly for brief interventions aimed at addressing problematic drug use and its associated consequences on health, social, and legal outcomes. Thus, the USPSTF claim that its recommendation is based on moderate evidence of moderate benefit might be premature. The draft recommendation is open for public comment until Sept 9. Those providing feedback should ask how beneficial and cost-effective an under-researched and prematurely implemented measure could be in addressing the harms of opioid and substance use in the USA? Screening US adults for substance useThe Editors' concern for potential harms of screening for drug use should be weighed against the potential harms of not screening.1 The US Preventive Services Task Force (USPSTF) review found no evidence addressing harm from drug screening. What we do know is that drug use impacts the health of patients whom we see every day in primary care. To not incorporate drug screening in medical visits perpetuates stigma and invites addiction to be viewed as a personal failing or a social issue, rather than an important and treatable health problem. Full-Text PDF