August 15, 2019
For the first time, the US Preventive Services Task Force (USPSTF) has issued a draft statement recommending primary care providers to screen for illicit drug use in adults aged 18 years or older.1
The statement serves as a pending update to the USPSTF’s 2008 recommendation, which stated that evidence was “insufficient” to assess the harms and benefits of screening for illicit drug use in adults, pregnant women, and adolescents.2
Evidence supporting the Task Force’s 2019 draft recommendation, which was given a grade B, was deemed sufficient to conclude that:1
- Screening for illicit drug use in adults is associated with moderate net benefit when services for accurate diagnosis of unhealthy drug use or drug use disorders, effective treatment, and appropriate care can be offered or referred (moderate certainty).
- Currently, no studies provide direct evidence of the benefits and harms of screening, but adequate evidence indicates that available screening tools can detect illicit drug use.
- Adequate evidence indicates that 3 opioid FDA-approved pharmacotherapy agents (naltrexone, buprenorphine, and methadone) are associated with moderate benefits for reducing relapse and increasing treatment retention among adults with opioid use disorder.
- Adequate evidence indicates that psychosocial interventions are associated with moderate benefits for increasing abstinence from or reducing illicit drug use, with evidence suggesting the effects may be greater for intensive psychosocial interventions and for cannabis use.
- Direct evidence on the harms of screening is limited.
- The magnitude of the harms of screening, pharmacotherapy, and intensive psychosocial interventions is likely no greater than small based on lack of evidence that such interventions lead to serious adverse events and evidence that buprenorphine is associated with only minor side effects like constipation.
However, the USPSTF noted, current evidence is still insufficient to weigh the benefits and harms of screening for illicit drug use in adolescents.
- US Preventive Services Task Force. Draft recommendation statement: illicit drug use, including nonmedical use of prescription drugs: screening. https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/drug-use-in-adolescents-and-adults-including-pregnant-women-screening. August 2019. Accessed August 14, 2019.
- US Preventive Services Task Force. Drug use, illicit: screening. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/drug-use-illicit-screening. January 2008. Accessed August 14, 2019.