USPSTF recommends primary care screening for illicit drug use in all adults

The U.S. Preventive Services Task Force (USPSTF) issued a new draft recommendation in favor of screening for illicit drug use in adults age 18 years or older (grade B) when diagnostic and treatment services can be offered or referred.

Adults should be screened regardless of risk factors for illicit drug use, although there is not enough evidence to assess the balance of benefits and harms of screening in adolescents (grade I), according to the recommendation.

An estimated 7.5 million persons ages 12 years and older were classified as having a diagnosis of dependence on or abuse of illicit drugs in the past year. Illicit drug use is among the most common causes of preventable death, injuries, and disability. In 2017, illicit drug use caused more than 70,000 fatal overdoses, the Task Force noted.

While the agency's 2008 statement found insufficient evidence for screening in adults, the USPSTF now concludes with moderate certainty that screening among adults has a 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. No studies provide direct evidence on the benefits and harms of screening, they noted. The USPSTF found:

• adequate evidence that available screening tools can detect illicit drug use;
• adequate evidence that naltrexone, buprenorphine, and methadone, each approved by the FDA, have moderate benefits for reducing relapse and increasing retention in treatment in adults with opioid use disorder;
• adequate evidence that psychosocial interventions have moderate benefits for increasing abstinence from or reducing illicit drug use (effects may be greater for intensive psychosocial interventions and for cannabis use); and
• limited direct evidence on the harms of screening.

The magnitude of the harms of screening and pharmacotherapy and intensive psychosocial interventions are no greater than small, the Task Force concluded, based on a lack of evidence that these interventions cause serious adverse events, as well as evidence that buprenorphine is associated with only minor side effects (such as constipation).

The draft recommendation statement is intended to solicit public input, which will be accepted until Sept. 9 at 8 p.m. A final recommendation statement will be developed after review of the feedback and will include both a research plan and evidence review.