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JAMA Patient Page
June 9, 2020

Screening for Unhealthy Drug Use in Adults and Adolescents

Author Affiliations
  • 1Associate Editor, JAMA
JAMA. 2020;323(22):2350. doi:10.1001/jama.2020.8192

The US Preventive Services Task Force (USPSTF) has recently published recommendations on screening for unhealthy drug use in adults and adolescents.

What Is Unhealthy Drug Use?

Unhealthy drug use refers to using illegal drugs or misusing prescription medications or household products. Illegal drugs include cocaine, heroin, and hallucinogens (such as LSD). Prescription medications include sedatives (such as benzodiazepines), opioids, and stimulants. Household products include glues, solvents, and gasoline. Alcohol and tobacco are not considered drugs for the purposes of this recommendation statement but are illegal for underage persons.

Drug use is linked to risk-taking behaviors that cause injury and death, violence, unsafe sexual behaviors, and long-term mental health problems. There is also a risk of death due to overdose. Treatment for drug use disorders includes both medications as well as behavioral therapy and counseling.

How Is Screening for Unhealthy Drug Use Done?

Often, a primary care practitioner asks a simple yes/no question about drug use during wellness visits. For the purposes of clinical studies, more detailed questionnaires are used. Examples include the BSTAD (Brief Screener for Tobacco, Alcohol, and Other Drugs), ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), and TAPS (Tobacco, Alcohol, Prescription Medication, and Other Substance Use). These questionnaires are not meant to diagnose a drug use disorder, and people who report unhealthy drug use should be referred for further evaluation.

What Is the Population Under Consideration for Screening for Unhealthy Drug Use?

This recommendation applies to adults aged 18 years or older and adolescents aged 12 to 17 years who do not have a current diagnosis of any drug use disorders.

What Are the Potential Benefits and Harms of Screening for Unhealthy Drug Use?

The potential benefit of screening for unhealthy drug use is reducing negative health, social, or legal outcomes related to drug use. No studies have directly looked at the effects of screening on these outcomes. For adults, there is adequate evidence that screening questionnaires are able to accurately detect drug use disorders and that treatment of these disorders with medications and/or psychotherapy can reduce drug use as well as relapse. There are little data available for adolescents. Potential harms include stigma from being labeled a drug user as well as side effects from medications used to treat drug use disorders. For adolescents, there is uncertainty about how some of these medications may affect brain development.

How Strong Is the Recommendation to Screen for Unhealthy Drug Use?

The USPSTF concludes with moderate certainty that screening for unhealthy drug use in adults has moderate net benefit when services for further care and treatment can be offered. For adolescents, the balance of benefits and harms cannot be determined.

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Conflict of Interest Disclosures: None reported.

Source: US Preventive Services Task Force. Screening for unhealthy drug use: US Preventive Services Task Force recommendation statement. JAMA. Published June 9, 2020. doi:10.1001/jama.2020.8020