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US Preventive Services Task Force
Evidence Report
June 9, 2020

Screening for Unhealthy Drug Use: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Author Affiliations
  • 1Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
  • 2Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
  • 3School of Public Health, Oregon Health & Science University–Portland State University, Portland
  • 4Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
JAMA. 2020;323(22):2310-2328. doi:10.1001/jama.2019.21381

Importance  Illicit drug use is among the most common causes of preventable morbidity and mortality in the US.

Objective  To systematically review the literature on screening and interventions for drug use to inform the US Preventive Services Task Force.

Data Sources  MEDLINE, PubMed, PsycINFO, Embase, and Cochrane Central Register of Controlled Trials through September 18, 2018; literature surveillance through September 21, 2019.

Study Selection  Test accuracy studies to detect drug misuse and randomized clinical trials of screening and interventions to reduce drug use.

Data Extraction and Synthesis  Critical appraisal and data abstraction by 2 reviewers and random-effects meta-analyses.

Main Outcomes and Measures  Sensitivity, specificity, drug use and other health, social, and legal outcomes.

Results  Ninety-nine studies (N = 84 206) were included. Twenty-eight studies (n = 65 720) addressed drug screening accuracy. Among adults, sensitivity and specificity of screening tools for detecting unhealthy drug use ranged from 0.71 to 0.94 and 0.87 to 0.97, respectively. Interventions to reduce drug use were evaluated in 52 trials (n = 15 659) of psychosocial interventions, 7 trials (n = 1109) of opioid agonist therapy, and 13 trials (n = 1718) of naltrexone. Psychosocial interventions were associated with increased likelihood of drug use abstinence (15 trials, n = 3636; relative risk [RR], 1.60 [95% CI, 1.24 to 2.13]; absolute risk difference [ARD], 9% [95% CI, 5% to 15%]) and reduced number of drug use days (19 trials, n = 5085; mean difference, –0.49 day in the last 7 days [95% CI, –0.85 to –0.13]) vs no psychosocial intervention at 3- to 4-month follow-up. In treatment-seeking populations, opioid agonist therapy and naltrexone were associated with decreased risk of drug use relapse (4 trials, n = 567; RR, 0.75 [95% CI, 0.59 to 0.82]; ARD, –35% [95% CI, –67% to –3%] and 12 trials, n = 1599; RR, 0.73 [95% CI, 0.62 to 0.85]; ARD, –18% [95% CI, –26% to –10%], respectively) vs placebo or no medication. While evidence on harms was limited, it indicated no increased risk of serious adverse events.

Conclusions and Relevance  Several screening instruments with acceptable sensitivity and specificity are available to screen for drug use, although there is no direct evidence on the benefits or harms of screening. Pharmacotherapy and psychosocial interventions are effective at improving drug use outcomes, but evidence of effectiveness remains primarily derived from trials conducted in treatment-seeking populations.