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June 9, 2020

Screening for Drug Use in Primary Care: Practical Implications of the New USPSTF Recommendation

Author Affiliations
  • 1Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
  • 2University of Washington, Seattle
JAMA Intern Med. 2020;180(8):1050-1051. doi:10.1001/jamainternmed.2019.7335

The US Preventive Services Task Force (USPSTF) now recommends screening for unhealthy drug use if effective treatment is available (B recommendation), which is an update to its 2008 conclusion of insufficient information.1 The new recommendation is based on 3 important findings from large bodies of research in adults. First, valid screening tests for drug use are available. Second, treatments for drug use disorders (DUDs) are effective. Third, counseling adult primary care patients whose drug use is identified by screening does not decrease drug use.1-3 As a result, in contrast to USPSTF recommendations for unhealthy alcohol use, the USPSTF does not recommend brief preventive counseling in primary care to reduce drug use in patients identified by screening. Instead, the USPSTF recommends screening adults for unhealthy drug use, including nonmedical use of prescription drugs, when accurate diagnosis based on DUD symptoms and treatment of DUDs are available in primary care or by referral.1 For adolescents, the USPSTF found insufficient evidence to recommend screening for unhealthy drug use (I statement).1 We address several important issues regarding screening adult patients for drug use: (1) the importance of how screening is implemented, (2) the need to screen for cannabis use separately in the majority of states with legal medical or recreational cannabis use, (3) gaps in research on how to manage patients who screen positive for drug use, and (4) innovations that show promise for improving the diagnosis and treatment of DUDs in primary care.

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    1 Comment for this article
    Need to Emphasize Individual Responsibility
    Leon Garoyan |
    While we do not want to see drugs abused, the truth is that altering conscious states has been documented for centuries. Knowing this, we need to promote responsible use of legal and illegal substances. For decades the U.S. has mandated a black or white stance on drugs with no recognition of a gray area.

    There is a growing need for individuals to take responsibility for the materials they ingest. If a pharmaceutical is prescribed, there should be some effort made to understand what the positive and negative effects could be. The patient should be encouraged (if possible) to lower
    the dosage as needed. The same guidelines should especially be presented to nonmedical drug users.

    The emphasis should be to enhance ones physical / mental health, while not appearing impaired and maintaining responsible, socially acceptable behavior. These behavior modifications need to be introduced to the target population to achieve a widespread acceptance. Studies have shown popular media to be the most effective manner to gain compliance.