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Screen All Adult Patients for Drug Abuse, National Panel Urges

August 14, 2019

With 1 in 10 Americans saying they misuse drugs, doctors should ask everyone about both illegal and prescription use, the U.S. Preventive Services Task Force said.

A national panel of health experts recommended on Tuesday that doctors screen all adult patients for illicit drug use, including improper use of prescription medications. But the group, the United States Preventive Services Task Force, stopped short of endorsing such screening for teenagers, a position that puts them at odds with major adolescent health groups.

The panel, which is appointed by the federal Department of Health and Human Services but operates independently, said that its proposed guidelines are intended to combat alarmingly high rates of substance abuse in the United States. It cited a 2017 federal survey that found 1 in 10 Americans ages 18 and older said they were using illicit drugs or not using medications in ways that doctors intended.

The panel’s call for increased scrutiny by primary care doctors is an effort to slow the deadly use of opioids, including street fentanyl and heroin as well as prescription painkillers, perhaps the worst public health crisis in a generation. The experts hope that if front-line health professionals can detect patients’ burgeoning abuse of drugs early, they can help contain or reverse the problems.

The group’s guidelines are not binding on doctors but they carry weight: A provision in the Affordable Care Act says that services recommended by the task force must be covered by insurance with minimal or no co-payment.

The proposed new guidelines represent a major shift by the panel, which said in 2008 that it did not have sufficient evidence that screenings could helped people stop using drugs. But more recent research shows that screening can result in successful intervention, the panel said, so it is recommending that doctors or other health care providers ask patients about drug use either in brief written questionnaires or in private conversation during the office visit.

“We don’t want doctors and nurses to get hung up on one tool or another,” said Dr. Carol Mangione, an author of the proposals who is a professor of medicine and public health at the University of California Los Angeles. “Just that they do it.”

But the guidelines, which are open for public comment through Sept. 9, carry significant challenges for implementation.

Most doctors have no training in how to elicit honest answers from patients about such a stigmatizing behavior.

Additionally, medical practices must also be knowledgeable about state laws, some of which require them to report pregnant patients whom they even suspect of using illicit drugs.

And, the task force noted, screening can’t take place in a vacuum: Doctors must be able to offer referrals for further diagnosis and treatment.

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