USPSTF Update: Screening adults for unhealthy drug use has moderate net benefit

1. Screening for drug abuse in adult populations by asking questions during patient appointments was found to have moderate net benefit as long as further diagnostic tests, treatment, and supportive care were also available.

2. The benefit of screening for drug abuse in adolescents was not able to be assessed.

Evidence Rating Level: 1 (Excellent)

Study Rundown: The US Preventative Task Force (USPSTF) commissioned systematic reviews of evidence evaluating the risks and benefits of screening for harmful drug use by asking questions in adults and adolescents above the age of 12. This study was conducted in an effort to update the 2008 USPSTF recommendations, in which evidence for conducting screening for unhealthy use of drugs in this manner was found to be inconclusive. The USPSTF further evaluated the accuracy of the different screening tools used, as well as the risks and benefits of subsequent treatment, both pharmacological and psychosocial, of patients who were diagnosed with a drug use disorder.

The USPSTF concluded that screening patients over the age of 18 for unhealthy drug use by asking questions had a moderate net benefit, if patients can be provided with further diagnostic testing, treatment, and supportive care. They suggested clinicians consider the use of screening tools such as NIDA Quick Screen, ASSIST, TAPS, and PRO.  Additionally, treatment with pharmacotherapy, including buprenorphine, methadone, and naltrexone for opioid use disorder reduced relapse rate and improved retention in recovery programs. Psychosocial therapy was found to increase short-term rate of abstinence. Potential harms of drug screening included dissuading patients who wish to avoid screening from seeing primary care physicians, and adversely impacting those who screened positive due to social stigma.

This study was limited by a lack of inclusion of studies originating from outside of the United States and lack of standardization of screening methods. Additionally, while a significant number of adolescents ages 12-17 are known to be impacted by drug abuse, the data regarding the benefits and accuracy of screening for this disorder in this population was inconclusive. Further study in this population is warranted.

Click to read the study in JAMA

Relevant Reading: Screening for Unhealthy Drug Use. Neither an Unreasonable Idea Nor an Evidence-Based Practice

In-Depth [systematic review]: In an effort to update recommendations on screening for unhealthy drug use, the US Preventative Task Force commissioned systematic reviews studying the risks and benefits of screening for unhealthy drug use, accuracy of screening tests that were utilized, and the risks and benefits of pharmacologic and psychosocial treatments for drug abuse.  It was determined that in non pregnant adults, direct screening tools detect unhealthy drug use with a sensitivity ranging from 0.71 to 0.94 and a specificity of 0.87-0.97. The data for use of screening tools in adolescent patients was inconclusive. In regard to the risks and benefits of treatment, the USPSTF determined that pharmacological and psychosocial treatment of drug use disorder was beneficial in adult populations. The effectiveness of naltrexone, methadone, and buprenorphine was studied in a number of trials in non-pregnant adults with opioid-use disorders. All were found to significantly reduce the rate of relapse (pooled RR 0.73 for naltrexone, 0.75 for buprenorphine and/or methadone) and increase patient retention (pooled RR 1.71 for naltrexone, 2.58 for buprenorphine and/or methadone). Psychosocial treatment tools significantly increased the likelihood of likelihood of abstaining from drug use at 3-4 months (pooled RR 1.6), with the greatest benefit seen in cannabis users (RR 2.08) and those who were actively seeking treatment (RR 2.08). Overall, the USPSTF has concluded that screening adults for unhealthy drug use confers a moderate net benefit, as long as further appropriate treatment and resources can be offered.

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