Screening for drug use in primary care: Practical implications of the new USPSTF recommendation [editorial].

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. 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. 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. For adolescents, the USPSTF found insufficient evidence to recommend screening for unhealthy drug use (I statement), In this editorial, the authors 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.

Related protocols: CTN-0065