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Screen all adult patients for drug abuse, national panel urges

A national panel of health experts recommended that doctors screen all adult patients for illicit drug use, including improper use of prescription medications. But the group, the U.S. Preventive Services Task Force, stopped short of endorsing such screening for teenagers, a position that puts them at odds with major adolescent health groups. (Kathryn Gamble/The New York Times/File)
A national panel of health experts recommended that doctors screen all adult patients for illicit drug use, including improper use of prescription medications. But the group, the U.S. Preventive Services Task Force, stopped short of endorsing such screening for teenagers, a position that puts them at odds with major adolescent health groups. (Kathryn Gamble/The New York Times/File)(NYT)

A national panel of health experts recommended Tuesday that doctors screen all adult patients for illicit drug use, including improper use of prescription medications. But the group, the US 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, appointed by the Department of Health and Human Services but operated 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.

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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 copayment.

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 help 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.”

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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 cannot take place in a vacuum: Doctors must be able to offer referrals for further diagnosis and treatment.

Mangione, a primary care physician, said that doctors are becoming increasingly eager to learn about medication-assisted treatments for addiction, because such services can be hard to come by and require special training.

The thrust of the recommendations is directed at patients who appear asymptomatic; those in the throes of addiction will be more readily apparent. There is no upper age limit for screening, said Mangione. While some people may assume that patients struggling with substance use disorders will be younger adults, older patients need scrutiny, too.

Careful screening could correct some problems, Mangione said. Since many older patients are prescribed medications from different doctors, some may be taking too many medicines for the same condition, unaware of drug interactions. And some could be sharing a friend’s pain medications.

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While the task force did not recommend screening ages 12 to 17, it did not advise against such a step either.

“We’re not telling people to screen and we’re not telling people not to screen,” Mangione said about teenagers.

The task force relies on academic research. Those researchers concluded that the few clinical trials looking at screening as an intervention for teenagers were small and largely focused on cannabis, and they did not have clear beneficial results. The panel, therefore, said it was calling for more research on adolescent screening.