Alex H Krist1,2, Karina W Davidson3, Carol M Mangione4, Michael J Barry5, Michael Cabana6, Aaron B Caughey7, Susan J Curry8, Katrina Donahue9, Chyke A Doubeni10, John W Epling11, Martha Kubik12, Gbenga Ogedegbe13, Lori Pbert14, Michael Silverstein15, Melissa A Simon16, Chien-Wen Tseng17,18, John B Wong19. 1. Fairfax Family Practice Residency, Fairfax, Virginia. 2. Virginia Commonwealth University, Richmond. 3. Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York. 4. University of California, Los Angeles. 5. Harvard Medical School, Boston, Massachusetts. 6. University of California, San Francisco. 7. Oregon Health & Science University, Portland. 8. University of Iowa, Iowa City. 9. University of North Carolina at Chapel Hill. 10. Mayo Clinic, Rochester, Minnesota. 11. Virginia Tech Carilion School of Medicine, Roanoke. 12. Temple University, Philadelphia, Pennsylvania. 13. New York University, New York, New York. 14. University of Massachusetts Medical School, Worcester. 15. Boston University, Boston, Massachusetts. 16. Northwestern University, Evanston, Illinois. 17. University of Hawaii, Honolulu. 18. Pacific Health Research and Education Institute, Honolulu, Hawaii. 19. Tufts University School of Medicine, Boston, Massachusetts.
Abstract
IMPORTANCE: An estimated 12% of adults 18 years or older and 8% of adolescents aged 12 to 17 years report unhealthy use of prescription or illegal drugs in the US. OBJECTIVE: To update its 2008 recommendation, the USPSTF commissioned reviews of the evidence on screening by asking questions about drug use and interventions for unhealthy drug use in adults and adolescents. POPULATION: This recommendation statement applies to adults 18 years or older, including pregnant and postpartum persons, and adolescents aged 12 to 17 years in primary care settings. This statement does not apply to adolescents or adults who have a currently diagnosed drug use disorder or are currently undergoing or have been referred for drug use treatment. This statement applies to settings and populations for which services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred. EVIDENCE ASSESSMENT: In adults, the USPSTF concludes with moderate certainty that screening by asking questions about unhealthy drug use has moderate net benefit when services for accurate diagnosis of unhealthy drug use or drug use disorders, effective treatment, and appropriate care can be offered or referred. In adolescents, because of the lack of evidence, the USPSTF concludes that the benefits and harms of screening for unhealthy drug use are uncertain and that the balance of benefits and harms cannot be determined. RECOMMENDATION: The USPSTF recommends screening by asking questions about unhealthy drug use in adults 18 years or older. Screening should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred. (Screening refers to asking questions about unhealthy drug use, not testing biological specimens.) (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for unhealthy drug use in adolescents. (I statement).
IMPORTANCE: An estimated 12% of adults 18 years or older and 8% of adolescents aged 12 to 17 years report unhealthy use of prescription or illegal drugs in the US. OBJECTIVE: To update its 2008 recommendation, the USPSTF commissioned reviews of the evidence on screening by asking questions about drug use and interventions for unhealthy drug use in adults and adolescents. POPULATION: This recommendation statement applies to adults 18 years or older, including pregnant and postpartum persons, and adolescents aged 12 to 17 years in primary care settings. This statement does not apply to adolescents or adults who have a currently diagnosed drug use disorder or are currently undergoing or have been referred for drug use treatment. This statement applies to settings and populations for which services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred. EVIDENCE ASSESSMENT: In adults, the USPSTF concludes with moderate certainty that screening by asking questions about unhealthy drug use has moderate net benefit when services for accurate diagnosis of unhealthy drug use or drug use disorders, effective treatment, and appropriate care can be offered or referred. In adolescents, because of the lack of evidence, the USPSTF concludes that the benefits and harms of screening for unhealthy drug use are uncertain and that the balance of benefits and harms cannot be determined. RECOMMENDATION: The USPSTF recommends screening by asking questions about unhealthy drug use in adults 18 years or older. Screening should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred. (Screening refers to asking questions about unhealthy drug use, not testing biological specimens.) (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for unhealthy drug use in adolescents. (I statement).
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