National Center for Health Research, September 8, 2019
National Center for Health Research’s Public Comments on the USPSTF’s Draft Recommendation Statement on Illicit Drug Use, Including Nonmedical Use of Prescription Drugs: Screening
Thank you for the opportunity to express our views on the U.S. Preventive Services Task Force (USPSTF) draft recommendation on screening for illicit drug use. The National Center for Health Research is a nonprofit think tank that conducts, analyzes, and scrutinizes research, policies, and programs on a range of issues related to health and safety. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.
We support the efforts of the USPSTF to re-evaluate the 2008 recommendations on illicit drug use screening. It is encouraging that pharmacotherapy and psychosocial interventions have been shown to successfully treat illicit drug use in adults 18 years and older, and we acknowledge that screening can potentially ensure that more individuals receive appropriate care. Unfortunately, however, effective and affordable treatments and interventions are frequently not available to newly screened individuals. Barriers to access include too few spaces, long waiting times, and high costs. In addition, some treatment facilities offer treatments that have not been scientifically proven to effectively treat persons struggling with addiction.
We are concerned that the draft recommendation encouraging screening “when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred” will lead to unintended harm. Physicians are not always aware if appropriate care is available. If treatment facilities are not available or affordable, screening will not be helpful. In fact, if patients are encouraged to admit their illicit drug use but not able to get treatment, this could discourage them from returning to that physician. Moreover, asking patients about illicit drug use may make some individuals (especially those who use drugs illicitly) reluctant to return to their physician, or any physician, in the future.
In summary, as the draft recommendation points out, there is no scientific evidence related to the benefits and, particularly, the potential harms of screening. Furthermore, this lack of evidence is not addressed in the research needs and gaps section. We strongly encourage the USPSTF to delay recommendations until they obtain evidence to ensure that screening for illicit drug use does not have unintended consequences that outweigh any benefits.
In particular, we would like to see evidence that:
- Screening does not deter individuals from seeking care. This could discourage many patients from going to their doctor in the future, and is of particular importance for pregnant teens and women who might not seek prenatal care out of fear of being reported to legal authorities,
- Screenings would only be offered when effective treatments and appropriate care can be offered to individuals who need it, and
- Physicians can easily access information about the availability of treatments, associated costs, and potential legal requirements to report results to authorities and how this information impacts when they implement screening.
Additionally, we are concerned that the reported accuracy of some screening tools is relatively low for some types of patients or some types of drugs. For example, the ability of these types of tools to detect the use of illicit drugs in pregnant persons range from 37% – 76% and they accurately identify problem use from 60% – 83% of the time. The risks associated with the low accuracy may thus outweigh the benefits of screening.
Thank you for the opportunity to comment on this important issue.
For questions or more information, please contact Nina Zeldes at the National Center for Health Research at firstname.lastname@example.org or at (202) 223-4000.