National Center for Health Research, October 28, 2019
National Center for Health Research’s Public Comments on the USPSTF’s
Draft Recommendation Statement Concerning Illicit Drug Use in Children,
Adolescents, and Young Adults: Primary Care–Based Interventions
Thank you for the opportunity to express our views on the U.S. Preventive Services Task Force (USPSTF) draft recommendation regarding guidance for primary-care based intervention for illicit drug use in children, adolescents, and young adults. The National Center for Health Research is a non-profit 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 agree with the USPSTF recommendation that more research is needed on interventions to reduce or prevent illicit drug use in children, adolescents, and young adults. The fact that several studies found that the intervention was associated with an increase in illicit drug use raises major concerns about the risks of implementing programs without evidence that they work. In addition, many of the interventions targeted a narrow set of circumstances, which may not be generalizable to other settings.
On a positive note, several studies found promising results, so with additional research a future recommendation may be able to support one or more interventions. However, there needs to be sufficient evidence to determine which interventions are appropriate for which setting before making a recommendation. Furthermore, additional research is needed to identify what approaches may be most useful for a more general population, as the studies analyzed in this recommendation focused on specific demographics.
There is also a need for more research concerning the impacts of these types of interventions for children and young adults. The draft recommendation was extended to include individuals younger than 10 years of age; however, as noted in the draft recommendation, there is no research evaluating interventions to prevent or reduce illicit drug use in children younger than age 10. In addition, there was limited evidence for young adults (ages 18 to 25 years). More information would be needed to address how specific interventions impact these age groups.
In addition, most prescription opioids are approved for people of all ages, with no warnings about their use for infants, children, or adolescents. As a result, illicit drug use often stems from legal prescriptions, where either the person with the prescription becomes addicted or shares their leftover pills with friends. We encourage USPSTF to recommend research on improving safe prescribing practices and interventions aimed at reducing inappropriate prescriptions of opioids, especially for children and adolescents.
In summary, while there is a need to reduce and prevent illicit drug use in children, adolescents and young adults, more research is needed to identify which interventions are most effective to achieve this goal without causing unintended harms. Recommending interventions before the effects are well understood could cause more harm than good.
For questions or more information, please contact Stephanie Fox-Rawlings, PhD at the National Center for Health Research at firstname.lastname@example.org or at (202) 223-4000.