The US Preventive Services Task Force has issued guidelines that suggest all US adults be screened for any illicit drug use by their providing doctor—if said doctor can appropriately offer active treatment for when any level of abuse has been found.
The Substance Abuse and Mental Health Administration (SAMHSA) reports that nearly 11.5 percent of American adults have used illicit drugs within the past month. That’s about 30.5 million people. The Centers for Disease Control and Prevention (CDC) has reported that the number-one cause of injury-related deaths is due to drug poisoning.
Though most forms already ask whether their patient is actively using any substance, the panel encourages more direct engagement to address the possibility of illicit and prescription drug use. If drug use is detected, information on the dangers and the risks of the substance should be supplied to the patient. As well as possible treatment options, for example follow-up counseling or therapy, and education on medically assisted treatment when necessary.
“All of us should be keenly aware that on average, one in 10 of our patients are doing drugs—whether we ask them or not—and we’re not going to cause someone to use illicit drugs because we ask the question,” said Dr. Gary LeRoy, a staff physician at the East Dayton Health Clinic in Dayton, Ohio. The doctor, also president-elect of the American Academy of Family Physicians states how his office has been practicing this line of questioning in his office for years. “When you create an atmosphere of trust where you have safe conversations, they appreciate that you ask.”
The Heavy Impact of Stigma on Drug Screening
LeRoy mentions how some doctors are hesitant when raising the question, but also how it helps to remove the shame and secrecy associated with addiction. “They say, ‘Oh I had no idea I already had these people in my practice.’ When I started asking these questions and providing the service, they came out of the woodwork.”
Karina Davidson, behavioral medicine specialist who co-chaired the task force’s panel on the drug screening, said that the recommendation was prompted by more than the growing number of fatal overdoses in the United States of which the CDC reported approximately 68,600 in 2018.
“Since 2008, for instance, drug-abuse specialists have devised brief screening mechanisms that help identify illicit drug use and those at risk for it,” Davidson said. “In addition, a growing stack of research studies have shown that treatments for drug-use disorder and addiction—including behavioral interventions and pharmacological therapies—are effective in helping patients quit or cut back.”
Successful treatment options remain scarce and largely inaccessible. “The evidence of effectiveness is a key change from earlier years,” said Dr. Carol Mangione, a UCLA internal medicine specialist who also co-chaired the committee. “We don’t want to screen for something unless we know there’s an effective treatment. If you don’t have a treatment that’s effective for people who screen positive, you haven’t really helped.”
Medication-assisted treatment programs that use the help of prescriptions to support people when weening off illicit substances use drugs like naltrexone, methadone, and buprenorphine. Because of the workload and specialized training that’s required when prescribing said drugs, doctors, insurers, and state legislatures are hesitant to embrace such methods. However, this new suggestion could help change how these prescriptions are viewed.
Deeper physician involvement and cooperation in drug screening could lead to wider embrace of lifesaving treatment resources, such as MAT. There would also be an established layer of trust between the doctor and the client. The process seems to already be in motion according to Mangione who said the only available space was “standing-room only” at a medication-assisted treatment workshop that was held for the Society for General Internal Medicine. “We’re motivated to use these treatments and pair them up with individual and group therapy,” she said in hopes to raise awareness about such protocols.
“If everyone is asked, we can get to some people who are at a less-severe stage in their drug use, not all the way into their addiction,” Davidson said. The goal is to lessen the stigma surround drug use and addiction. By addressing these issues and providing options for treatment, the drug use could be caught before the more serious, life-threatening consequences manifest.