USPTF: All Adults Should Be Screened For Illegal Drugs

Illegal drug use in the United States is on the rise. To address this growing problem, the U.S. Preventive Service Task Force (USPSTF) recently drafted a recommendation that all adults in the country should be screened for drugs, regardless of their risk factors.

The USPSTF is a group of independent volunteer experts in disease prevention whose goal is to make evidence-based recommendations to improve the lives of Americans. The USPSTF has been trusted to guide physicians when considering care options.  It is important to note that the USPTF does not take into consideration costs when making a recommendation, so their guidance should not be seen as proven to generate a positive return for employer.

Previous recommendations from the USPSTF include cervical cancer screening for women aged 21 to 65, colorectal cancer screening for adults aged 50 to 75 years old, and asymptomatic adults do not need a routine annual exam.  The last recommendation is proof employers should not offer biometric screenings or promote annual physicals to all employees.

Now, the USPSTF is turning its attention to drug use. The panel declined to make a recommendation in 2008, saying it lacked evidence to make one. Now, it does, and the statistics on drug use in America are concerning.

• The Centers for Disease Control reported that in 2017 alone, more than 70,000 people died from drug overdoses. That rate was 9.6% higher than in 2016.
• In a 2017 survey, 11.5% of Americans 18 years and older said they were currently using illegal drugs. In that same survey, 8.5% of pregnant women, aged 18 to 44, had used drugs in the past month.
• From 1999 to 2017, nearly 400,000 people died from opioid-related overdoses, with half from prescription opioids.
• The rate of drug overdose deaths for synthetic opioids other than methadone increased by 45% from 2016 to 2017.
• Issues of drugs in the workplace result in $200 billion of lost productivity each year.

Physicians Provide Screening, Not Diagnosis

With the USPSTF recommendation, physicians would ask patients questions about any drug use, and if a person answers positively, the physician could have a more in-depth discussion and offer diagnostic assessment and resources.

The recommendation is only for adults. The panel did not make a recommendation for individuals under 18 because it did not have enough information to say that the benefits of screening would outweigh the risks.

For adults, however, the panel found no direct evidence that screening would be harmful and it did find evidence that effective treatments existed for opioid use and other illicit drug use, so a screening provided an upside.

The screening would be from a selection of recommended questionnaires, six questions or more. If a person screens positively, doctors could take additional steps, such assess possible misuse, abuse of alcohol or tobacco, or co-existing mental health disorders.

Physicians should be mindful of any state requirements for mandatory screening or reporting of positive screening results.

Murky Area Ahead For Employers

Drug use, both illicit and legal, affects the individual, and when that individual is an employee, the company is also affected. Most employers are not prepared for the opioid crisis, with 80% of employers not confident they can spot the warning signs of opioid misuse. Drug use in the workplace may get more complicated as states legalize marijuana, and some organizations are reviewing their zero-tolerance stances.

Still, the USPSTF’s screening recommendation indicates a step to start the conversation about drug use. Employers should take note and see how this unfolds. The proposal is available for comment and review until September 9, 2019.