Nav: Home

BU researcher: Screening for drug use can be reasonable, but not evidence-based

June 09, 2020

Little evidence supports the new recommendations for clinical screening for drug use. Do the potential benefits outweigh the potential harms?

In the June 9 issue of JAMA, the U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen for unhealthy drug use (that is, any use of drugs that are illegal or medications not used for medical purposes) for all adult patients, but admits that there is still little evidence weighing the benefits and risks of this practice.

Screening for unhealthy drug use "is reasonable to consider in clinical practice, but it is not evidence-based for improving health," writes Dr. Richard Saitz, professor and chair of community health sciences at the Boston University School of Public Health (BUSPH), in an accompanying editorial.

"A service that likely has substantial harms for some, and small benefit for few under the most generous assumptions should be held to the same standards as other preventive services, regardless of whether it is a laboratory test that leads to an invasive treatment or a series of questions that lead to counseling and referral," writes Saitz, who is also professor of medicine at the Boston University School of Medicine, and a physician in the Clinical Addiction Research and Education Unit and the Grayken Center for Addiction at Boston Medical Center.

In the editorial, Saitz points out that the USPSTF did not hold drug screening to the same standards to which it usually holds other preventive services it evaluates. Instead, he writes, the Task Force included studies of people who were seeking help for their drug use. Usually, evidence for preventive services comes from people who are asymptomatic and not seeking help, because interventions differ in terms of their effectiveness depending on whether people are seeking help or not. In the case of drug use, those seeking help are likely to be more amendable to changing their use than are people who are not seeking to change--and may not even think their use is risky. The only evidence the Task Force found for efficacy of drug screening, Saitz notes, was in people seeking help for cannabis use. There was no benefit for other drugs, such as opioids or stimulants, nor were there any effects on any health outcomes.

Saitz writes that screening is "not unreasonable" for clinicians, mainly because knowledge of a patient's drug use is valuable and sometimes vital to understanding a patient's health needs. Making screening standard practice could also help reduce stigma by demonstrating that drug use is a health issue, and might encourage patients to talk to their health care providers about their drug use and even seek treatment through them, he writes.

However, Saitz also points out that screening comes with risks, particularly during pregnancy: 23 states and the District of Columbia consider drug use to be child abuse, three states consider drug use grounds for civil commitment, Alabama considers drug use to be chemical endangerment of a child, and South Carolina considers drug use to be criminal child abuse. Drug counseling delivered poorly also poses risks, he writes, and having drug use on a patient's medical record could expose them to stigma in their health care.

"These observations should serve as an important call for the development and study of new strategies to identify and address drug use in ways that can reduce related harms," Saitz writes.
-end-
Read the full editorial here: https://jamanetwork.com/journals/jama/article-abstract/2766846

About the Boston University School of Public Health

Founded in 1976, the Boston University School of Public Health is one of the top five ranked private schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations--especially the disadvantaged, underserved, and vulnerable--locally and globally.

Boston University School of Medicine

Related Child Abuse Articles:

Molecular stress indicator not observed in survivors of child sexual abuse
Researchers and medical experts have long known that child sexual abuse has profoundly negative effects on the health of survivors; however, an international team of researchers was not able to find a link between the abuse and telomere length, considered an indicator of cellular aging and health.
Research shows child abuse and neglect results in increased hospitalizations over time
In a new study published in the leading international journal, Child Abuse and Neglect, University of South Australia researchers have found that by their mid-teens, children who were the subject of child protective services contact, are up to 52 per cent more likely to be hospitalised, for a range of problems, the most frequent being mental illness, toxic effects of drugs and physical injuries.
Research helps police understand child to parent abuse more than ever before
Researchers have provided detailed insights and recommendations to help one of the UK's largest police forces recognise, report and analyse instances of violence from children towards parents.
Drug reduces the risk of child sexual abuse
A drug that lowers levels of the male hormone testosterone in the body reduces the risk of men with pedophilic disorder sexually abusing children, a study from Karolinska Institutet published today in the journal JAMA Psychiatry shows.
Child abuse awareness month during COVID-19 pandemic
This Patient Page calls attention to risk factors for child abuse during the COVID-19 pandemic and discusses ways to reduce stress and risk of child abuse during social isolation.
Infant home visiting program linked to less child abuse
Family Connects, a nurse home visiting program for newborns and their parents, is linked to substantial reductions in child maltreatment investigations in children's earliest years, according to new research from Duke University.
Child abuse associated with physiologically detected hot flashes
Childhood abuse has been shown to lead to an array of health problems later in life.
Injury more likely due to abuse when child was with male caregiver
The odds of child physical abuse vs. accidental injury increased substantially when the caregiver at the time of injury was male, according to a new study published in The Journal of Pediatrics.
Child abuse linked to risk of suicide in later life
Children who experience physical, sexual, and emotional abuse or neglect are at least two to three times more likely to attempt suicide in later life, according to the largest research review carried out of the topic.
An understudied form of child abuse and intimate terrorism: Parental Alienation
According to Colorado State University social psychologist Jennifer Harman, about 22 million American parents have been the victims of behaviors that lead to something called parental alienation.
More Child Abuse News and Child Abuse Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: The Power Of Spaces
How do spaces shape the human experience? In what ways do our rooms, homes, and buildings give us meaning and purpose? This hour, TED speakers explore the power of the spaces we make and inhabit. Guests include architect Michael Murphy, musician David Byrne, artist Es Devlin, and architect Siamak Hariri.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at Radiolab.org/donate.     You can read The Transition Integrity Project's report here.