It's not the place of pediatricians and other primary care providers to counsel patients about illicit drug use—at least not until more research can be done, according to a federal task force. The US Preventive Services Task Force (USPSTF) issued the recommendation that primary care providers not offer interventions on avoiding illicit drug use in young patients who have no history of using drugs. Drug use among teenagers and young adults is a big problem requiring a big solution. Nearly 8% of adolescents who are 12 to 17 years oldadmitted to using illicit drugs over the past month in a 2017 poll referenced by the USPSTF in its report. Roughly 50% of all teenagers use an illicit drug before graduating high school, and almost 25% of young adults who are 18 to 25 years old are currently using illicit drugs.
The recommendation against clinician intervention in drug prevention is based on a lack of data, not a lack of knowledge or skill on the part of the clinician, the report notes. Providers are still urged to use their judgment, and their relationship with patients and families as they see fit, but a blanket recommendation in favor of any particular intervention can't be made without more data.
"Pediatricians should know that we need more research on how they can help address the serious problem of illicit drug use among children and teenagers in the United States," says Michael Silverstein, MD, MPH, staff pediatrician and associate chief medical officer for research and population health at Boston Medical Center in Massachusetts and member of the USPSTF. "The task force is calling for further research on this issue in the hope that we can make a strong, evidence-based recommendation in the future."
Silverstein says the USPSTF uses scientifically rigorous methods to assess the best available evidence to determine the benefits and harms of each preventive service. "Unfortunately, the task force did not find enough available evidence on the potential benefits and harms of education and counseling to prevent drug use among children and teenagers, and therefore, could not make a recommendation on this topic," Silverstein says.
The task force identified several areas in which further research would strengthen the available evidence on primary care-based interventions. First, research on this issue would benefit greatly from a standardized way to measure health, behavioral, social, and legal outcomes across trials, according to Silverstein. The task force is also calling for additional research on technology-based interventions, clinician training and education in this area, and the benefits and harms of counseling, he said.
Although the task force isn't necessarily suggesting that primary care clinicians are not suited to talking to patients about preventing drug abuse, the report points to a deficit in evidence on the benefits and harms of primary care-based interventions. The task force identified a need for standardized outcome measurement in order to gauge to success or harms of interventions, and more research is needed to replicate and refine existing programs that have shown promise before they can be used more widely. In the meantime, clinicians are encouraged to continue to use their own best judgment.
"Clinicians should continue to rely on their judgment to determine how best to address issues around illicit drug use in their young patients," Silverstein says. "Clinicians should remain alert to the concerns of parents and caregivers, and note that this recommendation does not apply to patients who use drugs regularly or have been diagnosed with a substance use disorder. If a clinician suspects that their patient may be using drugs, the clinician should provide appropriate treatment or refer the patient to specialized care."
The task force is hopeful that the recommendation will elevate awareness around the issue of drug use in children and young adults while encouraging further research on primary care-based interventions to identify the best way for clinicians to help address this problem, Silverstein says.