ABSTRACT

Background: In June 2020, the U.S. Preventive Services Task Force (USPSTF) issued a final recommendation on screening for unhealthy drug use in adults and adolescents. It assigned a “B” rating on a recommendation for screening in primary care for adults when services for accurate diagnosis, effective treatment, and appropriate care can be provided or referred, but declined to recommend the same for adolescents, concluding that current evidence is insufficient to assess the balance of benefits and harms. Objectives: To examine and provide recommendations to address gaps in the USP ST recommendation on screening for unhealthy drug use. Results: The lack of recommendation to screen adolescents represents a critical gap and highlights the need for research on adolescent substance use screening. While research is limited, available evidence shows short-term benefits from youth screening and early intervention and no evidence of harm. The lack of recommendation for youth leaves practitioners without guidance and incentive to intervene with youth who use substances, discourages expansion/support of youth screening, and reinforces treatment barriers. The statement also lacks guidance to address barriers to implementing screening in adults. Despite promotion of the practice, implementation in primary care is sporadic. Providers should be made aware of implementation barriers and the clinical guides and training available to facilitate implementation. Conclusions/Importance: Screening and intervention are vital for addressing the addiction crisis, and USPSTF recommendations are critical for making preventive health care services accessible and affordable. These gaps must be addressed for the recommendation statement to reach its full life-saving potential.

摘要

背景： 2020 年 6 月，美国预防服务工作组 (USPSTF) 发布了关于筛查成人和青少年不健康药物使用的最终建议。当可以提供或转诊准确诊断、有效治疗和适当护理的服务时，它对成人初级保健筛查的建议给予“B”评级，但拒绝为青少年推荐同样的服务，认为目前的证据不足评估利益和危害的平衡。目的：检查并提供建议，以解决 USP ST 关于筛查不健康药物使用的建议中的差距。结果：缺乏筛查青少年的建议代表了一个关键差距，并强调了对青少年物质使用筛查进行研究的必要性。虽然研究有限，但现有证据显示青少年筛查和早期干预有短期益处，但没有证据表明有害。缺乏对青少年的推荐使从业者没有指导和激励干预使用药物的青少年，阻碍扩大/支持青少年筛查，并加强治疗障碍。该声明还缺乏解决成人筛查障碍的指导。尽管推广了这种做法，但在初级保健中的实施是零星的。应使提供者了解实施障碍以及可用于促进实施的临床指南和培训。结论/重要性：筛查和干预对于解决成瘾危机至关重要，USPSTF 的建议对于使预防性医疗保健服务变得可及且负担得起至关重要。必须解决这些差距，以使推荐声明充分发挥其挽救生命的潜力。