Screen all adult patients for drug abuse, panel urges

A national panel of health experts recommended Tuesday that doctors screen all adult patients for illicit drug use, including improper use of prescription medications. But the group, the U.S. Preventive Services Task Force, stopped short of endorsing such screening for teenagers, a position that puts them at odds with major adolescent health groups.

The panel, which was appointed by the federal Department of Health and Human Services but operates independently, said its proposed guidelines are intended to combat alarmingly high rates of substance abuse. It cited a 2017 federal survey that found 1 in 10 Americans ages 18 or older said they were using illicit drugs or not using medications in ways that doctors intended.

The panel’s call for increased scrutiny by primary care doctors is an effort to slow the deadly use of opioids. The experts hope that if front-line health professionals can detect patients’ burgeoning abuse of drugs early, they can help contain or reverse the problems.

The group’s guidelines are not binding on doctors but they carry weight: A provision in the Affordable Care Act says that services recommended by the task force must be covered by insurance with minimal or no co-payment.

The panel is recommending that doctors or other health care providers ask patients about drug use either in brief written questionnaires or in private conversation during the office visit.

‘‘We don’t want doctors and nurses to get hung up on one tool or another,’’ said Dr. Carol Mangione, an author of the proposals who is a professor of medicine and public health at the University of California, Los Angeles. ‘‘Just that they do it.’’

But the guidelines, which are open for public comment through Sept. 9, carry significant challenges for implementation.

Most doctors have no training in how to elicit honest answers from patients about such a stigmatizing behavior.

Additionally, medical practices must also be knowledgeable about state laws, some of which require them to report pregnant patients whom they even suspect of using illicit drugs.