The U.S. Preventive Services Taskforce has temporarily revised its guidelines for illicit drug use screening, now advising healthcare practitioners to do so in patients 18 or older.
“Screening should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred,” reads the draft recommendation, which is open to public comment until Sept. 9. It also suggests providers screen pregnant and postpartum women.
Teenagers, however, are a different story. The statement deliberately doesn’t draw a hardline stance on whether (and when) it’s appropriate to ask kids between 12 and 17 years old about illicit drug use.
“The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for illicit drug use in adolescents,” the new guidelines state. The USPSTF also didn’t find enough evidence to indicate that current screening tools are effective for children.
How Often Should Providers Screen Teens for Substance Use?
Lack of definitive guidelines aside, the USPSTF is certainly not recommending providers never screen teens for drug use. In fact, providers should strive to screen teenage patients for substance abuse at least once a year, says Lucien Gonzalez, MD, MS, FAAP, chair of the American Academy of Pediatrics Committee on Substance Use and Prevention.
“Screening is about casting a wide net,” Dr. Gonzalez tells Florence Health. “It’s done to detect potential health issues in people who do not yet have any symptoms. In addition to identifying kids with substance-related problems, it’s an opportunity to catch kids earlier so we can educate, prevent, and provide earlier intervention where we can.”
For younger adolescents, it’s relatively easy for providers to throw in a screening at a well visit. On the other hand, 16 and 17 year olds are less likely to attend regular check-ups, so it’s often appropriate to screen older teens when they’re seeking acute care, Dr. Gonzalez says.
He also stresses the difference between screening and “fact-finding.” The latter occurs when you believe substance use could’ve played a role in the reason the child is seeking care — for example, he or she got injured in a car accident while driving with friends.
“You may look at a kid and think, ‘On the list of possible contributing factors would be substance use. I’m going to spend some time talking about that,'” Gonzalez explains. “But that’s different from [screening]. Now you’re taking a history, and that’s more in depth.”
What are Some Signs of Teen Substance Use Providers Should Look for?
Whether or not a child presents with symptoms of substance abuse shouldn’t be the determining factor for screening. Instead, practices should set up their own system to make sure every teenager is screened at least once a year, Dr. Gonzalez says.
When considering fact-finding or any screening done outside that schedule, you should use your clinical judgement. Keep in mind:
- 1 in 5 teens have misused prescription medications, according to the Centers for Disease Control.
- Approximately 21 percent of high school seniors have reported using marijuana in the past month, according to the National Institute of Drug Abuse.
- Kids who experience behavioral health issues, such as depression and anxiety, are more likely to use nicotine, alcohol and other drugs.
- A history of trauma and family members with substance use disorder are significant risk factors for teen substance use.
What are the Recommended Substance Abuse Screening Tools for Teens?
According to the AAP policy statement on screening adolescents for drug and alcohol use, only 50 to 86 percent of pediatricians screen their teenage patients, and many of them didn’t use a validated tool, opting instead to rely on “clinical impressions.”
In response to this statistic, Gonzalez says: “A validated screening tool is just a better detector than we are. I can’t tell by looking at a kid. The existing [screeners] do not take a lot of time, and much of it can be done by rooming staff, like a medical assistant.”
The AAP doesn’t recommend one specific screener, but Gonzalez is partial to the Screening to Brief Intervention (S2BI) Tool, which takes about 2 minutes. If any responses require follow-up, then the CRAFFT questionnaire, which takes 5 minutes, can be a good guide.
To elicit the most honest response, Gonzalez says you should allow patients to answer the screener away from parents and remind them their answers will be confidential. But you should also understand the limits of provider confidentiality for kids within your specific state.
The goal of screening, ultimately, is to make sure substance abuse in teens is “talked about more and thought about more,” Gonzalez says. “It’s just one means to make sure it doesn’t get missed. Resources and other challenges can arise around intervention and referral, but not asking is not going to help.”