New advice from a panel of health experts who analyzed the quality of time physicians spend with patients suggests that primary care visits should include conversations about illicit drug use. According to a new report, issued this week by the United States Preventive Services Task Force, health experts now recommend all US adults should be screened for illicit drug use as long as their doctors can accurately and effectively track this use and, more importantly, offer quality treatment when abuse is detected.
Task force member and UCLA David Geffen School of Medicine chief of general internal medicine, Dr. Carol Mangione, comments, “We have a pretty high prevalence of adults using illicit drugs and we’re seeing harm every day from that. This is a big change that we’re really excited about. Effective treatment is where we will finally begin to move the needle on the epidemic.”
Asking questions about drug use should be something that physicians feel is necessary, but also something they are comfortable with. Furthermore, the report says that patients should be willing (and comfortable, too). Questions about drug use, then, should cover not only the potential use of street drugs like heroin or cocaine but also whether a patient might be secretly using pills taken from a family member’s pain prescriptions or using certain stimulant drugs prescribed for another family member.
Furthermore, drug use acknowledgment should prompt a physician to warn patients about the potential dangers that could be waiting for them in the future. Obviously, there are both short-term and long-term side effects of drug abuse. With that, then, physicians should be able to offer medication-assisted therapy (in combination with psychiatric or behavioral health models) for addiction whenever appropriate.
American Academy of Family Physicians president-elect Dr. Gary LeRoy explains that this is actually something he has been doing for nearly ten years, in his office. The East Dayton Health Clinic (Dayton, OH) staff physician goes on to say, “All of us should be keenly aware that on average, one in ten of our patients are doing drugs—whether we ask them or not—and we’re not going to cause someone to use illicit drugs because we ask the question. When you create an atmosphere of trust where you have safe conversations, they appreciate that you ask.”
In conclusion, Mangione adds that while there are definite challenges associated with implementing the new recommendation, the fact that the country is facing a growing substance abuse (mostly opioid) epidemic might encourage primary care providers to embrace the idea.