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Level III – Illicit Drug Use Screening

Level III Services: Preventive services that clinicians and care systems could provide to patients, but only after careful consideration of the costs and benefits. Providing these services is left to the judgment of individual care systems, clinicians and their patients.

The USPSTF recommendations are fully endorsed by the ICSI Preventive Services work group.
Grade of Recommendation and Level of Certainty as Evaluated by USPSTF
  1. “The current evidence is insufficient to assess the balance of benefits and harms of screening adolescents, adults and pregnant women for illicit drug use.”
(USPSTF Last Revised 2008)
Grade of Recommendation:
  1. I Statement

Level of Certainty:

  1. Insufficient
“Benefits:
There is good evidence that various treatments are effective in reducing illicit drug use in the short term. Evidence is insufficient, however, either to demonstrate that treatment reliably improves social and legal outcomes for patients, or to link treatment directly to longer-term improvements in morbidity or mortality. Since all but one published clinical trial of treatment interventions involved individuals who had already developed problems due to their drug use, it is not known whether the findings are generalizable to asymptomatic individuals whose illicit drug use is detected through screening. There is fair evidence that, regardless of the patient's history of treatment, reducing or stopping drug use is associated with improvement in some health outcomes.
Harms:
There is little evidence of harms associated with either screening for illicit drug use or behavioral interventions used in treatment. Several clinical trials of pharmacotherapy for drug misuse have reported mild to serious adverse events, although some of these events were likely related to underlying drug use. The specific adverse events noted to occur more frequently in the treatment arm of trials (compared to placebo) have been previously recognized as potential side effects of the treatment medication and cited on its product label.
Benefits-Harms Assessment:
The USPSTF concludes that for adolescents, adults and pregnant women, the evidence is insufficient to determine the benefits and harms of screening for illicit drug use.”
Relevant Resources:
http://www.uspreventiveservicestaskforce.org/uspstf/uspsdrug.htm