The U.S. Preventive Services Task Force (USPSTF) is panel of national health experts who make recommendations about evidence-based preventive services. They do this by determining whether there is sufficient evidence that a preventive service is beneficial and does not cause harm. The Affordable Care Act requires preventive services recommended by the USPSTF to be covered by insurance without cost sharing; meaning they are free to most patients who have health insurance. A USPSTF recommendation encourages health care providers to provide screening, a preventative service, which often helps to identify a disease in an early stage, leading to better health outcomes.
The UPSTF recommends a number of preventive services, including screenings for high blood pressure; breast cancer; HIV; depression in adolescents and adults; tobacco use in adults, adolescents and children; and unhealthy alcohol use in adults. Recently, the USPSTF issued a draft recommendation statement recommending screening for adults and pregnant women for illicit drug use, including non-medical use of prescription drugs. The USPSTF declined to recommend screening for illicit drug use for adolescents because they found there was insufficient evidence to determine the benefits of screening outweighed the harms. The draft recommendation statement was open for public notice and comment, a process that allows the public to review a proposed action (often, a federal rule) and provide input before the action is final.
Center on Addiction has extensive experience implementing screening, brief intervention and referral to treatment (SBIRT) for substance use in health care practice, including New York State’s largest health care provider, Northwell Health. Our experts have published several studies on SBIRT implementation barriers and created a number of tools and resources to make implementation easier. In partnership with Northwell, we created the SBIRT for Health Professionals app to help providers identify problematic drug or alcohol use among patients; guide providers in conversations with patients about their readiness to make lifestyle changes and set goals; and support providers in discussions with patients about substance use disorder (SUD) treatment referral. We have also collaborated with juvenile justice agencies across New York State to better identify teens and young adults in need of SUD treatment. Given our extensive expertise in screening, we submitted comments to the USPSTF in response to the draft recommendation statement.
In our comment letter, we:
Supported the USPSTF’s recommendation to screen adults and pregnant women for illicit drug use.
Disagreed with the USPSTF’s conclusion that there is insufficient evidence to determine whether the benefits of screening adolescents for illicit drug use outweigh the harms. Screening in adolescence is critical because preventing teen substance use and intervening early with teens who use is the key to preventing the consequences of risky substance use, including addiction. Our research shows nine out of 10 people with addiction began using an addictive substance before age 18. While a robust research base supporting youth screening does not yet exist, existing research acknowledges enormous potential benefit and it has been championed by virtually every major behavioral health organization. We asked the UPSTF to revise the recommendation statement to include language acknowledging that existing evidence demonstrates benefits of youth screening and shows no evidence of harm to encourage practitioners to use the more promising practices and facilitate development of a stronger evidence base.
Encouraged the USPSTF to include information on implementation barriers and tools and resources to assist providers in screening, including a manual developed by our experts, in the recommendation statement.
Suggested that the USPSTF include content specific to pregnant and postpartum women, including recommendations on screening intervals during prenatal and postpartum visits; information on resistance among pregnant and postpartum women to disclose substance use because of stigma and fears of child removal; and information on SUD treatment options for pregnant/postpartum women and parenting interventions that can be delivered in addition to treatment, such as home visiting.
The comment period is now closed and the USPSTF will determine whether to revise the recommendation statement, based on public comments. We encourage you to talk with your own provider about whether or not they provide screening to their patients.