Illicit Drug Use in Children, Adolescents, and Young Adults: Primary Care-Based Interventions --Children, adolescents, and young adults


General

Grade: I

Specific Recommendations

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care--based behavioral counseling interventions to prevent illicit drug use, including nonmedical use of prescription drugs, in children, adolescents, and young adults. See the Practice Considerations section for suggestions for practice regarding the I statement.

Frequency of Service

No information available.

Risk Factor Information

No information available.


Clinical

Practice

Patient Population Under Consideration

This recommendation applies to children (11 years and younger), adolescents (aged 12-17 years), and young adults (aged 18-25 years), including pregnant persons. The purpose of this recommendation is to assess the evidence on interventions to prevent the initiation of illicit drug use and thus does not apply to persons who already have a history of regular or harmful illicit drug use. Children, adolescents, and young persons who are regular users of illicit drugs (at least once per week) or have been diagnosed with a substance use disorder are outside the scope of this recommendation.Screening for illicit drug use in adults and adolescents (aged 12-17 years) is covered in a separate recommendation statement.5

Definitions of Illicit Drug Use, Including Nonmedical Drug Use

The term “illicit drug use” is defined as the use of substances (not including alcohol or tobacco products) that are illegally obtained or involve nonmedical use of prescription medications; that is, drug use for reasons, for duration, in amounts, or with frequency other than prescribed, or use by persons other than the prescribed individual. Nonmedical drug use also includes the use of over-the-counter medications, such as cough suppressants. Other illicit drugs include household products such as glues, solvents, and gasoline. These substances are ingested, inhaled, injected, or administered using other methods to affect cognition, affect, or other mental processes; to “get high”; or for other nonmedical reasons.

Interventions

The body of evidence to recommend specific interventions to prevent initiation of illicit drugs that can be provided or referred from the primary care setting is insufficient. Studied interventions include face-to-face or group counseling, print materials, interactive computer-based tools designed for patient use, and clinician training and quality improvement programs. Studies on these interventions provide inconsistent evidence on the net benefit to behavioral outcomes (drug abstinence or reduced frequency or quantity of illicit drug use) or health outcomes (morbidity, mortality, educational, or legal outcomes).

Other Related USPSTF Recommendations

The USPSTF has several recommendations on substance use–related services for young persons. The USPSTF is currently updating its recommendations on screening for illicit drug use in adults 18 years and older (B recommendation) and in adolescents aged 12 to 17 years (I statement).5 The USPSTF also has recommendations on screening and behavioral counseling interventions to reduce unhealthy alcohol use in adults 18 years and older (B recommendation) and adolescents aged 12 to 17 years (I statement).6 In addition, the USPSTF is currently updating its recommendations on education or brief counseling interventions to prevent initiation of tobacco use among school-aged children and adolescents (B recommendation) and interventions for the cessation of tobacco use among school-aged children and adolescents (I statement).7

Suggestions for Practice Regarding the I Statement

Potential Preventable Burden

Illicit drug use is associated with multiple negative health, social, and economic consequences. In 2011, the Drug Abuse Warning Network estimated that approximately 190,000 emergency department visits by persons aged 0 to 21 years involved illicit drug use (not including alcohol),8 and more than 79,000 of those visits were related to nonmedical use of opioids in persons aged 12 to 25 years.9 In 2015, drug overdose (both intentional and unintentional) accounted for 9.7 deaths per 100,000 persons aged 15 to 24 years.10Frequent and heavy illicit drug use is associated with increased risk-taking behaviors while intoxicated, such as driving under the influence, unsafe sexual activity, and violence. In 2016, 73.6% of all deaths in young persons aged 10 to 24 years in the US resulted from 3 causes: unintentional injuries, including motor vehicle crashes (41.1%); suicide (17.3%); and homicide (14.9%).3 Among the leading health risk behaviors, the use of alcohol and illicit drugs are the primary health risk behaviors that contribute to these causes of death.11Illicit drug use can also have harmful long-term consequences. Children and adolescents who initiate marijuana use before age 17 years are more likely to progress to other drug use and drug abuse/dependence as adults compared with those who initiate use after age 18 years.12 Studies have linked use of cannabis to poorer academic performance and lower education attainment (ie, dropping out of high school or not obtaining a college degree).13-15 Persistent illicit drug use starting in adolescence has been associated with negative psychosocial and neurocognitive effects, including increased anxiety and impaired abstract thinking, attention, learning, and psychomotor functioning.16,17

Potential Benefits 

The USPSTF found inconsistent evidence on potential benefits associated with interventions. There was a small, statistically significant improvement in cannabis use specifically. However, other drug use outcomes (such as any illicit drug use and the number of times used in the last 3 months) failed to demonstrate statistically significant improvement. There was little evidence that interventions to prevent illicit drug use improve health outcomes such as mortality, educational attainment, or legal outcomes. 

Potential Harms

The USPSTF found limited evidence on potential harms associated with interventions. Only 1 study reported nonspecific “adverse events,” with no difference between intervention and control groups.18 Potential harms include a paradoxical increase in illicit drug use.19,20 

Current Practice

The USPSTF found little evidence on the frequency of use of behavioral counseling in primary care to prevent initiation of illicit drug use among nonusers or the escalation of use among persons who do not use illicit drugs regularly.This recommendation replaces the 2014 USPSTF recommendation, which was also an I statement.21 This recommendation statement incorporates new evidence since 2014 and now includes young adults (aged 18-25 years).


Rationale

AssessmentImportanceIn 2017, an estimated 7.9% of persons aged 12 to 17 years reported illicit drug use in the past month,1 and an estimated 50% of adolescents in the US had used an illicit drug by the time they graduated from high school.2 Young adults aged 18 to 25 years have a higher rate of current illicit drug use, with an estimated 23.2% currently using illicit drugs. Similar to adolescents, the illicit drugs most commonly used by young adults are marijuana (20.8%) and prescription psychotherapeutics (4.6%).1 Illicit drug use is associated with many negative health, social, and economic consequences and is a significant contributor to 3 of the leading causes of death among young persons (aged 10 to 24 years): unintentional injuries including motor vehicle crashes, suicide, and homicide.3Assessment of Magnitude of Net BenefitsBecause of limited and inadequate evidence, the US Preventive Services Task Force (USPSTF) concludes that the benefits and harms of primary care–based interventions to prevent illicit drug use in children, adolescents, and young adults are uncertain and that the evidence is insufficient to assess the balance of benefits and harms. More research is needed.See the Table for more information on the USPSTF recommendation rationale and assessment. For more details on the methods the USPSTF uses to determine the net benefit, see the USPSTF Procedure Manual.4


Others

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