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Primary Care–Based Interventions to Prevent Illicit Drug Use in Children, Adolescents, and Young AdultsUS Preventive Services Task Force Recommendation Statement

Educational Objective
To review the USPSTF recommendations regarding interventions to prevent illicit drug use in children, adolescents, and young adults.
1 Credit CME

Importance  In 2017, an estimated 7.9% of persons aged 12 to 17 years reported illicit drug use in the past month, and an estimated 50% of adolescents in the US had used an illicit drug by the time they graduated from high school. 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. 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 10-24 years): unintentional injuries including motor vehicle crashes, suicide, and homicide.

Objective  To update its 2014 recommendation, the USPSTF commissioned a review of the evidence on the potential benefits and harms of interventions to prevent illicit drug use in children, adolescents, and young adults.

Population  This recommendation applies to children (11 years and younger), adolescents (aged 12-17 years), and young adults (aged 18-25 years), including pregnant persons.

Evidence Assessment  Because of limited and inadequate evidence, the 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.

Recommendation  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. (I statement)

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Article Information

Corresponding Author: Alex H. Krist, MD, MPH, Virginia Commonwealth University, 830 E Main St, One Capitol Square, Sixth Floor, Richmond, VA 23219 (chair@uspstf.net).

Accepted for Publication: April 16, 2020.

The US Preventive Services Task Force (USPSTF) members: Alex H. Krist, MD, MPH; Karina W. Davidson, PhD, MASc; Carol M. Mangione, MD, MSPH; Michael J. Barry, MD; Michael Cabana, MD, MA, MPH; Aaron B. Caughey, MD, PhD; Katrina Donahue, MD, MPH; Chyke A. Doubeni, MD, MPH; John W. Epling Jr, MD, MSEd; Martha Kubik, PhD, RN; Gbenga Ogedegbe, MD, MPH; Lori Pbert, PhD; Michael Silverstein, MD, MPH; Melissa A. Simon, MD, MPH; Chien-Wen Tseng, MD, MPH, MSEE; John B. Wong, MD.

Affiliations of The US Preventive Services Task Force (USPSTF) members: Fairfax Family Practice Residency, Fairfax, Virginia (Krist); Virginia Commonwealth University, Richmond (Krist); Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York (Davidson); University of California, Los Angeles (Mangione); Harvard Medical School, Boston, Massachusetts (Barry); University of California, San Francisco (Cabana); Oregon Health & Science University, Portland (Caughey); University of North Carolina at Chapel Hill (Donahue); Mayo Clinic, Rochester, Minnesota (Doubeni); Virginia Tech Carilion School of Medicine, Roanoke (Epling Jr); Temple University, Philadelphia, Pennsylvania (Kubik); New York University, New York, New York (Ogedegbe); University of Massachusetts Medical School, Worcester (Pbert); Boston University, Boston, Massachusetts (Silverstein); Northwestern University, Evanston, Illinois (Simon); University of Hawaii, Honolulu (Tseng); Pacific Health Research and Education Institute, Honolulu, Hawaii (Tseng); Tufts University School of Medicine, Boston, Massachusetts (Wong).

Author Contributions: Dr Krist had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The USPSTF members contributed equally to the recommendation statement.

Conflict of Interest Disclosures: Authors followed the policy regarding conflicts of interest described at https://www.uspreventiveservicestaskforce.org/Page/Name/conflict-of-interest-disclosures. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings. Dr Barry reported receiving grants and personal fees from Healthwise.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: We thank Justin Mills, MD, MPH (AHRQ), who contributed to the writing of the manuscript, and Lisa Nicolella, MA (AHRQ), who assisted with coordination and editing.

Additional Information: The USPSTF makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms. It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

Key substance use and mental health indicators in the United States: results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Published September 7, 2017. Accessed August 26, 2019. https://www.samhsa.gov/data/report/key-substance-use-and-mental-health-indicators-united-states-results-2016-national-survey
Johnston  LD , Miech  RA , O’Malley  PM ,  et al. 2018 Overview: Key Findings on Adolescent Drug Use. Monitoring the Future. Published January 2019. Accessed August 26, 2019. http://www.monitoringthefuture.org//pubs/monographs/mtf-overview2018.pdf
Heron  M .  Deaths: Leading Causes for 2016.   Natl Vital Stat Rep. 2018;67(6):1-77.PubMedGoogle Scholar
Procedure Manual. US Preventive Services Task Force. Published December 2015. Accessed August 29, 2019. https://www.uspreventiveservicestaskforce.org/uspstf/procedure-manual
Screening for Illicit Drug Use, Including Nonmedical Use of Prescription Drugs: Draft Recommendation Statement. US Preventive Services Task Force. Published 2019. Accessed August 26, 2019. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/drug-use-in-adolescents-and-adults-including-pregnant-women-screening
Curry  SJ , Krist  AH , Owens  DK ,  et al; US Preventive Services Task Force.  Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force recommendation statement.   JAMA. 2018;320(18):1899-1909. doi:10.1001/jama.2018.16789PubMedGoogle ScholarCrossref
Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: Draft Recommendation Statement. US Preventive Services Task Force. Published 2019. Accessed August 26, 2019. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/tobacco-and-nicotine-use-prevention-in-children-and-adolescents-primary-care-interventions
Drug Abuse Warning Network. 2011: National Estimates of Drug-Related Emergency Department Visits. Substance Abuse and Mental Health Services Administration. Published May 2013. Accessed August 26, 2019. https://www.samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf
Crane  EH . Emergency Department Visits Involving Narcotic Pain Relievers. Substance Abuse and Mental Health Services Administration. Published 2015. Accessed August 26, 2019. https://www.samhsa.gov/data/sites/default/files/report_2083/ShortReport-2083.pdf
Hedegaard  H , Miniño  AM , Warner  M .  Drug overdose deaths in the United States, 1999-2017.   NCHS Data Brief. 2018;(329):1-8.PubMedGoogle Scholar
Kann  L , McManus  T , Harris  WA ,  et al.  Youth risk behavior surveillance—United States, 2017.   MMWR Surveill Summ. 2018;67(8):1-114. doi:10.15585/mmwr.ss6708a1PubMedGoogle ScholarCrossref
Lynskey  MT , Heath  AC , Bucholz  KK ,  et al.  Escalation of drug use in early-onset cannabis users vs co-twin controls.   JAMA. 2003;289(4):427-433. doi:10.1001/jama.289.4.427PubMedGoogle ScholarCrossref
Townsend  L , Flisher  AJ , King  G .  A systematic review of the relationship between high school dropout and substance use.   Clin Child Fam Psychol Rev. 2007;10(4):295-317. doi:10.1007/s10567-007-0023-7PubMedGoogle ScholarCrossref
Green  KM , Doherty  EE , Ensminger  ME .  Long-term consequences of adolescent cannabis use: examining intermediary processes.   Am J Drug Alcohol Abuse. 2017;43(5):567-575. doi:10.1080/00952990.2016.1258706PubMedGoogle ScholarCrossref
Nargiso  JE , Ballard  EL , Skeer  MR .  A systematic review of risk and protective factors associated with nonmedical use of prescription drugs among youth in the United States: a social ecological perspective.   J Stud Alcohol Drugs. 2015;76(1):5-20. doi:10.15288/jsad.2015.76.5PubMedGoogle ScholarCrossref
Grant  I , Gonzalez  R , Carey  CL , Natarajan  L , Wolfson  T .  Non-acute (residual) neurocognitive effects of cannabis use: a meta-analytic study.   J Int Neuropsychol Soc. 2003;9(5):679-689. doi:10.1017/S1355617703950016PubMedGoogle ScholarCrossref
Schreiner  AM , Dunn  ME .  Residual effects of cannabis use on neurocognitive performance after prolonged abstinence: a meta-analysis.   Exp Clin Psychopharmacol. 2012;20(5):420-429. doi:10.1037/a0029117PubMedGoogle ScholarCrossref
Barlow  A , Mullany  B , Neault  N ,  et al.  Effect of a paraprofessional home-visiting intervention on American Indian teen mothers’ and infants’ behavioral risks: a randomized controlled trial.   Am J Psychiatry. 2013;170(1):83-93. doi:10.1176/appi.ajp.2012.12010121PubMedGoogle ScholarCrossref
Jalling  C , Bodin  M , Romelsjö  A , Källmén  H , Durbeej  N , Tengström  A .  Parent programs for reducing adolescent’s antisocial behavior and substance use: a randomized controlled trial.   J Child Fam Stud. 2016;25(3):811-826. doi:10.1007/s10826-015-0263-yPubMedGoogle ScholarCrossref
Kerr  JC , Valois  RF , Farber  NB ,  et al.  Effects of promoting health among teens on dietary, physical activity and substance use knowledge and behaviors for African American adolescents.   Am J Health Educ. 2013;44(4):191-202. doi:10.1080/19325037.2013.798218PubMedGoogle ScholarCrossref
Moyer  VA ; US Preventive Services Task Force.  Primary care behavioral interventions to reduce illicit drug and nonmedical pharmaceutical use in children and adolescents: U.S. Preventive Services Task Force recommendation statement.   Ann Intern Med. 2014;160(9):634-639. doi:10.7326/M14-0334PubMedGoogle ScholarCrossref
O’Connor  EA , Thomas  R , Robalino  S ,  et al.  Interventions to Prevent Illicit and Nonmedical Drug Use in Children, Adolescents, and Young Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force: Evidence Synthesis No. 190. Agency of Healthcare Research and Quality; 2019. AHRQ Publication No. 19-05258-EF-1.
O’Connor  E , Thomas  R , Senger  CA , Perdue  L , Robalino  S , Patnode  C .  Interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults: updated evidence report and systematic review for the US Preventive Services Task Force.   JAMA. Published May 26, 2020. doi:10.1001/jama.2020.1432Google Scholar
Moyer  VA ; US Preventive Services Task Force.  Primary care interventions to prevent tobacco use in children and adolescents: U.S. Preventive Services Task Force recommendation statement.   Ann Intern Med. 2013;159(8):552-557.PubMedGoogle Scholar
Walkup  JT , Barlow  A , Mullany  BC ,  et al.  Randomized controlled trial of a paraprofessional-delivered in-home intervention for young reservation-based American Indian mothers.   J Am Acad Child Adolesc Psychiatry. 2009;48(6):591-601. doi:10.1097/CHI.0b013e3181a0ab86PubMedGoogle ScholarCrossref
Barlow  A , Varipatis-Baker  E , Speakman  K ,  et al.  Home-visiting intervention to improve child care among American Indian adolescent mothers: a randomized trial.   Arch Pediatr Adolesc Med. 2006;160(11):1101-1107. doi:10.1001/archpedi.160.11.1101PubMedGoogle ScholarCrossref
Kim  HK , Leve  LD .  Substance use and delinquency among middle school girls in foster care: a three-year follow-up of a randomized controlled trial.   J Consult Clin Psychol. 2011;79(6):740-750. doi:10.1037/a0025949PubMedGoogle ScholarCrossref
Baldus  C , Thomsen  M , Sack  PM ,  et al.  Evaluation of a German version of the Strengthening Families Programme 10-14: a randomised controlled trial.   Eur J Public Health. 2016;26(6):953-959. doi:10.1093/eurpub/ckw082PubMedGoogle ScholarCrossref
Bannink  R , Broeren  S , Joosten-van Zwanenburg  E , van As  E , van de Looij-Jansen  P , Raat  H .  Effectiveness of a web-based tailored intervention (E-health4Uth) and consultation to promote adolescents’ health: randomized controlled trial.   J Med Internet Res. 2014;16(5):e143. doi:10.2196/jmir.3163PubMedGoogle Scholar
D’Amico  EJ , Parast  L , Shadel  WG , Meredith  LS , Seelam  R , Stein  BD .  Brief motivational interviewing intervention to reduce alcohol and marijuana use for at-risk adolescents in primary care.   J Consult Clin Psychol. 2018;86(9):775-786. doi:10.1037/ccp0000332PubMedGoogle ScholarCrossref
Dembo  R , Briones-Robinson  R , Schmeidler  J ,  et al.  Brief intervention impact on truant youths’ marijuana use: 18-month follow-up.   J Child Adolesc Subst Abuse. 2014;23(5):318-333. doi:10.1080/1067828X.2014.928116PubMedGoogle ScholarCrossref
Estrada  Y , Lee  TK , Wagstaff  R ,  et al.  eHealth Familias Unidas: efficacy trial of an evidence-based intervention adapted for use on the internet with Hispanic families.   Prev Sci. 2019;20(1):68-77. doi:10.1007/s11121-018-0905-6PubMedGoogle ScholarCrossref
Fang  L , Schinke  SP , Cole  KC .  Preventing substance use among early Asian-American adolescent girls: initial evaluation of a web-based, mother-daughter program.   J Adolesc Health. 2010;47(5):529-532. doi:10.1016/j.jadohealth.2010.03.011PubMedGoogle ScholarCrossref
Foxcroft  DR , Callen  H , Davies  EL , Okulicz-Kozaryn  K .  Effectiveness of the strengthening families programme 10-14 in Poland: cluster randomized controlled trial.   Eur J Public Health. 2017;27(3):494-500.PubMedGoogle Scholar
Lee  CM , Neighbors  C , Kilmer  JR , Larimer  ME .  A brief, web-based personalized feedback selective intervention for college student marijuana use: a randomized clinical trial.   Psychol Addict Behav. 2010;24(2):265-273. doi:10.1037/a0018859PubMedGoogle ScholarCrossref
Sanci  L , Chondros  P , Sawyer  S ,  et al.  Responding to young people’s health risks in primary care: a cluster randomised trial of training clinicians in screening and motivational interviewing.   PLoS One. 2015;10(9):e0137581. doi:10.1371/journal.pone.0137581PubMedGoogle Scholar
Schinke  SP , Fang  L , Cole  KC .  Preventing substance use among adolescent girls: 1-year outcomes of a computerized, mother-daughter program.   Addict Behav. 2009;34(12):1060-1064. doi:10.1016/j.addbeh.2009.06.007PubMedGoogle ScholarCrossref
Schinke  SP , Fang  L , Cole  KC .  Computer-delivered, parent-involvement intervention to prevent substance use among adolescent girls.   Prev Med. 2009;49(5):429-435. doi:10.1016/j.ypmed.2009.08.001PubMedGoogle ScholarCrossref
Schwinn  TM , Schinke  SP , Hopkins  J , Keller  B , Liu  X .  An online drug abuse prevention program for adolescent girls: posttest and 1-year outcomes.   J Youth Adolesc. 2018;47(3):490-500. doi:10.1007/s10964-017-0714-4PubMedGoogle ScholarCrossref
Walton  MA , Bohnert  K , Resko  S ,  et al.  Computer and therapist based brief interventions among cannabis-using adolescents presenting to primary care: one year outcomes.   Drug Alcohol Depend. 2013;132(3):646-653. doi:10.1016/j.drugalcdep.2013.04.020PubMedGoogle ScholarCrossref
Walton  MA , Resko  S , Barry  KL ,  et al.  A randomized controlled trial testing the efficacy of a brief cannabis universal prevention program among adolescents in primary care.   Addiction. 2014;109(5):786-797. doi:10.1111/add.12469PubMedGoogle ScholarCrossref
Rhee  H , Hollen  PJ , Belyea  MJ , Sutherland  MA .  Decision-making program for rural adolescents with asthma: a pilot study.   J Pediatr Nurs. 2008;23(6):439-450. doi:10.1016/j.pedn.2008.01.079PubMedGoogle ScholarCrossref
Malmberg  M , Kleinjan  M , Overbeek  G ,  et al.  Effectiveness of the “Healthy School and Drugs” prevention programme on adolescents’ substance use: a randomized clustered trial.   Addiction. 2014;109(6):1031-1040. doi:10.1111/add.12526PubMedGoogle ScholarCrossref
Knight  JR , Sherritt  L , Gibson  EB ,  et al.  Effect of computer-based substance use screening and brief behavioral counseling vs usual care for youths in pediatric primary care: a pilot randomized clinical trial.   JAMA Netw Open. 2019;2(6):e196258. doi:10.1001/jamanetworkopen.2019.6258PubMedGoogle Scholar
Screening, brief intervention, and referral to treatment (SBIRT). Substance Abuse and Mental Health Services Administration. Published September 15, 2017. Accessed August 27, 2019. https://www.samhsa.gov/sbirt
Committee on Substance Use and Prevention.  Substance use screening, brief intervention, and referral to treatment.   Pediatrics. 2016;138(1):e20161210. doi:10.1542/peds.2016-1210PubMedGoogle Scholar
Grant  CN , Bélanger  RE .  Cannabis and Canada’s children and youth.   Paediatr Child Health. 2017;22(2):98-102. doi:10.1093/pch/pxx017PubMedGoogle ScholarCrossref
Drug misuse prevention: targeted interventions [NICE guideline NG64]. National Institute for Health and Care Excellence. Published February 22, 2017. Accessed August 27, 2019. https://www.nice.org.uk/guidance/ng64
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