And, the task force noted, screening can’t take place in a vacuum: Doctors must be able to offer referrals for further diagnosis and treatment.
Dr. Mangione, a primary care physician, said that doctors are becoming increasingly eager to learn about medication-assisted treatments for addiction, because such services can be hard to come by and require special training.
“It’s on all of us providers to understand the diagnostic and treatment sources in our communities and not to use our lack of knowledge as a reason not to treat people,” she said.
The thrust of the recommendations is directed at patients who appear asymptomatic; those in the throes of addiction will be more readily apparent. There is no upper age limit for screening, said Dr. Mangione. While some people may assume that patients struggling with substance use disorders will be younger adults, older patients need scrutiny too.
Careful screening could correct some problems, Dr. Mangione said. Since many older patients are prescribed medications from different doctors, some may be taking too many medicines for the same condition, unaware of drug interactions. And some could be sharing a friend’s pain medications.
When patients are pregnant, screening has obvious benefits and potential harms. According to the Guttmacher Institute, which researches reproductive health policy, 25 states and the District of Columbia mandate that health care professionals report suspected drug abuse by pregnant women. Reporting may not necessarily lead to criminal sanctions or the scrutiny of child protective services: Instead, a few states, including California, Connecticut and Maryland, direct these women to treatment. The task force urged providers to be aware of the implications of screening for patients, as well as understand the nuances of state mandates.
The American College of Obstetrics and Gynecology says that while screening should be part of routine prenatal care, urine drug testing itself — which is not included in the new guidelines — should be used with extreme caution, because it can be inaccurate and lead to dire consequences for mother and baby, said Dr. Mishka Terplan, an obstetrician-gynecologist and addiction medicine consultant for Virginia Medicaid.
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