Current evidence is insufficient to ascertain the benefits and harms of primary care interventions aimed at preventing or reducing drug use in the pediatric population, according to an updated guideline published March 10 online in the Annals of Internal Medicine.
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After a review of studies that attempted to ascertain the benefits and harms of drug use, interventions yielded "almost no evidence of significant improvements in health outcomes," Dr. Virginia A. Moyer and her associates concluded.
The U.S. Preventive Services Task Force, a voluntary organization that is independent of government and industry, and funded by the Agency for Healthcare Research and Quality, reviews medical evidence and makes recommendations about specific preventive care services. For this guideline, the USPSTF found only six fair- or good-quality studies of four different primary care interventions to prevent children and adolescents from using illicit drugs or misusing prescription drugs, said Dr. Virginia A. Moyer, chair of the writing committee and a vice president of the American Board of Pediatrics, and her associates.
The four interventions were face-to-face counseling, videos, print materials, and interactive computer-based tools, and were "substantially varied in their intensity, components, [target] populations, and sample sizes." But the six studies yielded "almost no evidence of significant improvements in health outcomes," Dr. Moyer and her colleagues reported (Ann. Intern. Med. 2014 March 10).
Drug use is a significant contributor to three of the leading causes of death among adolescents – vehicular accidents, homicide, and suicide – and increases risk-taking behaviors while the youths are under the influence, including driving while impaired, unsafe sexual activity, and violence. It also is associated with low educational achievement. More adolescents use illicit drugs or intentionally misuse prescription drugs than use tobacco, the USPSTF noted.
Dr. Virginia A. Moyer
Currently, the American Academy of Pediatrics recommends that clinicians screen all adolescents for alcohol and drug use, and based on those results, "provide guidance and brief counseling interventions, and, if appropriate, refer for treatment." The screening tool recommended by the AAP, called the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble), takes less than 2 minutes to administer and was designed to be delivered "as an interview or paper- or computer-based self-report," according to the USPSTF.
The American Academy of Family Physicians is in the process of reviewing its recommendation on addressing drug use among children and adolescents.
The USPSTF is an independent, voluntary body supported by the Agency for Healthcare Research and Quality. Dr. Moyer and her associates reported no potential conflicts of interest.