No good evidence on primary care interventions to reduce drug use in children: USPSTF

By Frederik Joelving

NEW YORK (Reuters Health) - At least for now, primary care doctors are on their own when it comes to preventing or reducing drug use in kids, according to the U.S. Preventive Services Task Force.

A review commissioned by the group found no solid evidence that behavioral interventions feasible in primary care have an impact on youngsters' drug abuse, whether of illicit substances or pharmaceuticals.

"Computer-based interventions that are self-administered in the home at convenient times and involve parents and adolescents show promise, but youths who were actively using drugs or had problematic use were not well-represented in the included trials and primary care-based interventions were generally not effective," Dr. Carrie Patnode and colleagues from Kaiser Permanente Center for Health Research in Portland, Oregon, write in Annals of Internal Medicine, online March 10.

It is estimated that more than 4300 adolescents between 12 and 17 take drugs for the first time every day in the U.S. Most often it is marijuana, but many also use prescription drugs for non-medical purposes.

The new report is based on a review of the literature up to 2013 and includes six trials of good or fair quality. Studies of youths with a known substance use disorder were excluded.

There were too few trials -- and too much variability in interventions, target populations and other factors -- to do a meta-analysis, the researchers say.

Only one of three primary care-based trials found a statistically significant effect on drug use at one to two years, and this was limited to non-U.S. participants.

All three trials of computer-based interventions found significant differences in self-reported marijuana use favoring the interventions. But Dr. Patnode and colleagues caution that the research "relied on a self-reported measure of marijuana, prescription drug, and inhalant use occasions, which has limitations in ease of recall among participants and limited clinical applicability. In addition, we have concerns with this group of computer-based studies that involved the same group of investigators."

One of the computer-based interventions also appeared to have a positive effect on mood, but it did not persist over two years of follow-up.

In a guideline based on the review, the USPSTF says that "given the lack of clear and consistent findings and the overall small evidence base, the USPSTF could not draw definitive conclusions."

Similarly, in 2008 the group concluded that there was insufficient evidence to recommend for or against routine screening for drug abuse in adolescents and adults alike.

Dr. Albert Siu, co-vice chair of the USPSTF, said the lack of convincing data doesn't necessarily mean doctors should sit on their hands.

"We recognize that, even in the face of insufficient evidence, clinicians have to do something," he told Reuters Health by email.

"While we found no evidence-proven intervention that we can recommend, many clinicians may choose to talk with a teen who is engaging in risky behaviors, such as drug use," Dr. Siu said. "Clinicians should continue to educate their patients about the impact of illicit and nonmedical pharmaceutical drug use if that is part of their standard practice."

He added that health providers who know or strongly suspect that a patient is abusing drugs should refer the patient to specialized care or offer appropriate treatment themselves.

SOURCE: http://bit.ly/1fkK6o8 and http://bit.ly/1nCot9B

Ann Intern Med 2014.

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