War on Drugs

No Evidence Doctors Can Stop Young Patients From Using Drugs, Say Researchers



Forget pushing physicians to nag their young patients about drug use. Chances are that few doctors look forward to playing nosy aunt and even fewer teens eagerly anticipate a lecture while they turn their heads and cough, but now they can easily shrug off those unpleasant roles. As it turns out, there's little evidence that physicians have any effect when it comes to nagging those darned kids to spurn pot or avoid popping pills.

Research performed on behalf of the U.S. Preventive Services Task Force, an "independent, volunteer panel of national experts in prevention and evidence-based medicine," and published in the Annals of Internal Medicine, finds:

The USPSTF found only 6 fair- or good-quality studies of 4 primary care–relevant behavioral interventions that focused on reducing drug use in adolescents. These interventions included face-to-face counseling, videos, print materials, and interactive computer-based tools. Although the interventions substantially varied in their intensity, components, populations, and sample sizes, they provide almost no evidence of significant improvements in health outcomes. A few changes in drug use and drug initiation were found, but given the lack of clear and consistent findings and the overall small evidence base, the USPSTF could not draw definitive conclusions. It is possible that brief primary care–relevant interventions do not significantly affect adolescent drug use or that more effective interventions may need to be developed.

The surveyed interventions, according to author Dr. Virginia A. Moyer, the vice president for maintenance of certification and quality at the American Board of Pediatrics, ranged from 10-minute in-office discussions to 45-minute interactive online interventions. Overall, the intent was to discourage the recreational use of marijuana, alcohol, and prescription drugs. While some reductions in use were reported, the biggest changes were, apparently, hard to interpret. "It is not clear whether the intervention helped girls who had never used drugs to remain abstinent or helped a few girls who were frequently using drugs to reduce or stop their drug use."

Overall, there was little to go on in order to assess the benefits, or harms, of using primary care physicians to convince kids to avoid drug and alcohol use.

As of 2003, U.S. Preventive Services Task Force recommendations for preventive services would add 7.4 hours to a primary care doctor's day, and they probably haven't become less demanding in the intervening years. The ineffectiveness of drug interventions is plenty of reason to refrain from trying to shoehorn them into an already busy schedule.

Well, that and the risk of alienating patients with endless rounds of nagging.