Primary prevention
Your Organizational Guidance
ebpracticenet urges you to prioritize the following organizational guidance:
GeneesmiddelenverslavingPublished by: Domus Medica | SSMGLast published: 2011Assuétude aux médicamentsPublished by: Domus Medica | SSMGLast published: 2011Efforts directed toward education of teenage and preteenage populations are needed. Universal primary prevention aligns with pediatric principles of healthy development and can be implemented through evidence-based parenting interventions. In 2020, the US Preventive Services Task Force concluded that there was insufficient evidence to assess the use of primary care-based behavioral counseling interventions to prevent illicit drug use in children, adolescents, and young adults.[48] However, some studies show reduced substance use into adulthood among children whose parents received primary prevention interventions. Programs like Guiding Good Choices, Triple P Parenting, and Familias Unidas have been successfully adapted to primary care settings with positive outcomes.[49][50][51]
It is recommended that clinicians educate adolescents and families on the risks of nonmedical use of controlled drugs including amphetamines and how to use such drugs safely, including secure storage, supervised access, proper disposal, and avoiding sharing or selling drugs. Be familiar with local practice requirements on prescription monitoring databases, and make appropriate use of such programs. Address unusual prescription patterns (e.g., frequent refills, multiple prescribers) with the patient or family while maintaining confidentiality when possible.[51]
Secondary prevention
Expert opinion supports the use of a brief intervention including harm reduction education and motivational interviewing techniques for people presenting to a healthcare professional where there is evidence of risky stimulant use, in order to reduce risk of harm, including progression to stimulant-use disorder.[13] Depending on local service arrangements, consider offering referral for a comprehensive assessment for substance use disorder for all patients who describe a history of risky stimulant use.[13] Harm reduction measures are important for those who continue to engage in nonmedical use of stimulants, see Patient discussions. Referral to local harm reduction services may be indicated, depending on local service arrangements, and on the individual clinical risk. In some locations, patients may be referred to local supervised consumption sites.[13]
The US Centers for Disease Control and Prevention (CDC) recommends hepatitis A vaccination for people who use illicit/recreational drugs via injection and non-injection methods (i.e., all those who use illicit drugs).[142] The CDC also recommends universal hepatitis B vaccination in all adults ages 19-59 years. In people 60 years of age or older, hepatitis B vaccination is recommended in the presence of additional risk factors, including current or recent injection drug use.[142]
The CDC recommends pre-exposure prophylaxis (PrEP) for HIV for adults and adolescents who inject drugs and report injection practices that place them at substantial ongoing risk of HIV exposure and acquisition (e.g., sharing needles).[143]
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