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Primary Care Behavioral Interventions to Prevent or Reduce Illicit Drug Use and Nonmedical Pharmaceutical Use in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task ForceInterventions to Prevent or Reduce Drug Use in Children and Adolescents

Carrie D. Patnode, PhD, MPH; Elizabeth O’Connor, PhD; Maya Rowland, MPH; Brittany U. Burda, MPH; Leslie A. Perdue, MPH; and Evelyn P. Whitlock, MD, MPH
[+] Article, Author, and Disclosure Information

This article was published online first at www.annals.org on 11 March 2014.

From Kaiser Permanente Northwest, Portland, Oregon.

Note: This review was conducted by the Kaiser Permanente Research Affiliates Evidence-based Practice Center under contract to AHRQ. AHRQ staff provided oversight for the project and assisted in the external review of the companion draft evidence synthesis.

Acknowledgment: The authors thank the AHRQ; members of the USPSTF; Sara Becker, PhD, Richard Brown, MD, MPH, Sharon Levy, MD, MPH, Matthew Young, PhD, and Stephen W. Banspach, PhD, for providing expert or federal partner review of the report; and Jillian T. Henderson, PhD, Kevin Lutz, MFA, Keshia Bigler, and the medical librarians at Kaiser Permanente Center for Health Research.

Financial Support: By contract HHS-290-2007-10057-I from AHRQ.

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2064.

Requests for Single Reprints: Reprints are available from the AHRQ Web site (www.ahrq.gov).

Current Author Addresses: Drs. Patnode, O’Connor, and Whitlock; Ms. Rowland; Ms. Burda; and Ms. Perdue: Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227.

Author Contributions: Conception and design: C.D. Patnode, E. O’Connor, E.P. Whitlock.

Analysis and interpretation of the data: C.D. Patnode, E. O’Connor, E.P. Whitlock.

Drafting of the article: C.D. Patnode.

Critical revision of the article for important intellectual content: C.D. Patnode, E. O’Connor, E.P. Whitlock.

Final approval of the article: C.D. Patnode, E. O’Connor, M. Rowland, B.U. Burda, L.A. Perdue, E.P. Whitlock.

Provision of study materials or patients: C.D. Patnode.

Statistical expertise: C.D. Patnode, E. O’Connor.

Obtaining of funding: E.P. Whitlock.

Administrative, technical, or logistic support: M. Rowland, B.U. Burda, L.A. Perdue, E.P. Whitlock.

Collection and assembly of data: C.D. Patnode, E. O’Connor, M. Rowland, B.U. Burda, L.A. Perdue.

Ann Intern Med. 2014;160(9):612-620. doi:10.7326/M13-2064
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Background: Drug use among youths is associated with negative health and social consequences. Even infrequent use increases the risk for serious adverse events by increasing risk-taking behaviors in intoxicated or impaired persons.

Purpose: To systematically review the benefits and harms of primary care–relevant interventions designed to prevent or reduce illicit drug use or the nonmedical use of prescription drugs among youths.

Data Sources: PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through 4 June 2013; MEDLINE through 31 August 2013; and manual searches of reference lists and gray literature.

Study Selection: Two investigators independently reviewed 2253 abstracts and 144 full-text articles. English-language trials of primary care–relevant behavioral interventions that reported drug use, health outcomes, or harms were included.

Data Extraction: One investigator abstracted data from good- and fair-quality trials into prespecified evidence tables, and a second investigator checked these data.

Data Synthesis: Six trials were included, 4 of which examined the effect of the intervention on a health or social outcome. One trial found no effect of the intervention on marijuana-related consequences or driving under the influence of marijuana; 3 trials generally found no reduction in depressed mood at 12 or 24 months. Four of the 5 trials assessing self-reported marijuana use found statistically significant differences favoring the intervention group participants (such as a between-group difference of 0.10 to 0.17 use occasions in the past month). Three trials also reported positive outcomes in nonmedical prescription drug use occasions.

Limitations: The body of evidence was small, and there were heterogeneous measures of outcomes of limited clinical applicability. Trials primarily included adolescents with little or no substance use.

Conclusion: Evidence is inadequate on the benefits of primary care–relevant behavioral interventions in reducing self-reported illicit and pharmaceutical drug use among adolescents.

Primary Funding Source: Agency for Healthcare Research and Quality.


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Appendix Figure 1.

Analytic framework and key questions.

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Appendix Figure 2.

Summary of evidence search and selection.

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