Screening for illicit drug use; endorsement of the U.S. preventive services task force: merit of staggering data security— A hasty move with probable feeble import
The investigation of a medical problem with a methodical survey, to assess suitability for a particular treatment is an efficient tool in preventing, and maintaining public safety. It also expands the human knowledge base on medical science and technological advances. But concomitant to positive utilities without proper validation it may hinder the progress originally intended to carry out. Even more crucial is to realize that medical science due to its attributes to humanity does indeed convey factors which have little or none to do with the prevailing applied scientific discipline. Thus, to Screen is the science-based overture which not incongruously is integrated with the social, political and ethical determinants within its linguistic context. For instance, in a recent publication, U.S. National panel advocates screening all adults for use of recreational drugs. The recommendation is a moving part of a major initiative designed to challenge counter to the mounting opioid epidemics in the country. The panel’s endorsement of the screening protocol advises physicians routinely ask patients a series of questions about their drug usage and habits.
Before we get to the core of the discussion I would shadow the task forces recommendation with the following question—— “what makes them so confident patients will comply truly by the screening questions?”
The task force claims drug testing is not included within the framework of the protocol, and that emphasizing the proposed instrument of screening is not designed to diagnose drug dependence, abuse, addiction, or experimentation. It confirms as well; by implementing the protocols- physicians may show who might need to be offered appropriate support.
The U.S. Preventive Services Task Force’s recommendation conveys the impression of premature stride. Few Points need to be addressed before committing to such a drastic measure without facing significant backfire from the community. One major concern has got to do with the public’s ability to tell apart between drug uses, abuse, addiction, dependence, and delineate their social, ethical and legal ramifications. The crucial is to cultivate the public mindset that addiction and dependence are medical problems merely like asthma or diabetes. Removing the demonizing social mindset around criminality or illegitimate cultural perception of drug abuse is vital to launching effectual screening protocols. Even to a greater magnitude is imperative to observe that the upshot of the screening is one hundred percent secure and confidential. One might aver these prerequisites are easy to meet but so with its significant public misconception it would call for comprehensive mass education.
Current Layperson tends to interchangeably equate addiction, drug abuse, and drug dependence. For them, an addict typically draws a picture of a person who uses the substance on a regular basis and is unable to stop abruptly. If for any rationale the drug intake is interrupted then the patient will manifest signs of disabling withdrawal symptoms. Although under certain censor the hooked individual may indeed show withdrawal signs but is not imperative to the diagnosis of addiction or abuse. Addiction is a behavioral condition. The addicted person engages in the habit of substance seeking and intake or activity for which the rewarding effects offer a compelling incentive to pursue the comportment despite damaging consequences. Such compulsive behavior is pathological in nature and plausible than not can be contained through psychological empowerment.
As mentioned in the beginning- screening if designed aright and utilized in proper mode saves and improves quality of life. But to consider limited screening without the diagnostic workup will still carry poor prognosis of its own. Because once a patient admits using a legally prohibited drug, it will inevitably raise “red flag”, hence and in respects will suffer the false presumptuousness of drug abuse, dependence or addiction. Under pure clinical scenario and doctor-patient confidentiality, sharing drug habits would not be the cause for a conflict, but within the framework of current healthcare dysfunction where patient information is flattering more accessible to entities; it would serve as a ground for potential inducement if it’s mishandled, more so if insurance carriers or employers may access such information.
In order for the illicit drug use surveillance to be effectual, it must at foremost be established as a culture without legal, social and ethical ramification, hence to be treated like diabetes or hypertension. The patient must find assured there won’t be discriminatory consequences of disclosing such information. For a patient without the proper pledge of his sovereignty, today admitting to drug use would be as consequential as admitting to its exercise under false effrontery of addiction by 3rd party bystander. Besides screening may have false positives and negatives; cheap impingement of screening tests to rule out or even try to engage each candidate in preventive measures would potentially be overwhelming. The Ethical implications besides are destined to conflict with the actual mission of the cull. Individual choice more so as the reflection of personal trust to be screened will make for a strong tone on the accuracy of the collected data. Unlike most other surveillance tests including smoking which carriers less humiliation, admitting to heroin use would entail saying goodbye to job opportunities and low insurance premiums. Assuming illicit drug users or those who have experimented with one in the past criminal by merit of affiliation is unfitting.
Patient Privacy and health Information security has become a shaky terra firma for public rustiness. To date- no entity has invested unbiased travail to effectively award it to the populace— not because they were unable to but solely entities desperately seek admittance to confidential valuable patient data. Implementing an effective security protocol would undermine long term corporate mission. That does not exclude data associated with illicit drug use, opening another theme in the data piracy discourse.
Current data precariousness is a big healthcare worry specifically with the current partnership drifts between giant corporations and the government entities. For instance, Amazons Alexa with all the Artificial intelligence algorithms incorporated within would constitute a challenging chore to forestall outflow of the illicit drug screening outcome to 3rd party entities.
Screening for illicit drugs vs other medical conditions
Without a doubt, addiction and drug dependence are major healthcare trepidations. They must be diligently identified and treated. Equally, it’s imperative to hold in mind public precept surrounding the particular disease, as it will shape the level of patient compliance with the recommended screening course. But regrettably, the public is yet to arrive at the stratum of understanding embrace that demonization of the addiction and drug abuse is fundamentally morbid and off beam.
Looking in reverse— during 1980,s we have traversed through a similar scenario with regard to HIV and AIDS when the public struggled to be vetted under the individual liberty and discretion. The mass stood fretful about discriminatory consequences associated with a positive ending. Hence, the encroachment of revelation of drug habit comprises distrust by the chastity of deprecating one’s action using current social perception and nonstarter to intelligently differentiate between the terms’ experimentation, medical use, dependence, and addiction. It will probably flunk to delineate those who use prescription opioids who also purchase the same medicine in the black market. As long as the mentioned matter go unsolved health Insurance Portability and Accountability Act (HIPAA) will not suffice to remedy the substantive broken trust. What is undermining is Data security and big data business functioning hand in hand with Artificial intelligence to practically show patient data for the sake of corporate fiscal gain and prejudicial medical service delivery.
Screening is an efficient instrument but it will not extend a desirable effect, because there is no inducement for a patient under the current socio-political environment acknowledges using illicit drugs.
Before opening the “can of worms”, the preventative task force may consider educating the public by promoting general knowledge of what drug revilement and addiction are; later in the sequence build the more specific preventive measures over that whimsy. Since drug safety is not another typical public health issue, thus if screening of a patient yielded positive result then the treatment would still call for further education and rectify patient’s willingness to seek help.
How about Prohibition?
I have published a piece on e-cigarettes and prohibition. The article outlines the grandness of creating healthy and legal environs where fundamental solutions can be applied to real problems associated with e-cigarettes and any other substance usage.
The Prerequisite to screening is establishing the initial full legal protection of the drug user and so working to alter the public mindset through transparent public education. Concomitantly first requires wiping off the evilness of addiction. An Addict or a person physiologically dependent on a substance needs to feel safe from social and fiscal implications of sharing information, like losing a job or credibility which would potentially subject the patient to societal prejudices. Health data needs to be decentralized, secure and owned by the individual patient. Sharing data with or without disclosure of the identity of the patient must be with the consent of its proprietor. This would include any form of accessing data through machine learning algorithms or any form of application program interface (API). Screening is a personal alternative and under the current arrangement of healthcare delivery when it comes to addiction would confirm the poor outcome.