Drug use screening at a checkup: who is asked

When it starts, when it can stop

Starts: At 18. Teens are not covered (grade I). (USPSTF, 2020)
Can stop: The USPSTF sets no upper age limit. (USPSTF, 2020)

Who it is for

Adults 18 years or older, including pregnant and postpartum people, in settings that can offer or refer people for accurate diagnosis, effective treatment and appropriate care. (USPSTF, 2020)

It does not apply to people already diagnosed with a drug use disorder or in or referred to treatment, or to settings where treatment cannot be provided or the result would be punitive. (USPSTF, 2020)

Test and how often

Questions asked by the clinician, or answered on a form, computer or tablet. Screening means asking questions, not testing blood or urine. (USPSTF, 2020)
Brief tools such as the NIDA Quick Screen, which asks 4 questions about alcohol, tobacco, nonmedical use of prescription drugs and illegal drugs in the past year; or longer tools such as the 8-item ASSIST. (USPSTF, 2020)
No set interval: there is little evidence on when to start asking or how often. (USPSTF, 2020)

Drug use screening by age

Unhealthy drug use screening by age: USPSTF 2020
Who	Grade	What it means
Teens	I	Evidence not enough to weigh screening
Adults 18 and older, including pregnant and postpartum people	B	Ask about drug use when care can be offered or referred
People already diagnosed or in treatment	Not covered	The recommendation does not apply

The USPSTF uses "unhealthy drug use" for illegal drugs and for using a prescription drug other than as prescribed, such as to get high or change your mood. It does not include alcohol or tobacco, which have their own recommendations. (USPSTF, 2020)

The USPSTF asks clinicians to know their state rules on consent, records and confidentiality, to lower the risk of stigma or legal consequences from screening. (USPSTF, 2020)

If you need help now

SAMHSA's National Helpline, 1-800-662-HELP (4357), is free, confidential and open 24 hours a day, every day, in English and Spanish. It refers callers to local treatment, support groups and community organizations; it does not provide counseling. If you are in crisis, call or text 988. Read more: SAMHSA National Helpline. (SAMHSA)

Where the USPSTF draws the line

Grade C means a small net benefit, so it is offered to some people; D means do not screen; I means the evidence is not enough to decide. (USPSTF grade definitions)

Grade I: the evidence is not enough to weigh screening teens for unhealthy drug use. (USPSTF, 2020)

Questions people ask

Is there a drug test at a physical?

Not as part of this recommendation. The USPSTF defines drug use screening as asking questions about drug use, not testing blood or urine. A clinician may order a test for other reasons; ask if you are unsure what a test is for. (USPSTF, 2020)

What questions are asked in a drug use screening?

Brief tools ask whether, in the past year, you used illegal drugs or used a prescription drug for nonmedical reasons. The NIDA Quick Screen asks 4 questions covering alcohol, tobacco, prescription drugs used other than prescribed, and illegal drugs. (USPSTF, 2020)

At what age does drug use screening start?

The grade B starts at 18. For teens the USPSTF found the evidence insufficient (grade I). There is little evidence on the best age to start asking or how often to repeat it. (USPSTF, 2020)

Is what I tell my doctor about drug use confidential?

The USPSTF asks clinicians to follow their state rules on consent, record keeping and confidentiality. Ask your doctor how your answers are recorded and who can see them. (USPSTF, 2020)

Where can I find treatment?

SAMHSA's National Helpline, 1-800-662-HELP (4357), is free and confidential, 24 hours a day, in English and Spanish, and refers callers to local treatment. You can also text your ZIP code to 435748 (HELP4U). (SAMHSA)

Source

U.S. Preventive Services Task Force, "Unhealthy Drug Use: Screening", final recommendation released June 9, 2020. Read it on uspreventiveservicestaskforce.org. Checked against the live page on 2026-10-28.