Validity Of Self-reported Drug Use Research Articles

Comparison of self-reported substance use with biological testing among treatment-seeking patients with opioid use disorder

BackgroundSeveral factors may influence the validity of self-report. In this study, we aimed to assess the validity of self-reported drug use compared to urine testing among treatment-seeking patients with opioid use disorder (OUD). MethodsThis cross-sectional study recruited 293 patients with OUD, referred to the Iranian National Center for Addiction Studies (INCAS) clinic, from November 2015 to June 2017. The study compared self-reported opioid use in the past 72 h with the results of urinalysis, using immunoassay technique. We estimated sensitivity, negative predictive value, percent agreement, positive percent agreement, and Cohen's kappa statistics for those with OUD. ResultsThe sensitivity of self-reported opioid use was 85.9%. Percent agreement, positive percent agreement, and Cohen's Kappa statistics between self-reported opioid use and urine testing for morphine in the first month were 88.5%, 78.1%, and 77.0, respectively. Multilevel logistic regression showed that longer treatment duration (OR = 1.21, 95%CI: 1.07–1.37, p-value = 0.002) was significantly associated with the agreement of self-reported opioid use with urine testing. ConclusionSelf-report can be used as a reliable method for monitoring treatment adherence combined with random urine tests.

Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine

Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine

The validity of self-reported drug use with urine test: results from the pilot phase of Azar cohort study.

Background: The present study aimed at assessing the validity of self-reported drug use in people aged 35 and older in a pilot phase of a population-based cohort study. Methods: A total of 1038 adults over 35 years old in Khamene city in East Azerbaijan province were recruited for the pilot phase of Azar cohort; a province-level of a nationwide PERSIAN cohort study completing a questionnaire and providing biological samples from October to December 2014. Information about the history and duration of smoking tobacco, using drug and medication were obtained by the physician. The validity of the drug use was assessed through comparing the questionnaire response with three urine strip tests for the detection of morphine, amphetamine and methamphetamine among 259 randomly selected subjects. Results: The prevalence of drug use according to self-report was 2.6% (95% CI: 1.7%-3.8%).One-step drug test as the gold standard for the use of drug self-reported demonstrated a sensitivity(95% CI) and specificity 15% (10-22) and 99.7% (98.9%-99.9%) respectively. All participants with positive self-report were male; however, in the urine analysis drug test, it was positive for 7out of 68 randomly selected women. Conclusion: The validity of self-reported drug use in this population was low; therefore, the self reported use of the drug should be used with caution in this population. It is recommended to use alternative techniques to improve the validity of data using the self-report procedure.

What's the agreement between self-reported and biochemical verification of drug use? A look at permanent supportive housing residents

Self-reported substance use is commonly used as an outcome measure in treatment research. We evaluated the validity of self-reported drug use in a sample of 334 adults with mental health problems who were residing in supportive housing programs. The primary analysis was the calculation of the positive predictive values (PPVs) of self-report compared to an oral fluid test taken at the same time. A sensitivity analysis compared the positive predictive values of two self-reported drug use histories: biological testing window (ranging between the past 96h to 30days depending on drug type) or the full past 90-day comparison window (maximum length recorded during interview). A multivariable logistic regression was used to predict discordance between self-report and the drug test for users. Self-reported drug use and oral fluid drug tests were compared to determine the positive predictive value for amphetamines/methamphetamines/PCP (47.1% agreement), cocaine (43.8% agreement), and marijuana (69.7% agreement) drug tests. Participants who misreported their drug use were more likely to be older, non-White, have no medical insurance, and not report any alcohol use. In general, amphetamine/methamphetamine/PCP and cocaine use was adequately captured by the biological test, while marijuana use was best captured by a combination of self-report and biological data. Using the full past 90day comparison window resulted in higher concordance with the oral fluid drug test, indicating that self-reported drug use in the past 90days may be a proxy for drug use within the biological testing window. Self-report has some disadvantages when used as the sole measure of drug use in this population.

Racial differences in the validity of self-reported drug use among men who have sex with men in Atlanta, GA

BackgroundMen who have sex with men (MSM), particularly young black MSM, are disproportionately affected in the United States’ HIV epidemic. Drug use may contribute to these disparities, yet previous studies have failed to provide evidence of elevated use among black MSM, relying exclusively on self-reported usage. This study uses biological assays to validate self-reports of drug use and explore the potential for misclassification to distort findings on racial patterns of use in this population. MethodsFrom an Atlanta-based cohort study of 454 black and 349 white MSM from 2010 to 2012, participants’ self-reported drug use was compared to urine drug screening findings. The sensitivity of self-report was calculated as the proportion reporting recent usage among those who screened positive. Multivariable regression models were constructed to examine racial patterns in self-report, urine-detection, and self-report sensitivity of marijuana and cocaine usage, adjusted for socio-demographic factors. ResultsIn analyses that adjusted for age, education, income, sexual orientation, and history of arrest, black MSM were less likely to report recent use of marijuana (P<0.001) and cocaine (P=0.02), but equally likely to screen positive for either drug. This discrepancy between self-reported and urine-detected drug use was explained by significantly lower sensitivity of self-report for black participants (P<0.001 for marijuana, P<0.05 for cocaine). ConclusionsThe contribution of individual drug-related risk behaviors to the HIV disparities between black and white MSM should be revisited with methods that validate self-reports of illegal drug use.

Concordance between self-report and urine drug screen data in adolescent opioid dependent clinical trial participants

Objective measures of drug use are very important in treatment outcome studies of persons with substance use disorders, but obtaining and interpreting them can be challenging and not always practical. Thus, it is important to determine if, and when, drug-use self-reports are valid. To this end we explored the relationships between urine drug screen results and self-reported substance use among adolescents and young adults with opioid dependence participating in a clinical trial of buprenorphine–naloxone. In this study, 152 individuals seeking treatment for opioid dependence were randomized to a 2-week detoxification with buprenorphine–naloxone (DETOX) or 12weeks of buprenorphine–naloxone (BUP), each with weekly individual and group drug counseling. Urine drug screens and self-reported frequency of drug use were obtained weekly, and patients were paid $5 for completing weekly assessments. At weeks 4, 8, and 12, more extensive assessments were done, and participants were reimbursed $75. Self-report data were dichotomized (positive vs. negative), and for each major drug class we computed the kappa statistic and the sensitivity, specificity, positive predictive value, and negative predictive value of self-report using urine drug screens as the “gold standard”. Generalized linear mixed models were used to explore the effect of treatment group assignment, compensation amounts, and participant characteristics on self-report. In general, findings supported the validity of self-reported drug use. However, those in the BUP group were more likely to under-report cocaine and opioid use. Therefore, if used alone, self-report would have magnified the treatment effect of the BUP condition.

Power of Automated Algorithms for Combining Time-Line Follow-Back and Urine Drug Screening Test Results in Stimulant-Abuse Clinical Trials

Background: In clinical trials of treatment for stimulant abuse, researchers commonly record both Time-Line Follow-Back (TLFB) self-reports and urine drug screen (UDS) results. Objectives: To compare the power of self-report, qualitative (use vs. no use) UDS assessment, and various algorithms to generate self-report-UDS composite measures to detect treatment differences via t-test in simulated clinical trial data. Methods: We performed Monte Carlo simulations patterned in part on real data to model self-report reliability, UDS errors, dropout, informatively missing UDS reports, incomplete adherence to a urine donation schedule, temporal correlation of drug use, number of days in the study period, number of patients per arm, and distribution of drug-use probabilities. Investigated algorithms include maximum likelihood and Bayesian estimates, self-report alone, UDS alone, and several simple modifications of self-report (referred to here as ELCON algorithms) which eliminate perceived contradictions between it and UDS. Results: Among the algorithms investigated, simple ELCON algorithms gave rise to the most powerful t-tests to detect mean group differences in stimulant drug use. Conclusions: Further investigation is needed to determine if simple, naïve procedures such as the ELCON algorithms are optimal for comparing clinical study treatment arms. But researchers who currently require an automated algorithm in scenarios similar to those simulated for combining TLFB and UDS to test group differences in stimulant use should consider one of the ELCON algorithms. Scientific Significance: This analysis continues a line of inquiry which could determine how best to measure outpatient stimulant use in clinical trials (NIDA. NIDA Monograph-57: Self-Report Methods of Estimating Drug Abuse: Meeting Current Challenges to Validity. NTIS PB 88248083. Bethesda, MD: National Institutes of Health, 1985; NIDA. NIDA Research Monograph 73: Urine Testing for Drugs of Abuse. NTIS PB 89151971. Bethesda, MD: National Institutes of Health, 1987; NIDA. NIDA Research Monograph 167: The Validity of Self-Reported Drug Use: Improving the Accuracy of Survey Estimates. NTIS PB 97175889. GPO 017-024-01607–1. Bethesda, MD: National Institutes of Health, 1997).

Impaired Reproduction of Three-Dimensional Objects by Cocaine-Dependent Subjects

Impaired Reproduction of Three-Dimensional Objects by Cocaine-Dependent Subjects

Differences in the Validity of Self-Reported Drug Use Across Five Factors: Gender, Race, Age, Type of Drug, and Offense Seriousness

This study expands our knowledge about the validity of self-reported drug use by examining how gender, race, age, type of drug, and offense seriousness interact to affect the validity of self-reported drug use. This study also provides a conceptual framework that can be used to examine the validity of self-reported drug use. Differences in the validity of self-reported drug use are explained by examining differences in underreporting and overreporting. Differences in underreporting and overreporting are then further examined while controlling for differences in base rates of drug use. As shown, whether one controls for base rates of use may drastically affect estimates of underreporting and overreporting. By using hierarchical loglinear, logit, and logistic regression models with the Drug Use Forecasting data, we show that Black offenders provide less accurate self-reports than White offenders. Black offenders do so because they are more likely to underreport crack/cocaine use than White offenders. This difference, however, disappears once differences in base rates are controlled. A Black offender who tests positive is not more likely to underreport crack/cocaine use than a White offender who tests positive. Black offenders are also more likely to overreport both marijuana and crack/cocaine use relative to White offenders. Contrary to the first, this difference is not attributable to a difference in base rates. Methodological and substantive implications of this distinction are discussed. No differences across gender, age, or offense seriousness were found.

Validity of Self-Reported Drug Use Among People with Co-Occurring Mental Health and Substance Use Disorders

Objectives: The validity of self-reports of drug use from individuals who abuse substances has been questioned. Results from studies examining the accuracy of such self-reports have been mixed, indicating the need for closer examinations of the factors associated with concordance between self-reported drug use and results of urine screens. Methods: As part of a larger study examining the effectiveness of interventions for people with co-occurring mental health and substance use disorders, we examined the agreement between self-report and urine screens for recent drug use. Results: Overall, the concordance between self-report and results from urine screens was high (80-84% agreement overall and 75–79% for the subset where the urine screen indicated recent drug use). Estimates for the likelihood of use of marijuana and cocaine within the past 30 days were 15% and 32%, respectively, based on urine screens, 25% and 35% based on self-report, and 28% and 43% based on information from both sources combined. About 1/3 of individuals who had at least one positive urine screen misrepresented their drug use at least once. Such misrepresentation tended to increase with time in the study. Conclusions: The relatively high concordance rates between self-report and urine screens indicate that situations can be structured so that individuals with co-occurring mental health and substance use disorders report instances of substance use accurately most of the time. Given the observed increase in failure to report use through time, the utility of biological markers may be more valuable as clients develop relationships with clinicians.

Coverage of Student Drug Testing Offers Few Challenges to Policies

From 1995, the year the U. S. Supreme Court upheld the right of public schools to randomly drug test student athletes,1 until August 2001, when another and more wide-reaching student drug-testing case reached the Court,2 nearly one-third of Arkansas' 310 school districts embraced student drug testing as a perceived deterrent to student drug use. This research, through content analysis, attempted to answer the questions, What types of information did local newspapers in Arkansas provide their readers concerning student drug testing before local school boards adopted drug-testing policies? and What sources were most frequently quoted in articles about student drug testing?Literature ReviewSpurred on. by the National Collegiate Athletic Association's 1986 adoption of drug testing to support fair and equitable competition among athletes,3 and by various national and state survey results showing drug use among students in grades 7-12 had reached significant proportions,4 public schools across the nation5 and in Arkansas implemented various types of drugtesting programs for their student populations. The trend, and indeed the prospect of drug testing in general, led commentators, health professionals and researchers to identify the following salient issues related to student drug testing:1. Rationale for implementing a student drug-testing policy, including perceived high incidence of drug use by school-aged children,6 administrative desire to appear to be doing something to combat drug use by students7 and financial support of the drug-testing business.82. Reliability and accuracy of selfreport drug-use surveys, noting that such surveys sometimes suffer from over-reporting of drug use under-reporting of drug use, and inconsistency among individuals' answers9 and questioning the validity of self-reported drug use among various sub-populations.103. Necessity that a drug-testing program targets students most likely at risk, both for a program's credibility and for its legality.4. Interrelationships among drug testing, extracurricular activities, and drug use, citing possibilities of drugshifting12 and avoiding extracurricular activities,13 as well as the protective aspect of such activities.145. Accuracy of drug tests, citing low accuracy of the fairly inexpensive immunoassay test chosen by some school districtsl5 and the consequences of incorrect test results.166. Protocol of drug-testing programs.177. Legal implications of student drug testing, noting various interpretations of the initial U. S. Supreme Court drug-testing case in 1995.188. Efficacy of drug testing as a deterrent to targeted behaviors.199. Alternatives to drug testing, citing effective, research-based drug education programs20 and drug-use prevention guides for caregivers.21MethodTo determine how Arkansas newspapers covered the development and implementation of drug-testing policies in the state's public schools, each of the state's 310 school districts and the three state-run schools were contacted. Contact persons in 101 districts indicated there were student drug-testing policies in place, while contact persons in nine other districts said implementation of such a policy was being discussed. These contact persons identified 73 newspapers that covered their areas. Using the Associated Press Managing Editors Association categories for categorizing Arkansas newspapers for contest purposes, publications with circulations of less than 8,000 were designated as small newspapers; publications with circulations from 8,000 to 15,000 were designated as mediumsized newspapers; and publications with circulations of more than 15,000 were designated as large newspapers.To obtain relevant newspaper articles, accessible on-line archives of identified newspapers were searched; newspaper editors and reporters were contacted and asked to send article copies; school administrators were contacted and asked to forward copies of all relevant stories on file; and the Arkansas Historical Commission's microfilmed archives of newspapers relevant to this study (12 in all) also were reviewed. …

Comparing the Validity of Self-Reported Recent Drug Use Between Adult and Juvenile Arrestees

A large body of literature has explored the validity of self-reported drug use among criminal populations. These works have typically revealed strong underreporting of recent illicit drug use. To date, however, no studies have compared the validity of self-reported drug-using behaviors between adult and juvenile offenders. The authors overcome this limitation by assessing the validity of self-reported recent drug use with data collected from 1,425 adult and 551 juvenile Los Angeles arrestees surveyed through the Arrestee Drug Abuse Monitoring (ADAM) Program in 1997. Kappa statistics were computed and tests for specificity and sensitivity were conducted utilizing urinalysis as the reference standard. Results suggest that adult arrestees are more inclined to underreport their recent use of illicit drugs. Implications for drug use research are assessed in light of the current findings.

ASSESSING THE EFFICACY OF THE CALENDAR METHOD WITH OKLAHOMA CITY ARRESTEES

ABSTRACT While a plethora of research has ascertained that respondents underreport their recent use of illicit drugs, few studies have attempted to improve the validity of self-reported drug use. The Arrestee Drug Abuse Monitoring (ADAM) Program is a federally funded drug use surveillance system that has been collecting data from arrestees since 1987. In 2000, the ADAM Program fielded a new data collection instrument that uses a calendar method to enhance the reporting of personal drug use. To date, however, no research has assessed the degree to which this calendar method has improved drug use reporting among ADAM arrestees. To address this limitation, urinalysis results and 30-day self-report measures for marijuana, crack cocaine, powder cocaine, and heroin use collected in Oklahoma City in 1999 are compared to identical drug use measures collected in 2000. In addition, kappa statistics for marijuana, crack cocaine, powder cocaine, and heroin use are generated for each of the two time frames. Results indicate that, despite virtually identical drug-positive rates within the two samples of arrestees, the introduction of the calendar method in 2000 had no significant effect on the reporting of recent marijuana, crack cocaine, powder cocaine, and heroin use. Implications for the ADAM Program and survey methodology are discussed.

The validity of self-reported drug use in non-treatment seeking individuals with cocaine dependence: correlation with biochemical assays.

Accurate estimate of drug exposure plays an important role in studies of the neurobiology of drug dependence. The validity of self-reported drug use by subjects participating in such studies has not been well established. This study examined the relationship between self-reported drug use and biological markers in 18 non-treatment-seeking cocaine-dependent individuals participating in research on the effects of cocaine on the brain. A significant relationship was found between self-reported frequency of cocaine use and hair cocaine concentration. Frequency of alcohol use correlated significantly with plasma carbohydrate-deficient transferrin and aspartate aminotransferase levels. These results suggest that self-reported substance use in non-treatment seeking research subjects is generally valid.

Reliability and Validity of Not-in-Treatment Drug Users' Follow-Up Self-Reports

Based on a sample of 259 drug users not in treatment from five different sites, we examined the reliability of self-reported demographic and behavioral information and the validity of self-reported drug use. Data were collected twice with a 48-hr interval, using the Risk Behavior Follow-Up Assessment (RBFA; National Institute for Drug Abuse, 1992), a structured interview. We examined internal consistency and test–retest reliability and found that, overall, drug users were generally reliable reporters of information regarding their demographics, drug use, sexual behavior, work and income, and criminal behavior. Exceptions to these findings of reliability were noted for items that were phrased too broadly. Comparison of self-report data and urinalysis results indicates that drug users accurately report cocaine and opiate use, although reports of cocaine use were somewhat more valid. These findings indicate that self-report data from drug users, when collected by trained interviewers, can be considered reliable and valid.

Validity of self-reported drug use in chronic pain patients.

Previous researchers have reported that in psychiatric populations many patients provide incorrect self-report information on current drug use. Therefore, the purposes of the present study were to determine the percentage of chronic pain patients (CPPs) using illicit drugs (cannabis, cocaine), to determine the percentage of CPPs who provide incorrect self-report drug use information in the psychiatric examination, and to identify some variables that could help in identifying the CPP likely to provide an incorrect drug use history using drug urine toxicologies. DESIGN/SETTING/PARTICIPANTS/OUTCOME MEASURES: Two hundred seventy-four CPP consecutive admissions to a pain facility were psychiatrically examined according to criteria in the Diagnostic and statistical manual of mental disorders (3rd ed., rev; DSM-III-R), with special emphasis on all current drug use. Immediately after the psychiatric examination, all CPPs were asked to consent to urine toxicology. Urine was tested for benzodiazepines, opioids, tricyclics, propoxyphene, cannabinoids, barbiturates, amphetamines, methadone, methaqualone, phencyclidine, alcohol, and cocaine. CPPs were then segregated into three groups: negative toxicology, positive toxicology but concordant with self-report of current drug use, and positive toxicology discordant with self-report of current drug use. These groups were statistically compared with each other with regard to age, gender, race, workers' compensation status, and prevalence of individual DSM-III-R psychoactive substance use disorders. Sensitivities were also calculated for two conditions: accuracy of toxicology and accuracy of self-report. Toxicologies were obtained from 226 (82.5%) of the CPPs. Toxicologies were negative in 121 (53.5%) and positive in 105 (46.5%) of the CPPs. Of the 226 CPPs, 8.4% had illicit drugs in the urine (6.2% cannabis, 2.2% cocaine). Twenty (8.8%) of the CPPs provided incorrect self-report information about current drug use, the incorrect information most frequently about illicit drugs. Drug urine toxicology sensitivity results indicated that a significant percentage of CPPs was claiming to be taking a drug but was not taking it or taking it incorrectly. The psychiatric examination drug self-report sensitivity results indicated that a significant percentage of CPPs was withholding or providing incorrect information on current drug use. Lowest self-report sensitivity results were in reference to illicit drugs. CPPs who were more likely to provide incorrect psychiatric examination self-report information about current drug use were more likely to be younger, to be a workers' compensation CPP, and to have been assigned a DSM-III-R diagnosis of polysubstance abuse in remission. A significant percentage of CPPs appears to provide incorrect information on current illicit drug use. Urine toxicology studies may have a place in the identification of drugs for which incorrect information may be provided by CPPs. There are many possible reasons, such as assay error, that could lead to apparent misinformation. In the clinical setting, these possibilities should be considered if urine toxicology results appear to be incongruent with psychiatric examination drug use self-report.

Correlates of Underreporting Recent Drug Use by Female Arrestees

Much of the research literature on the validity of self-reported drug use, primarily drawn from studies of males in criminal justice and drug treatment populations, has focused on whether subjects positive for drug use by an objective measure such as urinalysis actually report recent drug use. Few studies have investigated correlates of underreporting in these populations. Using a sample of 437 female arrestees, we examined correlates of underreporting previously identified in the research literature. Findings suggest that female arrestees without prior treatment experience or charged with a nondrug offense were less likely to report recent cocaine use than their counterparts who had previously been in treatment or were charged with a drug offense. These correlates did not apply to recent heroin use. Some support was found for race as a correlate of underreporting. Implications of the findings for the measurement of drug use in arrestees are discussed.

Self-report among injecting drug users: A review

The use of behavioural self-reports of drug users is widespread among studies of illicit drug use. Despite widespread use, concerns about the accuracy of these reports continue to be raised. The current paper critically reviews the literature on the reliability and validity of self-reported drug use, criminality and HIV risk-taking among injecting drug users. The literature shows respectable reliability and validity of self-reported behaviours when compared to biomarkers, criminal records and collateral interviews. It concludes that the self-reports of drug users are sufficiently reliable and valid to provide descriptions of drug use, drug-related problems and the natural history of drug use.

Validity of self-reported drug use in high risk populations: a meta-analytical review.

Research involving drug users and treatment evaluations continue to rely extensively on self-reports of drug use. This paper presents a meta-analytical review of 24 studies published since 1985 that examined the validity of drug self-reports in high risk populations. Only studies employing a biological criterion of validity (e.g., urinalysis, hair analysis) are included. Coefficients of chance-corrected agreement between self-reports and the validity criteria are calculated from published data to facilitate cross-study comparisons. The median conditional kappa (kappa c) was .42, considerably below the level of kappa c = .80 that represents acceptable reporting accuracy. The magnitude of drug use underreporting documented in this review could seriously bias prevalence estimates and treatment outcome studies.

Validity of self-reported cocaine and opiate use among arrestees in five cities

Although several researchers have examined the validity of self-reported drug use, few studies have focused on those factors that affect validity. The present investigation uses Drug Use Forecasting data to identify predictors of valid self-reports among arrestees from five cities in the United States. The multivariate results show that factors affecting the misrepresentation of drug use vary by site and by drug category. Explanations for these findings are offered and suggestions for improving the validity of arrestees' self-reports are discussed.