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Stevens MWR, Harland J, Alfred S, Ali RL. Substance use in the emergency department: Screening for risky drug use, using the ASSIST-Lite. Drug Alcohol Rev 2022; 41:1565-1576. [PMID: 35866743 PMCID: PMC9796694 DOI: 10.1111/dar.13513] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 06/11/2022] [Accepted: 06/23/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Substance use is a common contributing factor to emergency department (ED) presentations. While screening, brief intervention, and referral to treatment for alcohol and tobacco is common in ED settings, it is not routinely conducted for illicit substances. This study aimed to deploy the ASSIST-Lite to screen for risky use of alcohol and other drugs in the ED, to identify differences in risk based on between demographic characteristics. METHOD All ED attenders, aged 18 years or older, deemed well enough to participate were approached. Recruitment occurred at the Royal Adelaide Hospital ED between May and June 2017. Participants were asked to self-complete the ASSIST-Lite in the ED waiting room. Overall, 632 people were approached, of which 479 (75.8%) agreed to participate. RESULTS Alcohol (72.2%), tobacco (27.1%) and cannabis (15.2%) were most commonly reported. Eighty-nine participants reported moderate- or high-risk use of two substances, and a further 49 individuals reported moderate- or high-risk use of three or more substances. Across most substances, age, gender and employment status was associated with risky substance use, with higher likelihood of risk reported by males, unemployed and younger participants. Unemployment was also significantly associated with increased risk severity for both moderate and high-risk illicit use. DISCUSSIONS AND CONCLUSIONS The rate of risky illicit and polysubstance use found here highlight the need more focused research in ED settings. The findings also provide support for more routine screening, and early intervention approaches; and suggest the need for active referral pathways through an alcohol and other drug consultation liaison service.
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Affiliation(s)
| | - Jennifer Harland
- School of MedicineUniversity of AdelaideAdelaideAustralia
- Alcohol and Drug ProgramCanberra Health ServiceCanberraAustralia
| | - Sam Alfred
- Royal Adelaide Hospital Emergency DepartmentAdelaideAustralia
| | - Robert L. Ali
- School of MedicineUniversity of AdelaideAdelaideAustralia
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Seay KD. Detection of Problematic Substance Use in the Child Welfare System: A Comparison of Self-Report and Caseworker Report. CHILD MALTREATMENT 2019; 24:152-160. [PMID: 30514089 DOI: 10.1177/1077559518815613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Using a national sample of American families investigated for child maltreatment, this article compares parental self-report on the Alcohol Use Disorders Identification Test and Drug Abuse Screening Test measures to caseworker report of problematic alcohol and drug use at investigation. Data in this article are from child welfare caseworkers and a subset of parents surveyed in the National Survey of Child and Adolescent Well-Being II-primary caregivers (most often the biological mother) whose child remained in the home following investigation ( n = 4,009). Caseworkers identified problematic alcohol use in only 17.7% of the parents who self-reported problematic alcohol use and problematic drug use in 37.6% of the parents who self-reported problematic drug use. Sensitivity and specificity for the detection of problematic alcohol use were 21.5% and 94.8%, respectively, and 65.3% and 83.7% for problematic drug use, respectively. After controlling for the other variables in the model, an allegation of substance use reduced the odds of caseworker detection of problematic alcohol use being consistent with parent self-report (odds ratio [ OR] = 0.45, p < .01) and the odds of caseworker detection of problematic drug use being consistent with parent self-report ( OR = 0.13, p < .001).
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Affiliation(s)
- Kristen D Seay
- 1 College of Social Work, University of South Carolina, Columbia, SC, USA
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Haidari M, Mansani S, Ponds D, Romero L, Alsaab S. Consumption of Movantik™ (Naloxegol) results in detection of naloxone in the patient's urine evaluated by confirmatory urine drug testing. Clin Biochem 2019; 67:48-53. [DOI: 10.1016/j.clinbiochem.2019.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/12/2019] [Accepted: 03/16/2019] [Indexed: 01/28/2023]
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Utility of Point-of-care Urine Drug Tests in the Treatment of Primary Care Patients With Drug Use Disorders. J Addict Med 2017; 10:196-201. [PMID: 27159345 DOI: 10.1097/adm.0000000000000220] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine if urine drug tests (UDTs) can detect under-reporting of drug use (ie, negative self-report, but positive UDT) and identify patient characteristics associated with underreporting when treating substance use disorders in primary care. METHODS Self-reported use (last 30 d) and UDTs were gathered at baseline, 3, 6, 9, and 12 months from 829 primary care patients participating in a drug use intervention study. Rates of under-reporting were calculated for all drugs, cannabis, stimulants, opioids, and sedatives. Logistic regressions were used to identify characteristics associated with under-reporting. RESULTS Among the participants, 40% (n = 331) denied drug use in the prior 30 days despite a corresponding positive UDT during at least 1 assessment. Levels of under-reporting during 1 or more assessments were 3% (n = 22) for cannabis, 20% (n = 167) for stimulants, 27% (n = 226) for opioids, and 13% (n = 106) for sedatives. Older (odds ratio [OR] 1.04), female (OR 1.66), or disabled (OR 1.42) individuals were more likely to under-report any drug use. Under-reporting of stimulant use was also more likely in individuals with lower levels of educational attainment, previous arrests, and family and social problems. Under-reporting of opioid use was more likely in those with other drug problems, but less likely in those with better physical health, more severe alcohol and psychiatric comorbidities, and African-Americans. CONCLUSIONS With the exception of cannabis, UDTs are important assessment tools when treating drug use disorders in primary care. UDTs might be particularly helpful when treating patients who are older, female, disabled, have legal and social problems, and have more severe drug problems.
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Hilario EY, Griffin ML, McHugh RK, McDermott KA, Connery HS, Fitzmaurice GM, Weiss RD. Denial of urinalysis-confirmed opioid use in prescription opioid dependence. J Subst Abuse Treat 2014; 48:85-90. [PMID: 25115135 DOI: 10.1016/j.jsat.2014.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/02/2014] [Accepted: 07/14/2014] [Indexed: 11/18/2022]
Abstract
Although research has generally supported the validity of substance use self-reports, some patients deny urine-verified substance use. We examined the prevalence and patterns of denying urinalysis-confirmed opioid use in a sample of prescription opioid dependent patients. We also identified characteristics associated with denial in this population of increasing public health concern. Opioid use self-reports were compared with weekly urinalysis results in a 12-week multi-site treatment study for prescription opioid dependence. Among those who used opioids during the trial (n=246/360), 44.3% (n=109) denied urinalysis-confirmed opioid use, although usually only once (78%). Overall, 22.9% of opioid-positive urine tests (149/650) were denied on self-report. Multivariable analysis found that initially using opioids to relieve pain was associated with denying opioid use. These findings support the use of both self-reports and urine testing in treating prescription opioid dependence.
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Affiliation(s)
- E Yvette Hilario
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA 02478, USA
| | - Margaret L Griffin
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | | | - Hilary S Connery
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Garrett M Fitzmaurice
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA; Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA 02478, USA; Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA
| | - Roger D Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.
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Wilcox CE, Bogenschutz MP, Nakazawa M, Woody G. Concordance between self-report and urine drug screen data in adolescent opioid dependent clinical trial participants. Addict Behav 2013; 38:2568-74. [PMID: 23811060 DOI: 10.1016/j.addbeh.2013.05.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/15/2013] [Accepted: 05/25/2013] [Indexed: 10/26/2022]
Abstract
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.
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Hyatt CJ, Assaf M, Muska CE, Rosen RI, Thomas AD, Johnson MR, Hylton JL, Andrews MM, Reynolds BA, Krystal JH, Potenza MN, Pearlson GD. Reward-related dorsal striatal activity differences between former and current cocaine dependent individuals during an interactive competitive game. PLoS One 2012; 7:e34917. [PMID: 22606228 PMCID: PMC3351439 DOI: 10.1371/journal.pone.0034917] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 03/08/2012] [Indexed: 11/18/2022] Open
Abstract
Cocaine addiction is characterized by impulsivity, impaired social relationships, and abnormal mesocorticolimbic reward processing, but their interrelationships relative to stages of cocaine addiction are unclear. We assessed blood-oxygenation-level dependent (BOLD) signal in ventral and dorsal striatum during functional magnetic resonance imaging (fMRI) in current (CCD; n = 30) and former (FCD; n = 28) cocaine dependent subjects as well as healthy control (HC; n = 31) subjects while playing an interactive competitive Domino game involving risk-taking and reward/punishment processing. Out-of-scanner impulsivity-related measures were also collected. Although both FCD and CCD subjects scored significantly higher on impulsivity-related measures than did HC subjects, only FCD subjects had differences in striatal activation, specifically showing hypoactivation during their response to gains versus losses in right dorsal caudate, a brain region linked to habituation, cocaine craving and addiction maintenance. Right caudate activity in FCD subjects also correlated negatively with impulsivity-related measures of self-reported compulsivity and sensitivity to reward. These findings suggest that remitted cocaine dependence is associated with striatal dysfunction during social reward processing in a manner linked to compulsivity and reward sensitivity measures. Future research should investigate the extent to which such differences might reflect underlying vulnerabilities linked to cocaine-using propensities (e.g., relapses).
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Affiliation(s)
- Christopher J Hyatt
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, Hartford, Connecticut, United States of America.
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Hjorthøj CR, Hjorthøj AR, Nordentoft M. Validity of Timeline Follow-Back for self-reported use of cannabis and other illicit substances--systematic review and meta-analysis. Addict Behav 2012; 37:225-33. [PMID: 22143002 DOI: 10.1016/j.addbeh.2011.11.025] [Citation(s) in RCA: 217] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 09/08/2011] [Accepted: 11/16/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Timeline Follow-Back (TLFB) is a widely used, calendar-based measure of self-reported use of (among other things) illicit substances. We examined agreement between TLFB and biological measures for illicit substances. METHODS PubMed, PsycINFO, Cochrane CENTRAL, and EMBASE were searched in December 2010. 16,633 papers screened to identify those that measured illicit substance use by both TLFB and biological measures. We extracted data on agreement between TLFB and biological measures, sample size, study type, inclusion criteria of participants, and length of recall of TLFB. RESULTS Twenty-nine papers were included, almost exclusively in substance-use-disorder populations. Some studies reported several overall agreement rates, e.g. over time. Lowest and highest weighted average agreement rates were: for cannabis, 87.3% (95% confidence interval 86.9% to 87.7%) and 90.9% (90.5% to 91.4%); for cocaine, 79.3% (79.1% to 79.6%) and 84.1% (83.9% to 84.2%); for opiates 94.0% (93.5% to 94.5%) for both weighted averages; and for studies not distinguishing between substances, 88.5% (88.4 to 88.7%) and 91.0% (90.7% to 91.2%). Higher agreement was found in populations without psychiatric comorbidity, and lower agreement in randomized controlled trials. Publication bias or selective outcome reporting bias was not detected. CONCLUSIONS TLFB validly detects use of illicit substances in populations with substance use disorders. Using TLFB may limit the need for biological samples, making information on illicit substance use easier and less costly to obtain and analyze.
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Schuler MS, Lechner WV, Carter RE, Malcolm R. Temporal and gender trends in concordance of urine drug screens and self-reported use in cocaine treatment studies. J Addict Med 2009; 3:211-7. [PMID: 20209029 PMCID: PMC2832304 DOI: 10.1097/adm.0b013e3181a0f5dc] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe temporal trends in concordance, sensitivity, and specificity and to explore demographic trends in concordance in two outpatient treatment studies for cocaine dependence. METHODS We obtained 2229 urine drug screens from 129 individuals, along with accompanying self-use reports. Paired self-use reports and urine drug screens were considered concordant if the two measures of cocaine use were in agreement. The sensitivity and specificity of the self-use reports in predicting the urine drug screen was also estimated. To model concordance, sensitivity, and specificity as a function of time, generalized estimating equations were used. Demographic effects on concordance among subjects who achieved 100% concordance and subjects who achieved a recently proposed 70% concordance threshold were tested. RESULTS Over the course of our studies, both sensitivity and concordance statistically decreased, yet specificity remained relatively constant. Median concordance for all subjects was 88%. Among all subjects, concordance varied significantly by gender, with females achieving significantly higher concordance than males (96% vs. 86%). Similarly, females were almost twice as likely to achieve 100% concordance as males (42% vs. 22%). Finally, 80% of participants achieved the 70% concordance threshold, and no differences among demographic groups with regards to the 70% concordance threshold were observed. CONCLUSIONS Temporal effects of concordance and sensitivity may have profound repercussions when using self-use reports to gauge efficacy of an experimental intervention. Furthermore, gender may differentially affect concordance. Finally, a substance abuse outcome measure that reliably combines objective and self-report data is promising, but further research is needed.
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Affiliation(s)
- Megan S. Schuler
- Department of Biostatistics, Bioinformatics and Epidemiology Medical University of South Carolina 135 Cannon Street Suite 303 Charleston, SC 29425
| | - William V. Lechner
- Center for Drug and Alcohol Programs Medical University of South Carolina 67 President Street, P.O. Box 250861 Charleston, SC 29425
| | - Rickey E. Carter
- Department of Biostatistics, Bioinformatics and Epidemiology Medical University of South Carolina 135 Cannon Street Suite 303 Charleston, SC 29425
| | - Robert Malcolm
- Center for Drug and Alcohol Programs Medical University of South Carolina 67 President Street, P.O. Box 250861 Charleston, SC 29425
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Lehrmann E, Afanador ZR, Deep-Soboslay A, Gallegos G, Darwin WD, Lowe RH, Barnes AJ, Huestis MA, Cadet JL, Herman MM, Hyde TM, Kleinman JE, Freed WJ. Postmortem diagnosis and toxicological validation of illicit substance use. Addict Biol 2008; 13:105-17. [PMID: 18201295 PMCID: PMC2639787 DOI: 10.1111/j.1369-1600.2007.00085.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The present study examines the diagnostic challenges of identifying ante-mortem illicit substance use in human postmortem cases. Substance use, assessed by clinical case history reviews, structured next-of-kin interviews, by general toxicology of blood, urine and/or brain, and by scalp hair testing, identified 33 cocaine, 29 cannabis, 10 phencyclidine and nine opioid cases. Case history identified 42% cocaine, 76% cannabis, 10% phencyclidine and 33% opioid cases. Next-of-kin interviews identified almost twice as many cocaine and cannabis cases as Medical Examiner (ME) case histories, and were crucial in establishing a detailed lifetime substance use history. Toxicology identified 91% cocaine, 68% cannabis, 80% phencyclidine and 100% opioid cases, with hair testing increasing detection for all drug classes. A cocaine or cannabis use history was corroborated by general toxicology with 50% and 32% sensitivity, respectively, and with 82% and 64% sensitivity by hair testing. Hair testing corroborated a positive general toxicology for cocaine and cannabis with 91% and 100% sensitivity, respectively. Case history corroborated hair toxicology with 38% sensitivity for cocaine and 79% sensitivity for cannabis, suggesting that both case history and general toxicology underestimated cocaine use. Identifying ante-mortem substance use in human postmortem cases are key considerations in case diagnosis and for characterization of disorder-specific changes in neurobiology. The sensitivity and specificity of substance use assessments increased when ME case history was supplemented with structured next-of-kin interviews to establish a detailed lifetime substance use history, while comprehensive toxicology, and hair testing in particular, increased detection of recent illicit substance use.
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Affiliation(s)
- Elin Lehrmann
- Cellular Neurobiology Research Branch, National Institute on Drug Abuse (NIDA IRP), National Institutes of Health, Baltimore, MD 21224, USA.
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Musshoff F, Driever F, Lachenmeier K, Lachenmeier DW, Banger M, Madea B. Results of hair analyses for drugs of abuse and comparison with self-reports and urine tests. Forensic Sci Int 2006; 156:118-23. [PMID: 16410161 DOI: 10.1016/j.forsciint.2004.07.024] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2004] [Revised: 07/22/2004] [Accepted: 07/23/2004] [Indexed: 11/24/2022]
Abstract
Urine as well as head and pubic hair samples from drug abusers were analysed for opiates, cocaine and its metabolites, amphetamines, methadone and cannabinoids. Urine immunoassay results and the results of hair tests by means of gas chromatography-mass spectrometry were compared to the self-reported data of the patients in an interview protocol. With regard to the study group, opiate abuse was claimed from the majority in self-reports (89%), followed by cannabinoids (55%), cocaine (38%), and methadone (32%). Except for opiates the comparison between self-reported drug use and urinalysis at admission showed a low correlation. In contrast to urinalysis, hair tests revealed consumption in more cases. There was also a good agreement between self-reports of patients taking part in an official methadone maintenance program and urine test results concerning methadone. However, hair test results demonstrated that methadone abuse in general was under-reported by people who did not participate in a substitution program. Comparing self-reports and the results of hair analyses drug use was dramatically under-reported, especially cocaine. Cocaine hair tests appeared to be highly sensitive and specific in identifying past cocaine use even in settings of negative urine tests. In contrast to cocaine, hair lacks sensitivity as a detection agent for cannabinoids and a proof of cannabis use by means of hair analysis should include the sensitive detection of the metabolite THC carboxylic acid in the lower picogram range.
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Affiliation(s)
- F Musshoff
- Institute of Legal Medicine, Rheinische Friedrich-Wilhelms-University, Stiftsplatz 12, 53111 Bonn, Germany.
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