The estimated predictive value of screening for illicit drugs in the workplace

Children taking risks: the association with cocaine and other drug use by young adulthood

In this report from a longitudinal study, the main aim was to evaluate the long-term predictive strength of a novel cartoon-based risk-taking trait assessment, which might prove to have utility in future research on mechanisms leading toward illegal drug involvement. The study population originated as 2311 first-graders entering 19 elementary schools during two successive school years. The assessments started soon after the children entered primary school. The key response variable was participants' use of cocaine by the time of a young adult assessment. We found that for each standard deviation increase in the risk-taking scale there was a two-fold increase in the risk of becoming a cocaine user by young adulthood (estimated relative risk, RR=1.9; 95% confidence interval, CI=1.3, 2.7). Independently, onset of cannabis use by young adulthood was also predicted by risk-taking scale values, but use of legal drugs (alcohol and tobacco) was not. These long-span associations provide support for new research on very early risk-taking mechanisms that lead toward illegal drug involvement.

The adolescent behavioral repertoire as a context for drug exposure: behavioral autarcesis at play

AIMS

The aim of this study is to investigate suspected behavioral autarcesis. Autarcesis refers to a mechanism of non-specific shielding from or immunity to infection or disease. Here, suspecting that some facets of the adolescent behavioral repertoire (ABR) might shield youths from early drug involvement, we studied recent-onset occurrence of first chances to try a drug and first actual drug use, expressed as a function of five observed ABR dimensions: religious, socializing, sports-related, gender socialization, and home-based activities.

DESIGN AND PARTICIPANTS

Nationally representative samples of school-attending youths were drawn in Panama, the five Spanish heritage countries of Central America and the Dominican Republic (n = 12797).

MEASUREMENTS

Drug involvement and ABR were assessed via anonymous self-administered questionnaires.

FINDINGS

A religious activity dimension and a separate sports dimension were associated inversely with recent onset of adolescent drug experiences, and a socializing activity dimension was related to an increased occurrence of these experiences. For example, for each unit increase of the religious activity dimension of the ABR, there was an associated reduced occurrence of the first chance to try tobacco (OR = 0.75, 95% CI: 0.63-0.90, P = 0.002). Adolescents at higher levels of sports activities and home-based activities were less likely to experience recent-onset actual use of marijuana (OR = 0.45, 95% CI: 0.30-0.67, P < 0.001; OR = 0.56, 95% CI: 0.32-0.99, P = 0.048, respectively).

CONCLUSIONS

The study evidence lends some support for behavioral autarcesis. Manipulation of selected ABR dimensions might help prevent or reduce adolescent drug involvement, enhancing autarcesis as a protective mechanism.

Passive exposure to cocaine in medical personnel and its effect on urine drug screening tests

This report studies the importance of passive exposure of medical personnel to cocaine hydrochloride and its impact on urine screening testing. Eleven medical staff members were exposed to cocaine hydrochloride by means of aerosol and cutaneous application, similar to that which may occur in medical practice. Urine drug screening tests were negative for everyone tested. This finding is supported by known drug kinetics. It is unlikely that a single passive exposure of medical staff to cocaine hydrochloride will produce a positive urine screening test. In all cases of positive urine tests, contaminants should be tested for which may indicate a source of the drug. The routine use of gloves and masks--which is recommended to prevent HIV infection--should further decrease medical personnel's passive exposure to cocaine hydrochloride.

A survey of state regulation of testing for drugs of abuse outside of licensed (accredited) clinical laboratories

We surveyed all 50 states to find out if testing for drugs of abuse outside of clinical laboratories was regulated. In 14 states such regulations existed or were contemplated. Eight additional states indicated that regulatory language does not restrict their oversight of such testing. Content of the regulations is described for each of these 22 states.

Association between intravenous drug use and early misbehavior

This investigation uses an epidemiologic strategy to examine a suspected association between misbehavior in early life and subsequent involvement in intravenous drug use. The 222 cases of i.v. drug use in this study were a subset of all persons recruited for a continuing study of drug use, HIV-1 infection, and the natural history of AIDS. It was possible to match these 222 i.v. drug users to 588 subjects from the NIMH Epidemiologic Catchment Area survey sample, for a total of 810 subjects in 60 matched sets. The matching factors were gender and census tract of residence. Conditional logistic regression models were used to estimate the degree of association between early misbehavior and i.v. drug use. The results showed a strong association between i.v. drug use and early misbehavior. For every unit increase in misbehavior score, the odds of being an i.v. drug user increased by a factor of 1.74 (P less than 0.001). Compared to subjects with low misbehavior scores, those with high scores were 24.67 times more likely to be i.v. drug users (P less than 0.001). Results of this study add to evidence now supporting field trials of public health strategies to modify the link between misbehavior in early life and later illicit drug use.