A comparison of self-reported drug use with a urine drug screen in a working population: Correction.

Reports an error in the original article by R. Bharucha-Reid et al (Experimental and Clinical Psychopharmacology, 1995, Vol 3 [3], 280–286). Rachel Kaufmann was inadvertently misspelled. (The following abstract of this article originally appeared in record 1996-92908-001.) This study summarized information on 162 workers who completed urine screen and self-report concerning drug use. It is the first to compare self-report of drug use in the workplace with a urine screen in which individual participant (nonaggregate) data were used. The findings indicate that agreement between the 2 methods of drug detection, although statistically significant, is at best only moderate. The level of agreement was consistent for segments of the sample when divided by sociodemographic characteristics. Although urine screen may be the more reliable and accurate method of detecting prevalence of drug use, self-report must be considered to assess drug use histories and the role of other variables. These 2 methods should be considered as complementary assessment techniques; the appropriate method depends on the conditions and purposes of the drug use study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concordance among biological, interview, and self-report measures of drug use among African American and Hispanic adolescents referred for drug abuse treatment.

This study examined the concordance among urine assays, interview measures, and self-report measures of marijuana and cocaine use among 190 drug-abusing/dependent African American and Hispanic adolescents and their families at 3 assessment points of an 18-month randomized clinical trial study. Results demonstrated concordance among urine assays, a calendar method self-report measure (Timeline Follow Back [TLFB]), and a noncalendar method self-report measure (Adolescent Drug Abuse Diagnosis Scale). Diagnostic criteria of marijuana and cocaine abuse/dependence from a clinical structured interview (Diagnostic Interview Schedule for Children [DISC]) also converged, albeit weakly, with self-report measures. Adolescent and parent reports on DISC marijuana abuse/dependence diagnostic criteria were related; however, collateral findings for DISC cocaine abuse/dependence diagnostic criteria were equivocal. Differences in concordance among biological and self-report cocaine use measures were found for baseline TLFB assessments among African American participants. Implications for future use and refinement of adolescent drug use assessments are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Urine drug testing for social service agencies. A Canadian experience

The introduction of urine drug testing for this program has been considered a success by the social services agencies in Nova Scotia for the following reasons: 1. The results of urine drug testing have been accepted by the Family Courts of Nova Scotia because the urine collection and testing are performed with chain of custody procedures from collection to reporting and the analysis includes confirmation of all positive immunoassay screening tests. 2. Urine drug testing (with established screening and confirmation cut-offs) provides an objective indication of recent drug use compared with relying on self-reporting of drug use. 3. Urine drug testing is believed to be a deterrent to drug use because several individuals with a history of drug use have consistently tested negative for 6 to 12 months (30% of the clients). 4. Some clients with a history of substance abuse are successful in becoming drug free with the support of the social workers and the deterrent effect of random drug testing.     

The validity of self-reported cocaine use in two groups of cocaine abusers.

To evaluate the validity of 2 self-report methods for estimating cocaine use, Timeline Follow-Back (TLFB) and weekly calendar reports from 65 patients with a cocaine use disorder were compared with urine drug test results. The TLFB showed fair to moderate validity, and the weekly calendar showed moderate to high validity in measuring the frequency of cocaine use. Similar results were obtained when the self-report measures were used to time specific cocaine use episodes. In addition to evidence for superiority of the weekly calendar, the validity of self-reports was inversely related to the percentage of positive urine test results. Furthermore, there was some evidence that validity increased as the time window over which the comparisons were drawn increased. Given the central role of self-reports in the clinical and research evaluation of drug use, factors affecting their validity warrant further investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identification of drug abuse

Drug abuse poses health and safety hazards, both in the workplace and in the wider community. There is increasing pressure to use urine drug tests to determine the prevalence of drug abuse, to deter illicit use of drugs, and to identify drug abusers for rehabilitation. Drug-abuse testing programs have been implemented for employees, job applicants, policemen, firemen, enlisted personnel of the army, athletes, and workers in occupations that are considered critical to public safety and health, such as those in nuclear power plants and the transportation industry. Since the consequences of a positive test can be quite severe, there is a need to develop uniform and internationally recognized methods for identifying drug abuse. The paper discusses selection of biological specimens for drug-abuse testing, main characteristics of drugs of abuse and recommended analytical techniques for their determination. The importance of a quality assurance program for drug-testing laboratories is emphasised.     

Motivational interviewing in drug abuse services: A randomized trial.

Motivational interviewing (MI) is a directive, client-centered brief intervention to elicit behavior change by helping clients explore and resolve ambivalence. In this clinical trial, 152 outpatients and 56 inpatients entering public agencies for treatment of drug problems were randomly assigned to receive or not receive a single session of manual-guided MI. Drug use was assessed by self-report, urine toxicology, and collateral reports from significant others at baseline, 3, 6, 9, and 12 months. Contrary to prior reports, MI showed no effect on drug use outcomes when added to inpatient or outpatient treatment, although both groups showed substantial increases in abstinence from illicit drugs and alcohol. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contingency management for accurate predictions of urinalysis test results and lack of correspondence with self-reported drug use among polydrug abusers.

Contingency management procedures have proven effective in the treatment of drug-dependent patients. These procedures, however, often require frequent urine testing, which is too costly for community treatment programs. To make urine testing procedures more cost effective, the feasibility of reinforcing accurate predictions of urine drug screen (UDS) results was evaluated. Participants made extremely accurate UDS predictions, particularly when they made drug-positive predictions, regardless of whether predictions were reinforced. However, self reports of recent drug use had poor correspondence with predictions of UDS results. Results suggested that if programs only tested samples predicted to be drug free, considerable cost savings could be incurred. Further research is needed to determine if validity would be enhanced by using a proportion of costs saved to provide nominal reinforcement when samples were verified to be drug free. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perspectives on overgrowth syndromes

Previous studies evaluated the prudent use and potential over use of drug screens in clinical decision making. However, the percentage of emergency physicians who can correctly identify which drugs are found on their hospital's basic drug screens has not been established. Results of physician closed-ended questionnaires were compared to the results of a telephone survey with each physician's individual hospital laboratory. Eighty-one (35.7%) of 227 emergency physicians responded. Four (4.9%) correctly identified what was on their individual institution's urine drug screens and 17 (21%) correctly identified what was on serum screens. In other results, 74.3% erroneously relayed that all benzodiazepines can be found on urine drug screens and 46.3% incorrectly answered that acetaminophen would be found on basic quantitative serum screens. Drug screen results can be misinterpreted if the drugs the physician expects to be screened for, and what is actually screened for, are not the same. Pharmacy and laboratory personnel have a responsibility to keep the physician informed of drug screen issues. They should be proactive in advising physicians of changes in drug testing and new drug screening methods or by providing reports on the occurrence of false positive results.     

Hepatitis B validity of drug users' self-report.

Although drug users' self-report has provided data for much of the published literature about drug use, little is known about self-report validity when participants are asked about diseases that are associated with drug abuse, such as hepatitis. Injecting drug users and crack cocaine smokers (N?=?669) were recruited in Anchorage, Alaska, and asked whether they had been diagnosed previously with hepatitis B. These self-report data were compared to various hepatitis B and C seromarkers as measures of validity of self-report expressed as sensitivity and specificity. Results indicate that although test-retest reliability for self-report is high (.905) and specificity is high (96.06% for hepatitis C virus, or HCV), sensitivity is low (23.74% for HCV). Thus, because of its low sensitivity, self-report of hepatitis should be used only as a prevalence estimate lower bound. More than half of the drug users who had contracted hepatitis had never been told that they were infected. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing self-reported cocaine use with repeated urine tests in outpatient cocaine abusers.

Sixty-one participants in outpatient therapy for cocaine dependence provided urine samples and self-reports of cocaine use 3 times a week for 4 weeks. Participants later gave a retrospective self-report of cocaine use for the month on the Addiction Severity Index (ASI). Comparisons with urine test values revealed substantial underreporting of cocaine use on both measures, and results from the 2 forms of self-report were only imperfectly correlated. More participants admitted to at least 1 cocaine use episode on the ASI than on the repeated self-reports, but the repeated reports provided a more accurate index of the relative frequency of cocaine use during the month. Self-reports can enhance cocaine use detection when urines are infrequently collected and can help determine whether consecutive positive urine samples represent elevated metabolite levels from a single drug use episode. However, self-reports cannot substitute for regular urine sampling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived race-based discrimination, employment status, and job stress in a national sample of black women: implications for health outcomes

This study examined concordance between self-reported drug use and urinalysis data among 341 applicants for methadone treatment in Sydney, Australia. Rates of under-reporting of use of specific drugs were low (0% to 10%). Irregular drug use, short half-life of some abused drugs, and relatively low sensitivity of the TLC assay procedure led to most detected drugs being found in only one of two urine samples collected. Subjects reported having recently used nearly twice as many drugs as were detected in their urine. Agreement (kappa) between self-report and urinalysis results was in the fair to good range for most drugs. None of the six predictors of misreporting examined were found to be of practical value.     

Determination of diethylcarbamazine, an antifilarial drug, in human urine by 1H-NMR spectroscopy

1H-NMR spectroscopy is a convenient method for determination of diethylcarbamazine (DEC) in urine, and can be used to monitor medication with the drug. Urine samples were mixed with 10% of deuterium oxide as a spectrometer field frequency lock, which is the only sample pretreatment required. Tailored excitation with the 1331 pulse was used for water peak suppression. The quantification of DEC was carried out with the triplet of the N-ethyl group, for which the T1 relaxation time was 1 s. In aqueous solutions, amounts below 1 microgram ml-1 of DEC could be easily detected. In urine, the detectability depended on the level of chemical noise but was better than 10 micrograms ml-1. The accuracy and precision of the method were better than 15%. Analysis of urine from volunteers receiving a single therapeutic dose of DEC (6 mg kg-1 body weight orally) showed that the drug was eliminated in unchanged form during 2 days, in agreement with earlier results. The concentration of DEC in urine several hours after the intake exceeded 100 micrograms ml-1 making the 1H-NMR assay rapid and easy. No significant amounts of the N-oxide of DEC could be detected.     

Drug use during pregnancy: Validating the Drug Abuse Screening Test against physiological measures.

This study examined the ability of the Drug Abuse Screening Test (DAST-10) to identify prenatal drug use using hair and urine samples as criterion variables. In addition, this study was the first to use “best practices,” such as anonymity, ACASI technology, and a written screener, to facilitate disclosure in this vulnerable population. 300 low-income, post-partum women (90.3% African-American) were recruited from their hospital rooms after giving birth. Participation involved (a) completing a computerized assessment battery that contained the DAST-10 and (b) providing urine and hair samples. Twenty-four percent of the sample had a positive drug screen. The sensitivity of the DAST-10 was only .47. Nineteen percent of the sample had a positive toxicology screen but denied drug use on the DAST-10. Findings suggest that brief drug use screeners may have limited utility for pregnant women and that efforts to facilitate disclosure via reassurance and anonymity are unlikely to be sufficient in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cocaine use in women from a defined population: prevalence at delivery and effects on growth in infants

Adverse health effects associated with intrauterine cocaine exposure (prematurity and its associated morbidity, intrauterine growth retardation, possible risk of sudden infant death syndrome) are based on studies from large urban hospitals, but few data exist from other sources. The current study, set in a community hospital, was designed to (1) estimate the prevalence of maternal cocaine use at delivery, (2) describe neonatal outcomes, and (3) evaluate physiological growth in exposed children. The study was conducted over 30 months (total births were 14,074) at The Children's Hospital of Greenville Memorial Hospital, the major source of neonatal care for Greenville County, South Carolina (1990 population: 320,000). A child was considered exposed to cocaine if there was documented evidence of use in the mother's medical record or if one member of the pair had a positive urine drug screen. Growth data were abstracted from clinical records. Overall prevalence of exposure was 1.0%. Of the 137 subjects (89, positive urine drug screen; 48 self-reported exposure), 21 (15%, 95% confidence interval, 9% to 21%) were premature (gestational age < 37 weeks) and 2 died of sudden infant death syndrome. Mean age- and sex-adjusted percentiles for weight, length, and head circumference increased from 23%, 29%, and 18%, respectively, at birth to 43%, 49%, and 54% in children followed for 12 months; however, 50% of the cohort were lost to follow-up, and these children were smaller at birth than those under active follow-up. Rates of prematurity and infant death were similar to those reported in urban hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)     

Direct radioiodination of metabolic 8-hydroxy-quinolyl-glucuronide, as a potential anti-cancer drug

8-Hydroxy-quinolyl-glucuronide (8-HOQ-Glu) can be deglucuronidated by the beta-glucoronidase enzyme, which has an activity that is considerably high in certain kinds of cancer cell. Owing to this enzyme activity, 8-HOQ-Glu can be considered as a potential anti-cancer drug. The combination of the radiotoxicity known of 125I nuclide with the cytotoxicity of 8-hydroxy-quinoline (8-HOQ) and particularly the selective carrying of 125I into the cancer cells is the principal aim of this study. As a first step, the metabolic 8-HOQ-Glu was extracted from the urine of rabbits treated with 8-HOQ directly radioiodinated using the iodogen method. The results showed that the radioiodination was successfully realized, and its yield was found to be about 90-95%.     

Thoracolumbar burst fractures: correlation between post-traumatic spinal canal stenosis and initial neurological deficit

We sought to define the prevalence of positive drug screens in adolescent victims of major trauma. The records of 125 consecutive adolescent patients presenting with major trauma to an inner-city trauma center during the last nine months of 1990 were reviewed. Eighty-five (68%) received urine toxicology screens for alcohol and illicit drugs. Twenty-one (25%) of screened patients had a positive urine drug screen. The most commonly detected drugs were alcohol, cocaine, and opiates. Gender, race, mechanism of injury, mental status at presentation, injury severity score, and revised trauma score were not associated with a positive drug screen. We conclude that: 1) 25% of screened adolescent victims of major trauma seen at an inner-city trauma center had positive urine toxicology screens for alcohol or illicit drugs. 2) As none of the study variables was associated with a positive drug screen, selective drug screening cannot be supported.     

Illicit drug use in the army: A social-organizational analysis.

Attempted to identify relationships between certain facets of the social environment of military units and the reported level of illicit drug use in the units. Two instruments were developed for the study, an anonymous self-report drug use questionnaire and a drug abuse prevalence index. From a total of 398 units ( N = 17,143) surveyed on drug use, 3,284 enlisted men in 31 high- and low-use units located in Korea, the US, and Germany were surveyed on the quality of the social environment. Several dimensions of the social and organizational environment were significantly related to illicit drug use, including opinion of officers, job satisfaction, opinion of the army, and morale. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of REMEDi HS in emergency toxicology for a rapid estimate of drug concentrations in urine, serum, and gastric samples

The REMEDi HS is a broad spectrum drug identification system, designed for emergency toxicology screening and forensic applications. The total analysis time is about 20 min. The current library has 555 drugs and metabolites. The system has a software routine that uses an internal standard (IS) to perform quantitative analysis for target compounds when calibrators are available; further, response factors (RF) are supplied for a rapid estimate of drug concentrations when calibrators are unavailable. In the present study, The concentrations of six drugs (bromisovalum, ephedrine, hydroxyzine, diphenhydramine, ranitidine, and lidocaine) and a metabolite of lidocaine (glycinexylidide) were determined using both methods. The slopes of the regression lines between the rapid estimate method and the IS method were generally within 20% of unity, in agreement with the manufacturer's claim. Semiquantitative estimates based on RF also showed good agreement with results obtained using multipoint calibration. These estimates were sufficient for clinical differentiation of routine and toxic levels. Our study demonstrated that the REMEDi HS is particularly useful for a rapid estimate of drug concentrations in the samples from emergency cases when calibrators are not readily available. Our study also showed that this system can be used for the therapeutic monitoring of ranitidine, bromisovalum, lidocaine, and diphenhydrmine.     

The use of methylergonovine (Methergine) in the initial control of drug induced refractory headache

This study investigated the efficacy of methylergonovine maleate (Methergine) in the treatment of drug induced refractory headache (DIRH). Sixty consecutive patients (51 female and 9 male) diagnosed with DIRH were treated with methylergonovine maleate for a maximum of six months, using a within subject design. All patients were withdrawn from the medications they were taking upon entering the study. Concurrently, they were given 0.2-0.4 mg of methylergonovine maleate three times a day. Patients were provided the means to control breakthrough episodes of headache. Treatment outcome was assessed using a patient self-report scale (much better, better, same, worse, and much worse), and also visual analogue pain intensity scales. The side effects of the drug were assessed with patient self-report. Methylergonovine was effective in 44 (73%) patients. Twelve (20%) patients reported unchanged pain and 4 (6%) patients got worse. Side effects were reported by 24 patients. These were predominantly abdominal cramping. It is concluded that methylergonovine maleate is effective in the initial control of drug induced refractory headache. However, because methylergonovine is a metabolic byproduct of methysergide, the possibility or fibrotic disorders needs to be considered if methylergonovine is to be used for long term therapy.     

Reliability of self-reported HIV risk behaviors of drug users.

In AIDS research, relatively little attention has been paid to reliability of self-report of drug users. The authors examined the test-retest reliability of the Risk Behavior Assessment (NIDA, 1991) questionnaire. This structured-interview questionnaire was administered twice to 196 drug users in 5 cities over a 48-hr period. Findings indicated that respondents consistently self-report drug use, injection practices, and sexual behaviors; discrepancies do not appear to reflect systematic decreases or increases in self-report; unreliability is associated with poorly worded questions and respondent characteristics; and discrepant reports warrant attention in analysis and interpretation of data. Measurement error has implications for estimating risks, understanding relationships between behavior and HIV transmission, and interpreting change after interventions. Items with low reliability have been revised, and further reliability studies are examining whether revisions have led to improved reliability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)