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

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 12 weeks 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.

The impact of non-concordant self-report of substance use in clinical trials research

“…Some conditions are more highly scrutinized than others. The validity of self-reported substance use has been questioned in the literature by both medical professions and scientists for almost 50 years (e.g., Ball, 1967; Carroll, 1995; Daiter et al, 2007; Jain et al, 2013; Schuler et al, 2009; Wilcox et al, 2013). There are multiple reasons to expect a lack of concordance between self-reported substance use and biochemically verified substance use (e.g., urine drug screen assay; UDS, blood test, hair analysis).…”

“…Thus, there are a number of reasons both conscious and unconscious as to why someone may deny or underreport substance use. Despite these reasons, empirical investigations comparing self-report substance use data to biochemical verification generally demonstrate high rates of concordance, often greater than 80% agreement (Basurto et al, 2009; Fendrich & Johnson, 2005; Drake, 1998; Wilcox et al, 2013). Indeed, in a literature review of sixteen studies on the validity of self-report of substance use Drake (1998) concluded that self-report was a valid means of assessing substance use and reported high rates of concordance between self-report and chemical verification (i.e., UDS and hair analysis).…”

“…The majority of the studies on concordance (e.g., Dillion et al, 2005; Jain et al, 2006; Jain et al, 2013; Melnikov et al, 2009; Schuler et al, 2009; Wilcox et al, 2013), including those in the Drake (1998) review, have examined patient samples that were presenting for an intake for substance use treatment, already in treatment for substance use, or had previously undergone treatment for substance use. It is possible that individuals who are not seeking treatment for substance use nor have a treatment history would be less inclined to provide accurate data about use in their self-report.…”

Denial of urinalysis-confirmed opioid use in prescription opioid dependence

“…A study of opioid-dependent adults found that those who underreported substance use were less likely to be dependent on amphetamine or cocaine (Rutherford, Cacciola, Alterman, McKay, & Cook, 2000). In a young adult opioid-dependent sample (mean age=19.7 years), no background or clinical differences were associated with denial of opioid use (Wilcox, Bogenschutz, Nakazawa, & Woody, 2013). …”

Self-reported substance use among high school students with and without learning difficulties

“…As with all research that uses self-report measures, the results are subject to influence from under-reporting and errors of memory (such problems are also characteristic of structured interviews) (Moller, Tait, & Byrne, 2012). However, there is evidence of concordance between adolescent self-report drug use and urine drug screen data (Wilcox, Bogenschutz, Nakazawa, & Woody, 2013) and the reliability of self-report inventories for measuring constructs such as psychopathology has been found to increase from childhood through adolescence (Frick, Barry, & Kamphaus, 2009;Kamphaus & Frick 2002).…”