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Denial of Urinalysis-Confirmed Opioid Use in Prescription Opioid Dependence.

Journal of Substance Abuse Treatment 2015;48(1):85-90.. [doi: 10.1016/j.jsat.2014.07.003]

E. Yvette Hilario (McLean Hospital, NEC Node), Margaret L. Griffin, PhD (McLean Hospital, NEC Node), R. Kathryn McHugh, PhD (McLean Hospital, NEC Node), Katherine A. McDermott (McLean Hospital, NEC Node), Hilary Smith Connery, MD, PhD (McLean Hospital, NEC Node), Garrett M. Fitzmaurice, ScD (Harvard Medical School, NEC Node), Roger D. Weiss, MD (McLean Hospital, NEC Node).

Although research has generally supported the validity of substance use self-reports, some patients deny urine-verified substance use. This study examined the prevalence and patterns of denying urinalysis-confirmed opioid use in a sample of prescription opioid dependent patients. It 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 the National Drug Abuse Treatment Clinical Trials Network's 12-week multi-site treatment study for prescription opioid dependence (CTN-0030: Prescription Opioid Addiction Treatment Study (POATS)). 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%). Participants who denied use only once and subsequently reported use may have later reported more accurately because they observed there were no negative consequences for drug use when the results of their urinalysis was discussed at the next visit. This change in accuracy of reporting may also have been affected by variation over time in individual factors such as craving or shame. 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.

Conclusions: The present study shows that, although the clear majority of self-reports were consistent with urine results, many participants denied urine-confirmed use, albeit infrequently. This result, combined with the finding that 7% of the positive self-reports were provided in a week with a negative urine test, shows the importance of obtaining both self-report data and urine tests; neither one alone is adequate. (Article (Peer-Reviewed), PDF, English, 2015)

Keywords: Buprenorphine/Naloxone | CTN platform/ancillary study | Opioid dependence | Pharmacological therapy | Prescription-type opiates | Suboxone | Urinalysis | Journal of Substance Abuse Treatment (journal)

Document No: 1101, PMID: 25115135, PMCID: PMC4250346.

Submitted by CTN Dissemination Librarians, 9/19/2014.

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