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Concordance Between Self-Report and Urine Drug Screen Data in Adolescent Opioid Dependent Clinical Trial Participants.

Addictive Behaviors 2013;38(10):2568-2574. [doi: 10.1016/j.addbeh.2013.05.015]

Claire E. Wilcox, MD (University of New Mexico, SW Node), Michael P. Bogenschutz, MD (Center on Alcoholism, Substance Abuse, and Addictions (CASAA), SW Node), Masato Nakazawa (Center on Alcoholism, Substance Abuse, and Addictions (CASAA), SW Node), George E. Woody, MD (University of Pennsylvania School of Medicine, DV Node).

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, National Drug Abuse Treatment protocol CTN-0010), 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 the kappa statistic and the sensitivity, specificity, positive predictive value were computed, as well as the 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.

Conclusions: In general, findings support the use of self-report of drug use as a valid outcome measure in treatment studies of adolescents and young adults with opioid use disorders. 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. Future studies could further define the predictors of greater or lower probability of over- and under-reporting, so that interpretations of treatment studies using self-report as primary outcome measures can be more accurate. (Article (Peer-Reviewed), PDF, English, 2013)

Keywords: Adolescents | Buprenorphine/Naloxone | CTN platform/ancillary study | Cocaine | Opioid dependence | Opioid detoxification | Pharmacological therapy | Self-report | Suboxone | Young adults | Addictive Behaviors (journal)

Document No: 996, PMID: 23811060, PMCID: PMC3733244 (available 10/1/2014).

Submitted by CTN Dissemination Librarians, 6/19/2013.

Bogenschutz, Michael P. search mail
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Woody, George E. search mail
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