Under-reporting of drug use among individuals with schizophrenia: prevalence and predictors

BackgroundIllicit drug use is common in individuals with schizophrenia, and it has been suspected that many individuals under-report their use of substances, leading to significant barriers to treatment. This study sought to examine the degree to which individuals with schizophrenia disclose their use of drugs on self-rated assessments, compared to laboratory assays, and to determine the contributors of under-reported drug use in this population.MethodA total of 1042 individuals with schizophrenia who participated in screening/baseline procedures for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) completed self-rated assessments of substance use and laboratory drug testing. Laboratory tests assayed cannabis, cocaine and methamphetamine use; the procedures included radioimmunoassay (RIA) and urine drug screens.ResultsA significant proportion of participants tested positive for drug use on laboratory measures (n = 397; 38%), and more than half (n = 229; 58%) did not report using these drugs. Logistic regression models confirmed that patients who were most likely to conceal their use tended to be older, and presented with greater neurocognitive deficits. Patients who accurately reported drug use tended to have greater involvement with the criminal justice system. Illness severity and psychopathology were not associated with whether patients disclosed drug use.ConclusionsRates of under-reported drug use are considerable among individuals with schizophrenia when compared to laboratory assays, and the exclusive reliance on self-rated assessments should be used with caution. Patients who under-report their drug use are more likely to manifest neurocognitive deficits, which could be improved by interventions attempting to optimize treatment.

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Illicit Drug Use in the Pain Patient Population Decreases with Continued Drug Testing

January 2018 - Pain Physician ◽

10.36076/ppj.2011/14/189 ◽

2011 ◽

Vol 3;14 (2;3) ◽

pp. 189-193 ◽

Cited By ~ 2

Author(s):

Amadeo Pesce

Keyword(s):

Drug Use ◽

Drug Testing ◽

Illicit Drugs ◽

Illicit Drug ◽

Illicit Drug Use ◽

Pain Patient ◽

Spearman Correlation ◽

Urine Drug Testing ◽

Urine Drug ◽

Pain Patients

Background: A major concern of physicians treating pain patients with chronic opioid therapy and similar drugs is determining whether the patients are also using illicit drugs. This is commonly determined by urine drug testing (UDT). However, there are few studies on whether or not monitoring patients by this technique decreases illicit drug use. Objective: To determine if the presence of illicit drugs decreases over a number of physician visits where UDT was performed. Method: The method involved a retrospective study of tests for the illicit drugs marijuana, cocaine, methamphetamine, ecstacy (MDMA) phencyclidine (PCP) and the heroin metabolite, 6-acetylmorphine as confirmed by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS). A database of 150,000 patient visits was examined for the presence of any of these 6 drugs. Results: A total of 87,000 patients were initially tested. The number of patients who were repeatedly tested decreased over time. The percentage of patients positive for any of these illicit drugs decreased from 23% to 9% after 14 visits where UDT was performed. When graphed there was a trend to decreasing use. The Spearman correlation = -0.88, P < 0.0001. The major illicit drug was marijuana. When this was removed from the analysis, there was an even greater correlation with decreased illicit drug use. Spearman correlation = -0.92 (P < 0.0001) using a weighted correlation. Limitation: Patients continuing to use illicit drugs might be dismissed from practices thus biasing the study towards illicit drug avoidance. Conclusion: Continued UDT might decrease illicit drug use among pain patients. Key words: Pain patients, UDT, urine drug testing, LC-MS/MS, illicit drugs, decrease drug use

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A Technique for Estimating the Impact of Improvements in Drug Testing Sensitivity on Detection and Deterrence of Illicit Drug Use by Navy Personnel.

10.21236/ada326352 ◽

1997 ◽

Author(s):

Jules I. Borack

Keyword(s):

Drug Use ◽

Drug Testing ◽

Illicit Drug ◽

Illicit Drug Use ◽

Navy Personnel ◽

The Impact

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Child awareness of and access to cigarettes: impacts of the point-of-sale display ban in England

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054511 ◽

2018 ◽

Vol 28 (5) ◽

pp. 526-531 ◽

Cited By ~ 2

Author(s):

Anthony A Laverty ◽

Eszter Panna Vamos ◽

Christopher Millett ◽

Kiara C-M Chang ◽

Filippos T Filippidis ◽

...

Keyword(s):

Logistic Regression ◽

Drug Use ◽

Regression Models ◽

Multivariate Logistic Regression ◽

Tobacco Advertising ◽

Point Of Sale ◽

Logistic Regression Models ◽

Annual Survey ◽

Perceived Difficulty ◽

Ease Of Access

IntroductionEngland introduced a tobacco display ban for shops with >280 m2 floor area (‘partial ban’) in 2012, then a total ban in 2015. This study assessed whether these were linked to child awareness of and access to cigarettes.MethodsData come from the Smoking, Drinking and Drug Use survey, an annual survey of children aged 11–15 years for 2010–2014 and 2016. Multivariate logistic regression models assessed changes in having seen cigarettes on display, usual sources and ease of access to cigarettes in shopsResultsDuring the partial display ban in 2012, 89.9% of children reported seeing cigarettes on display in the last year, which was reduced to 86.0% in 2016 after the total ban (adjusted OR 0.58, 95% CI 0.50 to 0.66). Reductions were similar in small shops (84.1% to 79.3%)%) and supermarkets (62.6% to 57.3%)%). Although the ban was associated with a reduction in the proportion of regular child smokers reporting that they bought cigarettes in shops (57.0% in 2010 to 39.8% in 2016), we did not find evidence of changes in perceived difficulty or being refused sale among those who still did.DiscussionTobacco point-of-sale display bans in England reduced the exposure of children to cigarettes in shops and coincided with a decrease in buying cigarettes in shops. However, children do not report increased difficulty in obtaining cigarettes from shops, highlighting the need for additional measures to tackle tobacco advertising, stronger enforcement of existing laws and measures such as licencing for tobacco retailers.

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Drug Testing and Other Tools for Patient Monitoring (DRAFT)

10.1093/med/9780190265366.003.0012 ◽

2018 ◽

Author(s):

Louis E. Baxter

Keyword(s):

Drug Use ◽

Drug Testing ◽

Patient Monitoring ◽

Self Report ◽

Test Methodology ◽

Breath Testing ◽

Yield Information ◽

Urine Drug ◽

Addiction Risk ◽

Urine Testing

Chapter 12 describes patient monitoring in the setting of addiction or addiction risk, and pain management, to include drug testing. The advantages, disadvantages, and types of available testing for drug use are described, with a discussion of their limitations. Body fluids and tissues for sampling include hair, blood, saliva, sweat, and urine; all yield information regarding drug use within unique limitations and at different levels of convenience. The test methodology imposes a need to know respective sensitivities and specificities, particularly in a forensic setting. Breath testing (alcohol) is not within the scope of this chapter. Recommended frequencies of urine testing are addressed. The utility of other forms of monitoring (self-report, collateral sources, PDMP) is assessed in the final section. Two tables are provided, (1) urine drug detection times, and (2) sources of false positive tests in urine immunoassay studies. Supplemental information sources are cited in a text box.

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Trends in drug use from urine drug testing of addiction treatment clients

Journal of Opioid Management ◽

10.5055/jom.2015.0253 ◽

2015 ◽

Vol 11 (1) ◽

Cited By ~ 2

Author(s):

Kenneth L. Kirsh, PhD ◽

Howard A. Heit, MD ◽

Angela Huskey, PharmD, CPE ◽

Jennifer Strickland, PharmD, BCPS ◽

Kathleen Egan City, MA, BSN, RN ◽

...

Keyword(s):

Drug Use ◽

Drug Testing ◽

Addiction Treatment ◽

National Laboratory ◽

Prescription Medication ◽

Urine Drug Testing ◽

Urine Drug ◽

Liquid Chromatography Tandem Mass ◽

Testing Company ◽

National Trends

Objective: Urine drug testing (UDT) can play an important role in the care of patients in recovery from addiction, and it has become necessary for providers and programs to utilize specific, accurate testing beyond what immunoassay (IA) provides.Design: A database of addiction treatment and recovery programs was sampled to demonstrate national trends in drug abuse and to explore potential clinical implications of differing results due to the type of testing utilized.Setting: Deidentified data was selected from a national laboratory testing company that had undergone liquid chromatography tandem mass spectrometry (LCMS/MS).Patients/Participants: A total of 4,299 samples were selected for study.Interventions: Descriptive statistics of the trends are presented. Results: In total, 48.5 percent (n = 2,082) of the samples were deemed in full agreement between the practice reports and the results of LC-MS/MS testing. The remaining 51.5 percent of samples fell into one of seven categories of unexpected results, with the most frequent being detection of an unreported prescription medication (n = 1,097).Conclusions: Results of UDT demonstrate that more than half of samples yield unexpected results from specimens collected in addiction treatment. When comparing results of IA and LC-MS/MS, it is important to consider the limits of IA in the detection of drug use by these patients.

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Do Demographic Factors Moderate How Well Criminal Thinking Predicts Recidivism?

International Journal of Offender Therapy and Comparative Criminology ◽

10.1177/0306624x17694405 ◽

2017 ◽

Vol 62 (7) ◽

pp. 2045-2062 ◽

Cited By ~ 7

Author(s):

Johanna B. Folk ◽

Jeffrey B. Stuewig ◽

Brandy L. Blasko ◽

Michael Caudy ◽

Andres G. Martinez ◽

...

Keyword(s):

Clinical Trial ◽

Logistic Regression ◽

Justice System ◽

Regression Models ◽

Demographic Factors ◽

Jail Inmates ◽

Criminal Thinking ◽

Logistic Regression Models ◽

Two Measures ◽

The Relationship

Is the relationship between criminal thinking and recidivism the same for criminal justice–involved individuals from varying demographic backgrounds? Relying on two independent samples of offenders and two measures of criminal thinking, the current studies examined whether four demographic factors—gender, race, age, and education—moderated the relationship between criminal thinking and recidivism. Study 1 consisted of 226 drug-involved probationers enrolled in a randomized clinical trial. Study 2 consisted of 346 jail inmates from a longitudinal study. Logistic regression models suggested that the strength of the relationship between criminal thinking and subsequent recidivism did not vary based on participant demographics, regardless of justice system setting or measure of criminal thinking. Criminal thinking predicts recidivism similarly for people who are male, female, Black, White, older, younger, and more or less educated.

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The Role of Drugs in Workplace Injuries: Is Drug Testing Appropriate?

Journal of Drug Issues ◽

10.1177/002204269502500404 ◽

1995 ◽

Vol 25 (4) ◽

pp. 703-722 ◽

Cited By ~ 21

Author(s):

Scott Macdonald

Keyword(s):

Drug Use ◽

Drug Testing ◽

Illicit Drug ◽

Household Survey ◽

Illicit Drug Use ◽

Alcohol Problems ◽

Age Group ◽

Workplace Injuries ◽

The Relationship

In the past decade, many employers have adopted drug-testing programs to reduce workplace injuries. However, little scientific evidence shows that drug use is a significant and substantial cause of total workplace injuries. The purpose of this study was to empirically assess the role of drugs and alcohol in causing workplace injuries. Questionnaires were received from 882 Ontario employees in a household survey. Results showed that many variables were significantly related to job injuries. The variables were ranked according to the relative importance of each variable's contribution to total job injuries. Alcohol problems, licit drug use, and illicit drug use ranked 7, 11, and 12 respectively among a group of 12 significant variables. In order to examine the likelihood that drug use was a cause of job injuries, the relationship between job injuries and alcohol problems, licit drug use, and illicit drug use was examined across categories of third variables. For age, the relationship between drug use and injuries remained strong for the youngest age group, but disappeared for the oldest age group. Logistic regression analysis confirmed the plausibility of noncausal explanations of job injuries for illicit drug use, but not for alcohol problems or licit drug use. Overall, the results indicated that illicit drug use does not appear to be a major cause of job injuries. The implications of these results for drug-testing programs are discussed.

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Patterns of Marijuana Use in a 6-Month Pain Management Sample in the United States

Substance Abuse Research and Treatment ◽

10.1177/1178221817724783 ◽

2017 ◽

Vol 11 ◽

pp. 117822181772478 ◽

Cited By ~ 1

Author(s):

Hope M Smiley-McDonald ◽

Katherine N Moore ◽

David C Heller ◽

Jeri D Ropero-Miller ◽

Gregory L McIntire ◽

...

Keyword(s):

Pain Management ◽

Drug Use ◽

Prescription Drugs ◽

Drug Testing ◽

Illicit Drugs ◽

Marijuana Use ◽

The United States ◽

Prescription Drug Use ◽

Urine Drug Testing ◽

Urine Drug

This study is a 6-month retrospective analysis of urine drug testing (UDT) data from a pain management population among specimens with clinician-ordered marijuana testing (N = 194 809). Descriptive statistics about the specimen positivity of clinician-ordered marijuana UDT are provided as well as other drug positivity. Specimens from men and adults aged 18 to 34 years had the highest prevalence rates of marijuana positivity. The prevalence of past-month marijuana use among a comparative national population was lower than the prevalence of positive marijuana tests in the UDT specimens by all characteristics. Among the specimens tested for illicit drugs and marijuana, 4.0% were positive for amphetamine, 2.8% were positive for cocaine, and 0.9% were positive for heroin. The most common prescription drugs listed were opioids (64.7%), benzodiazepines (20.5%), and antidepressants (19.9%). In sum, the findings reflect previous research showing high rates of marijuana use, illicit drug use, and prescription drug use in a pain management population.

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Using Urine Drug Testing to Estimate the Prevalence of Drug Use

Public Health Reports ◽

10.1177/0033354920965264 ◽

2020 ◽

Vol 136 (1) ◽

pp. 47-51

Author(s):

Benjamin H. Han ◽

Elizabeth Mello ◽

Ellenie Tuazon ◽

Denise Paone

Keyword(s):

Drug Use ◽

Prescription Drug ◽

Drug Testing ◽

Population Level ◽

Drug Misuse ◽

Prescription Drug Misuse ◽

Weighted Estimates ◽

Urine Drug Testing ◽

Urine Drug ◽

Nyc Hanes

Objectives Estimating the prevalence of drug use in the general population is important given its potential health consequences but is challenging. Self-reported surveys on drug use have inherent limitations that underestimate drug use. We evaluated the performance of linking urine drug testing with a local, representative health examination survey in estimating the prevalence of drug use in New York City (NYC). Methods We used urine drug testing from the NYC Health and Nutrition Examination Survey (NYC HANES) to estimate the prevalence of drug use (benzodiazepines, cocaine, heroin, and opioid analgesics) among the study sample and compare the findings with self-reported responses to questions about past–12-month drug use from the same survey. Results Of 1527 respondents to NYC HANES, urine drug testing was performed on 1297 (84.9%) participants who provided urine and consented to future studies. Self-reported responses gave past–12-month weighted estimates for heroin, cocaine, or any prescription drug misuse of 13.8% (95% CI, 11.6%-16.3%), for prescription drug misuse of 9.9% (95% CI, 8.1%-12.1%), and for heroin or cocaine use of 6.1% (95% CI, 4.7%-7.9%). Urine drug testing gave past–12-month weighted estimates for any drug use of 4.3% (95% CI, 3.0%-6.0%), for use of any prescription drug of 2.8% (95% CI, 1.9%-4.1%), and for heroin or cocaine use of 2.0% (95% CI, 1.2%-3.6%). Conclusion Urine drug testing provided underestimates for the prevalence of drug use at a population level compared with self-report. Researchers should use other methods to estimate the prevalence of drug use on a population level.

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