title: Hair drug testing results and self-reported drug use among primary care patients with moderate-risk illicit drug use.
abstract: BACKGROUND
  This study sought to examine the utility of hair testing as a research measure of drug use among individuals with moderate-risk drug use based on the internationally validated Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST).
  
  
  METHODS
  This study is a secondary analysis using baseline data from a randomized trial of brief intervention for drug misuse, in which 360 adults with moderate-risk drug use were recruited from two community clinics in New Mexico, USA. The current study compared self-reported drug use on the ASSIST with laboratory analysis of hair samples using a standard commercially available 5-panel test with assay screening and gas chromatography/mass spectrometry (GC/MS) confirmation. Both self-report and hair testing covered a 3-month period.
  
  
  RESULTS
  Overall concordance between hair testing and self-report was 57.5% (marijuana), 86.5% (cocaine), 85.8% (amphetamines), and 74.3% (opioids). Specificity of hair testing at standard laboratory cut-offs exceeded 90% for all drugs, but sensitivity of hair testing relative to self-report was low, identifying only 52.3% (127/243) of self-disclosed marijuana users, 65.2% (30/46) of cocaine users, 24.2% (8/33) of amphetamine users, and 2.9% (2/68) of opioid users. Among participants who disclosed using marijuana or cocaine in the past 3 months, participants with a negative hair test tended to report lower-frequency use of those drugs (p<.001 for marijuana and cocaine).
  
  
  CONCLUSIONS
  Hair testing can be useful in studies with moderate-risk drug users, but the potential for under-identification of low-frequency use suggests that researchers should consider employing low detection cut-offs and using hair testing in conjunction with self-report.
authors.affiliation: Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA. Electronic address: jgryczynski@friendsresearch.org.
authors.forename: Jan
authors.initials: J
authors.lastname: Gryczynski
authors.affiliation: Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Schwartz
authors.affiliation: Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
authors.forename: Shannon Gwin
authors.initials: SG
authors.lastname: Mitchell
authors.affiliation: University of Maryland, College Park, Department of Psychology, College Park, MD 20742, USA.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: O'Grady
authors.affiliation: Wayne State University, 42 W Warren Ave, Detroit, MI 48202, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Ondersma
mesh_terms: D000328:Adult; D000662:Amphetamines / Q000032:analysis; D000701:Analgesics, Opioid / Q000032:analysis; D002186:Cannabinoids / Q000032:analysis; D003042:Cocaine / Q000032:analysis; D055030:Drug Users; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006197:Hair / Q000737:chemistry*; D006801:Humans; D013287:Illicit Drugs / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D057566:Self Report; D015813:Substance Abuse Detection / Q000379:methods*; D019966:Substance-Related Disorders / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D000662:Amphetamines; D000701:Analgesics, Opioid; D002186:Cannabinoids; D013287:Illicit Drugs; D003042:Cocaine
keywords: Brief intervention; Hair testing; Moderate-risk drug use; Primary care; Self-report