title: Utility of Point-of-care Urine Drug Tests in the Treatment of Primary Care Patients With Drug Use Disorders.
abstract: To determine if urine drug tests (UDTs) can detect under-reporting of drug use (ie, negative self-report, but positive UDT) and identify patient characteristics associated with underreporting when treating substance use disorders in primary care.
  
  
  
  Self-reported use (last 30 d) and UDTs were gathered at baseline, 3, 6, 9, and 12 months from 829 primary care patients participating in a drug use intervention study. Rates of under-reporting were calculated for all drugs, cannabis, stimulants, opioids, and sedatives. Logistic regressions were used to identify characteristics associated with under-reporting.
  
  
  
  Among the participants, 40% (n = 331) denied drug use in the prior 30 days despite a corresponding positive UDT during at least 1 assessment. Levels of under-reporting during 1 or more assessments were 3% (n = 22) for cannabis, 20% (n = 167) for stimulants, 27% (n = 226) for opioids, and 13% (n = 106) for sedatives. Older (odds ratio [OR] 1.04), female (OR 1.66), or disabled (OR 1.42) individuals were more likely to under-report any drug use. Under-reporting of stimulant use was also more likely in individuals with lower levels of educational attainment, previous arrests, and family and social problems. Under-reporting of opioid use was more likely in those with other drug problems, but less likely in those with better physical health, more severe alcohol and psychiatric comorbidities, and African-Americans.
  
  
  
  With the exception of cannabis, UDTs are important assessment tools when treating drug use disorders in primary care. UDTs might be particularly helpful when treating patients who are older, female, disabled, have legal and social problems, and have more severe drug problems.
authors.affiliation: Addictions and Behavioral Health Innovations (MGM), Initiative for Research and Education to Advance Community Health, Washington State University Spokane, WA; Elson S. Floyd College of Medicine (MGM), Washington State University, Spokane, WA; Veterans Administration Puget Sound Health Care System (MCG), Seattle, WA; Department of Psychiatry & Behavioral Sciences (IIW, DMD, KB, AK, CD, DCA, PR-B), School of Medicine, University of Washington, Seattle, WA; and Department of Health Services (RKR, CM), School of Public Health, University of Washington, Seattle, WA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: McDonell
authors.forename: Meredith C
authors.initials: MC
authors.lastname: Graves
authors.forename: Imara I
authors.initials: II
authors.lastname: West
authors.forename: Richard K
authors.initials: RK
authors.lastname: Ries
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Donovan
authors.forename: Kristin
authors.initials: K
authors.lastname: Bumgardner
authors.forename: Antoinette
authors.initials: A
authors.lastname: Krupski
authors.forename: Chris
authors.initials: C
authors.lastname: Dunn
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: David C
authors.initials: DC
authors.lastname: Atkins
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems / Q000592:standards*; D011320:Primary Health Care; D015813:Substance Abuse Detection / Q000592:standards*; D019966:Substance-Related Disorders / Q000652:urine*