title: Under-reporting of Risky Drug Use Among Primary Care Patients in Federally Qualified Health Centers.
abstract: The Affordable Care Act encourages integration of behavioral health into primary care. We aim to estimate the level of under-reporting of drug use in federally qualified health centers (FQHCs) among self-reported risky drug users.
  
  
  
  Adult patients in the waiting rooms of 4 FQHCs who self-reported risky drug use on the screening instrument World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (score 4-26), who participated in the "Quit Using Drugs Intervention Trial," submitted urine samples for drug testing. Under-reporters were defined as patients who denied use of a specific drug via questionnaire, but whose urine drug test was positive for that drug. Descriptive statistics, Pearson chi-square test, and logistic regression were used for analysis.
  
  
  
  Of the 192 eligible participants, 189 (96%) provided urine samples. Fifty-four samples were negative or indeterminate, yielding 135 participants with positive urine drug tests for this analysis: 6 tested positive for amphetamines, 18 opiates, 21 cocaine, 97 marijuana. Thirty patients (22%) under-reported drug use and 105 (78%) reported drug use accurately. Under-reporting by specific substances was: amphetamines 66%, opiates 45%, cocaine 14%, and marijuana 7%. Logistic regression revealed that under-reporting of any drug was associated with history of incarceration and older age (odds ratios 2.6 and 3.3, respectively; P < 0.05).
  
  
  
  Under-reporting of drug use is prevalent even among self-reported drug users in primary care patients of FQHCs (22%), but varied considerably based on the substance used. Further research is indicated to assess the extent of under-reporting among all primary care patients, regardless of their self-reported drug use status.
authors.affiliation: UCLA Department of Family Medicine (CB, LG, MV, BL, JY-M); and UCLA Fielding School of Public Health (LG, BL, RMA), New Haven, CT.
authors.forename: Curtis
authors.initials: C
authors.lastname: Bone
authors.forename: Lilian
authors.initials: L
authors.lastname: Gelberg
authors.forename: Mani
authors.initials: M
authors.lastname: Vahidi
authors.forename: Barbara
authors.initials: B
authors.lastname: Leake
authors.forename: Julia
authors.initials: J
authors.lastname: Yacenda-Murphy
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Andersen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012309:Risk-Taking; D057566:Self Report; D015813:Substance Abuse Detection / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult