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Hair testing and self‐report of cocaine use by heroin users
Author(s) -
Tassiopoulos Katherine,
Bernstein Judith,
Heeren Timothy,
Levenson Suzette,
Hingson Ralph,
Bernstein Edward
Publication year - 2004
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/j.1360-0443.2004.00685.x
Subject(s) - heroin , medicine , cocaine use , addiction , opiate , cocaine dependence , psychiatry , drug , receptor
Aim Failure to disclose cocaine use can have a negative impact on medical care and research validity. This study was performed to identify predictors of cocaine non‐disclosure among individuals who self‐reported heroin use during a medical care encounter. Design A prospective comparison of self‐report of cocaine use among heroin users and hair analysis for cocaine. Setting Four health‐care clinics at an academic, inner‐city hospital. Participants Patients presenting for a health‐care visit who were willing to self‐report use of heroin and were not engaged in any form of drug treatment. Measurements (1) Self‐report using standardized instruments: the Drug Addiction Severity Test (DAST), the Addiction Severity Index (ASI) and quantity/frequency questions for heroin and cocaine use. (2) Biochemical evidence: analysis of hair by radioimmunoassay (RIA) for cocaine and opiate levels. Findings Among 336 heroin users who tested positive for cocaine in hair, 34.2% did not report their recent cocaine use. The mean cocaine level for discordant individuals was significantly lower than for concordant individuals (109.6 ng/10 mg versus 470.57 ng/10 mg; P < 0.0001). Multivariate predictors of disclosure included opiate and cocaine levels in hair and the ASI drug severity subscore. Conclusions Although self‐report has been validated for treatment system patients, almost a third of the out‐of‐treatment heroin users in this medical clinic study failed to disclose concomitant cocaine use. The likelihood of non‐disclosure was greatest for heavy users of heroin and light users of cocaine. Confirmation of self‐report with biochemical analysis in the medical setting may be necessary to improve both clinical care and research validity.