1. Using self report to gather information about drug use can be reasonably reliable and valid in certain situations, especially where there are no contingencies for reported use, and where certain measures are taken during the information gathering process (e.g., Del Boca & Noll, 2000). However, there are some contexts which make the self report data less useful, due to inaccuracies (e.g., Del Boca & Noll, 2000; Del Boca & Darkes, 2003; Hoffmann & Ninonuevo, 1994; Midanik, 1988). The purpose of this study was to explore overall concordance between urine drug screen results and self-report in an adolescent and young adult population by doing secondary analyses of a randomized controlled trial of a 12 week suboxone treatment versus a 14 day suboxone detoxification in opioid addicted youth ages 15~21 Concordance between Self-Report and Urine Drug Screen Data in Adolescent Opioid Dependent Clinical Trial Participants M. Nakazawa 1, C.E. Wilcox 2, M.P. Bogenschutz 1,2, G.E. Woody 3 1 Center on Alcoholism, Substance Abuse and Addictions (CASAA), University of New Mexico, Albuquerque, NM 2 Department of Psychiatry, University of New Mexico, Albuquerque, NM 3 Department of Psychiatry, University of Pennsylvania, Philadelphia, PA INTRODUCTION METHODS SUMMARY ACKNOWLEDGEMENTS Participants and Outcomes In the study, 152 subjects aged 15-21 seeking treatment for opioid dependence were randomized to 2 week detoxification with buprenorphine/naloxone (DETOX; N=78), or 12 weeks buprenorphine/naloxone (BUP; N=74) with a dose taper beginning in week 9 and ending in week 12, each with weekly individual and group drug counseling (Woody et al, 2008). Subjects were paid $5 for providing a weekly urine drug screen and self-report of drug use during the preceding 7 days, and $75 for more extensive assessments at weeks 4, 8 and 12. When provided, urine samples were tested for morphine/opiates and oxycodone (Opioids), Cocaine, Cannabis, Benzodiazepines, and Meth/Amphetamine. For each subject at each time point, urine samples and self-report of drug use were labeled as either positive, negative, or missing. Based on these values, three measures of concordance were computed: Cohen’s κ, and Sensitivity/Specificity of self report. This research was supported by NIDA’s Clinical Trials Network REFERENCES Del Boca, F. & Noll, J.A. (2000). Truth or consequences: The validity of self-report data in health services research on addictions. Addiction, 95 (Supplement 3), 347-360. Del Boca, F.K., & Darkes, J. (2003). The validity of self-reports of alcohol consumption: State of the science and challenges for research. Addiction, 98, 1-12. Hoffmann, N. G. & Ninonuevo, F. G. (1994). Concurrent validation of substance abusers self-reports against collateral information: Percent agreement vs. Kappa vs. Yule's Y. Alcoholism: Clinical and Experimental Research, 18, 231-237. Midanik, L.T. (1988). Validity of self-reported alcohol use: A literature review and assessment. British Journal of Addictions, 83,1019-1030. Woody, G.E., Poole, S.A., Subramaniam, G., Dugosh, K., Bogenschutz, M., Abbott, P., Patkar, A., Publicker, M.,McCain, K., Potter, J.S., Forman, R., Vetter, V., McNicholas, L., Blaine, J., Lynch, K.G., Fudala, P., 2008. Extended vs short-term buprenorphine-naloxone for treatment of opioid-addicted youth: a randomized trial. JAMA 300, 2003-2011. -Cohen’s κ averaged across 12 weeks was relatively high, exceeding 0.70 in all drugs except for Benzodiazepines (0.57). -In some drugs κ fluctuated wildly across weeks: in Benzodiazepines the standard deviation (SD) was 0.33 with the range of -0.04~1.00; in Meth/Amphetamine SD was 0.32 with the range of 0.00~1.00. -In terms of Sensitivity, Benzodiazepines again had the lowest average of 0.56. The other drugs had the average Sensitivity greater than 0.70. -Sensitivity fluctuated wildly in Benzodiazepines (SD = 0.33, range = - 0.04~1.00) and in Meth/Amphetamine (SD = 0.32, range = 0.00~1.00). -All drugs had very high Specificity averaged across 12 weeks with the highest of 0.99 in Meth/Amphetamine and the lowest of 0.89 in Cannabis. -Specificity was more stable than the other measures: the greatest SD was 0.04 in Cannabis and the lowest of 0.01 in Meth/Amphetamine. Week RESULTS where Pr(a) is the relative observed agreement among raters, and Pr(e) is the hypothetical probability of chance agreement. Pr(a) – Pr(e) 1 – Pr(e) κ =κ = Pr(+Self-Report | +Urine)Sensitivity = Specificity =Pr(-Self-Report | -Urine) SUMMARY -In opioids, cannabis, and cocaine, concordance of self-report with urine screen was acceptably high and stable across weeks. This results may mean that testing the use of these drugs may not require urine-screens, conserving resources. -On the other hand, in benzodiazepines and meth/amphetamines concordance of self-report was lower and very unstable. These results may be due to smaller numbers of positive cases. For instance, there were only 32 (+Self-Report | +Urine) cases summed across 12 weeks in benzodiazepines and 24 cases in Cocaine, whereas in other drugs the number ranged from 103 to 372. There results may indicate that testing the use of infrequently used drugs may require multiple measures to improve accuracy and precision of measurement.