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Journal of Cannabis Research volume 4 , Article number: 29 Cite this article. Metrics details. The relationship between drug use and traumatic injury is well documented, yet only a small proportion of patients are biochemically tested for cannabis and other substances. The study objective was to determine whether patient self-report can be used as a proxy for biochemical drug testing following traumatic injury. All patients were screened for self-reported current drug use, which was evaluated for any drug and specifically for cannabis use. Analyses used to compare results of self-reported drug use and tox screen included sensitivity, specificity, positive, and negative predictive values, and percent agreement. Future studies are needed to confirm these findings and should address risk of selection bias. Moreover, the incidence of cannabis and drug use among trauma patients is increasing Chung et al. The American College of Surgeons mandates alcohol screening for patients admitted to the highest and most comprehensive level I and II trauma centers, but there are no guidelines on drug use testing in this population. A small proportion of hospitalized trauma patients are biochemically tested for drugs despite the well-established association with injury. In general, clinicians screen all trauma admissions for drug and alcohol use, but biochemical drug testing is typically reserved for patients who have high injury severity based on mechanism or vital signs or where there is a high degree of suspicion. For alcohol, self-report is an accurate proxy for biochemical testing in a general emergency department ED setting Cherpitel ; Vitale et al. Generally, there is little debate on relying on alcohol self-reporting; rather, research has shifted to what approaches further improve validity of self-report Del Boca and Darkes There is less consistency among studies examining the validity of self-reported drug use for biochemical testing. In Iran, nearly one in ten hospitalized patients who denied recent opioid use tested positive for opioids Rashidian et al. On the other hand, there was little undisclosed use of drugs in outpatients diagnosed with substance use disorder Weiss et al. It is not clear whether self-report can be used as a proxy for biochemical testing in patients presenting to the ED with traumatic injuries. The study objective was to determine the validity and agreement between patient self-report and biochemical testing following traumatic injury. Population 1 included trauma patients admitted to four level I and II trauma centers in Colorado and Texas over a period of four months 1 January —30 April with motor vehicle crash MVC injuries. Additional information on study selection criteria can be found in previous publications Salottolo et al. Population 2 included 66 trauma patients who were admitted to a Level I trauma center in Colorado over a period of eight months 1 March —30 October for a variety of injuries. Study selection criteria for this population was previously reported Schneider-Smith et al. The drug tox screen was considered positive if any of the above drugs were detected. Cannabis use was separately examined and defined as positive when THC was detected. Statistical analysis was performed using SAS version 9. Analyses used to compare self-reported drug use and tox screen findings included measures of validity sensitivity, specificity, positive and negative predictive values and percent agreement. There was no threshold for statistical significance and no formal power calculations were performed. The analysis included trauma patients. Of these, 63 patients self-identified as cannabis users. Likewise, the proportion of patients with a tox screen was similar by patients self-reporting cannabis use or not The validity of self-reported drug use for tox screen results is shown in Table 1. These findings suggest that in patients with traumatic injury, self-report is a valid proxy for ruling out drug use, and there were no apparent differences in the validity of using self-report for cannabis compared to other drugs. There are several advantages to being able to rely on self-reported drug use, such as immediate results, no cost, and noninvasiveness. Self-report is also incentivized by hospitals because insurance companies in some states are allowed to deny reimbursement if an injury resulted from alcohol and drug use Elkbuli et al. However, there are clinical concerns with undisclosed drug use for patients presenting acutely to the ED. Drug use can confound vital sign assessments, diagnosis, and treatment DiGiorgio et al. Because of these concerns with undisclosed drug use, there is frequent debate about biochemically testing trauma patients for drugs. Our experience suggests clinicians are hesitant to rely on self-report, instead requesting a tox screen to determine if drugs are present. While these findings suggest there is utility in using self-reported drug use in trauma patients, as undisclosed use was rare for cannabis and other drugs, the implications of our findings should be considered with the study size and setting. Only of trauma patients had biochemical drug testing, and most of our population was admitted to hospitals in Colorado, the first state to legalize and commercialize cannabis. Patients in Colorado may be more willing to divulge drug use, especially cannabis. Currently, 37 states plus the District of Columbia, Guam, and the US Virgin Islands have permissive cannabis laws legalizing medical cannabis National Conference of State Legislatures , but our findings may not be generalizable to states with strict marijuana laws where medical and recreational cannabis are illegal. Published studies demonstrate an increase in self-reported cannabis use after medical legalization Levine et al. Vitale et al. In our study, sensitivity and positive predictive values were poor, suggesting that a negative tox screen may not accurately recognize a patient who is a current drug user. Similarly, Claudius et al. This study has limitations. Primarily, tox screens are not routinely ordered on all trauma patients or on a random set of patients. Results would be more interpretable in a setting with universal biochemical testing. Tox screens are typically ordered in the trauma setting based on clinical relevance e. In some settings, tox screens are ordered on clinical suspicion or to confirm drug usage. In our study, the proportion of patients who had a tox screen were statistically identical by self-reported drug use vs. Demographic characteristics were also similar based on whether a tox screen was done. There were differences based on cause of injury: tox screens were more frequently ordered for patients with a MVC injury. Had there been differences in tox screen testing based on self-reported drug use or demographics, this would have been a major source of selection bias. Fortunately, this was not observed. Still, future studies should test all patients or a random sample of patients in order to confirm our findings. Based on prior studies at U. Additional limitations are as follows. Third, this was a post hoc analysis of two convenience samples, and the populations differed in age, ISS, and cause of injury. Fourth, patients who were aware their urine was being collected for biochemical testing may have also been more willing to divulge illicit drug use, despite the risk of retribution or penalty. However, our data do not support this possibility since self-reported drug use was reported in Fifth, patients who were immediately treated with opiates or other benzodiazepines may have been misclassified as a positive tox screen, because urine sample collection is generally performed on admission and not in the ED. Finally, it is possible that the tox screen was negative because the drug was not present in detectable concentrations at the time of hospital admission. Approximate drug detection times in urine vary based on drug Moeller et al. This exploratory analysis of trauma patients suggests excellent validity in using self-report for ruling out drug use including cannabis use, affirming that a patient is not a user if they deny use. Undeclared use of cannabis was especially rare. These findings also underscore the issues in relying on biochemical testing as the gold standard for drug use. Opioid and benzodiazepine withdrawal syndromes in trauma ICU patients: a prospective exploratory study. Crit Care Explor. Article Google Scholar. Cherpitel CJ. Screening for alcohol problems in the U. Rapid alcohol problems screen. Alcohol Clin Exp Res. Validity of self-reported drinking before injury compared with a physiological measure: cross-national analysis of emergency-department data from 16 countries. J Stud Alcohol Drugs. The impact of recreational marijuana commercialization on traumatic injury. Inj Epidemiol. Marijuana self-report compared with testing in trauma patients before and after legalization. Clin Toxicol Phila. The validity of self-reports of alcohol consumption: state of the science and challenges for research. The impact of drug and alcohol intoxication on Glasgow coma scale assessment in patients with traumatic brain injury. World Neurosurg. 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Prevalence of marijuana use among trauma patients before and after legalization of medical marijuana: The Arizona experience. Testing for substance use in trauma patients: are we doing enough? Arch Surg Chicago, Ill : Luethi D, Liechti ME. Designer drugs: mechanism of action and adverse effects. Arch Toxicol. Clinical interpretation of urine drug tests: what clinicians need to know about urine drug screens. Mayo Clin Proc. National Conference of State Legislatures. Self-reported use of novel psychoactive substances in a US nationally representative survey: prevalence, correlates, and a call for new survey methods to prevent underreporting. Drug Alcohol Depend. Alarming rate of substance use in motor vehicle collisions at an appalachian trauma center. Sensitivity of self-reported opioid use in case-control studies: healthy individuals versus hospitalized patients. PLoS One. Occurrence, predictors, and prognosis of alcohol withdrawal syndrome and delirium tremens following traumatic injury. Crit Care Med. High on drugs: multi-institutional pilot study examining the effects of substance use on acute pain management. The grass is not always greener: a multi-institutional pilot study of marijuana use and acute pain management following traumatic injury. Patient Saf Surg. In Press. A matched pilot study examining cannabis-based Dronabinol for acute pain following traumatic injury. Trauma Surg Acute Care Open. A validation of self-reported substance use with biochemical testing among patients presenting to the emergency department seeking treatment for backache, headache, and toothache. Subst Use Misuse. Validity of self-reported alcohol consumption in nondependent drinkers with unintentional injuries. Key substance use and mental health indicators in the United States: results from the National Survey on drug use and health HHS publication no. Preinjury use of marijuana and outcomes in trauma patients. J Surg Res. Drug Test Anal. Substance use among emergency room patients: is self-report preferable to biochemical markers? Addict Behav. Validity of substance use self-reports in dually diagnosed outpatients. Am J Psychiatry. Download references. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Kristin Salottolo, Allen H. Kristin Salottolo, Matthew M. You can also search for this author in PubMed Google Scholar. KS performed the analysis and drafted the manuscript. EM conceptualized the study, interpreted the data, and critically revised the manuscript. All authors read and approved the final manuscript. Correspondence to David Bar-Or. All participating centers received approval through their respective Institutional Review Boards with a waiver of consent and HIPAA authorization via expedited review and minimal risk status. Reference numbers: Swedish Medical Center: ; St. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions. Salottolo, K. Validity between self-report and biochemical testing of cannabis and drugs among patients with traumatic injury: brief report. J Cannabis Res 4 , 29 Download citation. Received : 11 August Accepted : 27 May Published : 08 June Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Brief research report Open access Published: 08 June Validity between self-report and biochemical testing of cannabis and drugs among patients with traumatic injury: brief report Kristin Salottolo 1 , 2 , 3 , 4 , Emmett McGuire 1 , Robert Madayag 2 , Allen H. Tanner II 3 , Matthew M. Abstract Background The relationship between drug use and traumatic injury is well documented, yet only a small proportion of patients are biochemically tested for cannabis and other substances. Results The analysis included trauma patients. Table 1 Agreement between self-reported drug use and biochemical testing via urine toxicology screen for patients admitted with traumatic injury Full size table. Conclusion This exploratory analysis of trauma patients suggests excellent validity in using self-report for ruling out drug use including cannabis use, affirming that a patient is not a user if they deny use. Acknowledgements None. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. View author publications. Ethics declarations Ethics approval and consent to participate All participating centers received approval through their respective Institutional Review Boards with a waiver of consent and HIPAA authorization via expedited review and minimal risk status. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. About this article. Cite this article Salottolo, K. Copy to clipboard. Contact us Submission enquiries: nikki.

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