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Official websites use. Share sensitive information only on official, secure websites. Please address correspondence to Friends Research Institute, Inc. This study sought to examine the utility of hair testing as a research measure of drug use among individuals with moderate-risk drug use based on the internationally-validated Alcohol, Smoking, and Substance Involvement Screening Test ASSIST. This study is a secondary analysis using baseline data from a randomized trial of brief intervention for drug misuse, in which adults with moderate-risk drug use were recruited from two community clinics in New Mexico, USA. Both self-report and hair testing covered a 3 month period. Overall concordance between hair testing and self-report was Hair testing can be useful in studies with moderate-risk drug users, but the potential for under-identification of low-frequency use suggests that researchers should consider employing low detection cut-offs and using hair testing in conjunction with self-report. Keywords: Hair testing, self-report, moderate-risk drug use, brief intervention, primary care. Substance abuse treatment in the United States and many other countries is often delivered in a specialty sector, with programs serving patients whose problems have reached a critical threshold of severity. However, the last decade has seen growing integration of substance use services within the larger US healthcare system, with a corresponding shift towards addressing a wider spectrum of substance use problems to intervene before the onset of severe disorders. The screening, brief intervention, and referral to treatment SBIRT model promoted by the US federal government has broadened the provision of substance use services to individuals receiving care in mainstream medical settings such as hospitals, emergency departments, and primary care Madras et al. Prioritization of behavioral health services within the context of healthcare reform is further expected to broaden eligibility for substance misuse services and encourage their delivery in outpatient and primary care venues Buck, ; Mechanic, The World Health Organization likewise supports the integration of substance misuse services into primary care, and a multinational trial found that brief intervention led to reductions in illicit drug use risks Humeniuk et al. Within primary care settings, many patients who report illicit drug use may have risky but irregular use patterns, and may not require nor accept specialized drug abuse treatment. Individuals with drug use patterns that place them at a moderate level of risk can be very different from individuals in specialized drug abuse treatment settings, and pose unique challenges for research. Clinical trials of drug abuse interventions often gauge changes in drug consumption using self-report, and rigorous studies often include a biological measure. Use of self-report in addition to toxicology testing has been recommended Donovan et al. Urine testing is the most common form of biological testing in drug abuse studies, due to its low cost and widespread clinical use in treatment Moeller et al. Although urine testing provides a valuable measure of drug use among patients who use drugs regularly, it has limited utility for those exhibiting more moderate use patterns because of its short detection window less than a few days for most drugs. Hair testing is a promising alternative to urine testing, and has found use in a range of clinical, workplace drug testing, and forensic toxicology applications Curtis and Greenberg, ; Klein et al. Although not without limitations e. It has an extended detection window of approximately 1 month per half inch of hair. Thus, a 1. This detection window makes hair testing particularly attractive for studies with individuals whose intermittent and lower frequency drug use patterns resist detection by urine testing. Specimen collection is straightforward, does not pose a biohazard risk or require special storage to avoid spoilage, and is less intrusive than observed urine specimen collection. Given these advantages, it is no surprise that some clinical trials of brief intervention for drug use have begun to use hair testing as an outcome measure Bernstein et al. Previous research comparing hair testing to self-report has documented substantial under-reporting of drug use in both youth and adults Delaney-Black et al. A large epidemiological study with middle-aged men found that hair testing identified more cocaine users, but fewer marijuana users, compared to self-report Ledgerwood et al. Other studies have examined the validity of hair testing in controlled settings. For example, a study with ten volunteers in a secure research ward found that concentration of cocaine and its metabolites in hair was correlated with dose level, but affected by melanin content Scheidweiler et al. A controlled methamphetamine administration study found good evidence of dose-related detection levels for hair, but noted substantial inter-individual differences Polettini et al. Another study with 9 methamphetamine-dependent volunteers concluded that concentrations in hair generally reflect self-reported patterns of usage well, although the authors cautioned against extrapolating findings to light or occasional methamphetamine users Han et al. A study with marijuana users found that only 7 of 13 participants who smoked cannabis in a controlled administration setting had a positive hair test Huestis et al. Few studies, however, have examined hair testing among out-of-treatment individuals who access the broader healthcare system. A notable exception is a series of studies that examined patterns and predictors of non-disclosure of cocaine use among individuals who disclosed heroin use during an outpatient medical visit Tassiopoulos et al. The current study extends the literature on hair testing and self-reported drug use by examining their agreement in a sample of adult primary care patients who reported moderate-risk drug use on an internationally-validated screening instrument. The overarching aim of the study is to examine the utility of hair testing as a research measure in this population. Individuals who use drugs at a moderate-risk level have distinct service needs from those with severe substance use problems, and are poised to receive increased attention from clinical researchers given the emphasis on behavioral health integration and adoption of brief intervention services across healthcare settings. Researchers designing clinical services studies are faced with a number of commercially-available options for biological detection of drug use. Potentially important differences can exist in sample processing, analytical procedures, and coverage of different substances between laboratories, and even within the same laboratory across different testing products. In the current study, we examined a standard, commercially-available 5-panel hair test. This study is a secondary analysis using baseline pre-randomization data collected for a clinical trial comparing computerized vs. All participants provided written informed consent. Additional details about the parent study have been described elsewhere Schwartz et al. Research assistants approached patients in the clinic waiting rooms and invited them to be screened for a health study. The ASSIST can be used to triage patients into low-, moderate-, and high-risk categories for tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, inhalants, sedatives, hallucinogens, and opioids Humeniuk et al. Three hundred sixty participants were enrolled, one of whom was subsequently withdrawn due to current enrollment in substance abuse treatment an exclusion criterion. Several steps were taken to improve accuracy of self-report. The screening interview with the ASSIST was conducted anonymously, without recording names or identifying information. Screening information was linked with study data only after determining eligibility and obtaining written informed consent. Confidentiality protections were emphasized during the screening introduction, and participants were assured that their responses would not be shared with clinic staff or become part of their medical record. The mean age was Other items tap indicators of problem use e. Hair samples were collected using laboratory-recommended procedures, whereby samples were measured to 1. Participants with insufficient head hair were asked to provide body hair. Although it did not test for all possible drugs, the standard 5-panel test was selected for the parent study because it was readily commercially-available and was thought to cover the most common drugs encountered in primary care. The laboratory analyzed samples using assay screening Pujol et al. Thus, the test only covered morphine, codeine, and heroin. A test covering other opioids e. Three hundred thirty six hair specimens from participants in the parent study underwent laboratory processing. Reasons for not obtaining hair samples included participant refusal and insufficient hair quantity. Forty participants who provided body hair were excluded from the analysis due to potentially different growth rates for body vs. Of the scalp hair samples processed by the laboratory, depending on the drug, between 4. Sensitivity, specificity, and area under the curve AUC were calculated comparing self-report against hair test results, and hair test results against self-report. Similar comparisons were examined for participants who reported using a particular drug but had a negative hair test. Among participants who disclosed drug use, differences in self-reported frequency of use were examined based on hair test results, using Mann-Whitney U tests due to the ordinal nature of self-reported frequency of use i. Table 1 shows a detailed summary of drug use by self-report and hair testing. Marijuana had the highest prevalence by either self-report or hair testing. Cocaine was the only drug where more participants were identified as positive by hair test than by self-report. Overall concordance was Amphetamines included methamphetamine, amphetamine, and MDMA. Sample for each drug is restricted to those with non-missing hair test data. The hair test identified only Most participants with a negative hair test for marijuana actually reported using it in the past 3 months For drugs other than marijuana, most participants reported no past 3 month use, and this was confirmed by hair testing in most cases. Among participants who reported past 3 month cocaine use, Among participants with a cocaine-negative hair test, 7. For amphetamines, only Among participants who denied amphetamine use, 6. Among participants with an amphetamine-negative hair test, 9. Only 2. Approximately one quarter There was considerable variability in sensitivity and specificity across drugs, and depending on whether the hair test or self-report was considered the criterion standard. Assuming the hair test as the criterion standard, sensitivity of self-report was excellent for marijuana If self-report is considered the criterion standard, hair testing yielded poor sensitivity, ranging from a high of Cocaine non-disclosers were more likely to be Hispanic than the cocaine-concordant No other significant differences by race, ethnicity, gender, or age were identified between non-disclosers and the concordant. There were no significant differences in under-identification via hair testing by race or ethnicity. Compared to marijuana-concordant participants, participants who disclosed marijuana use but tested negative were more likely to be female The mean level of THC metabolite in hair increased with each category of self-reported frequency of use in a clear linear progression. Figure 1 shows scatterplots of levels of drug in hair for marijuana and cocaine. Linear fitted lines are shown for the full sample solid line and the subsample of participants with a positive hair test dashed line. Due to the sizable number of negative hair tests, the correlation was also tested in the subsamples with positive hair tests for each drug. Notes: Solid lines depict linear fitted lines for the full sample including participants with negative self-report and hair tests. Dashed lines depict the linear fitted line for the subsample with positive hair test results. Similar findings were obtained for cocaine metabolites benzoylecgonine and norcocaine figures not shown. This study examined the utility of hair testing as a research measure among community health center patients with moderate-risk drug use, as determined by an internationally-validated screening instrument Humeniuk et al. Although some discrepancy between biological testing and self-report is to be expected, our findings point to discrepancies that were surprising both in their extent and direction. The hair test was largely consistent with self-report for those reporting abstinence over the past 3 months. Nevertheless, self-report had low sensitivity against hair testing for drugs other than marijuana. A large proportion of the relatively few participants who tested positive for cocaine, amphetamines, or opioids denied recent use of those drugs. In a study comparing self-report to hair testing for cocaine among self-disclosed heroin users, Tassiopoulos and colleagues found that many heroin users with positive hair tests for cocaine denied cocaine use. Compared to marijuana, use of drugs like cocaine, amphetamines, and opioids may be perceived as more stigmatized, and therefore less subject to accurate disclosure. However, the current study also illustrates that the potential for inaccuracy cuts both ways: a large number of participants reported drug use but had negative hair tests. For marijuana, only about half of self-disclosed users had a positive hair test. Under-identification of drug use by hair testing or over-reporting was also widespread for cocaine, amphetamines, and opioids. A study examining the veracity of self-reported heroin and cocaine use in an urban community sample found that self-reports were usually corroborated by hair analysis, and evidence of under-reporting was more common Fendrich et al. However, ours was not a community sample, but rather a sample of patients who screened into and enrolled in a research study for moderate-risk drug users; that is, self-reported drug use was an inclusion criterion. The first study of brief intervention for drug use to use hair testing found some evidence of over-reporting of heroin and cocaine use at baseline Bernstein et al. There are several possible explanations for the inability to identify declared drug users via hair test. Two explanations were put forth in the seminal study by the Bernstein group, which also apply here. First, it is possible that participants were being untruthful in order to gain entry into the study. Nevertheless, it is possible that information about the study spread to the population by word of mouth. Another possibility is that participants did not accurately recall their drug use patterns, or that the hair test did not overlap perfectly with the self-report time frame e. Another possible explanation is that some moderate-risk drug users may consume drugs below the detection limits of the standard hair test. Experts in hair testing have noted that there is insufficient empirical data on minimum detectable dosages for some substances, and that a negative hair test does not necessarily guarantee lack of exposure Kintz, Thus, within our moderate-risk sample there is represented a range of use patterns and use-related problems. It is possible that hair testing at the standard cut-offs was not sufficiently sensitive to capture low levels of drug use or use patterns that were intermittent or sporadic. We do not believe that the results support replacing urine testing with hair testing as a research measure in all cases; rather, hair and urine testing should be viewed as different tools with unique advantages and disadvantages. The current study provides data on hair testing to inform studies focusing on non-addicted persons with moderate-risk drugs use. There are several limitations to the present study that should be considered when interpreting the findings. First, marijuana use was highly prevalent in the sample, but prevalence of other drug use was comparatively low. These low base rates reduce confidence in inferences regarding cocaine, amphetamines, and opioids. Nevertheless, these drug use patterns reflect those of the clinic populations from which the sample was drawn. This study did not aim to identify the best method of drug detection, but rather to evaluate the utility of a readily-available hair test as research measure in a moderate-risk population. Future research using hair testing with moderate-risk populations should consider lower drug detection cut-offs. The findings are limited to drugs covered by the 5-panel test, which does not include various substances e. Possibly, newer and more advanced techniques for hair testing e. However, these techniques were not offered by the laboratories we queried. While more advanced approaches are becoming more available, the approach in the current study remains widely used, and our findings provide important data on this readily available approach. It may be of particular interest to clinical drug abuse researchers due to the dissemination of drug misuse screening and brief intervention services across healthcare settings, and increased emphasis on behavioral health integration in primary care. In the coming years, these factors are likely to lead to increased research with individuals who use drugs at a moderate-risk level, and our findings may be of interest to clinical substance use researchers working with these populations. The discrepancy between hair testing and self-report for opioids may be due in part to the laboratory testing only for morphine, codeine, and heroin metabolites. Non-medical use of prescription opioids is a growing public health problem with massive societal costs, and is being encountered more frequently in primary care settings Birnbaum et al. Finally, the present study was conducted with community health center patients who disclosed moderate-risk drug use. Although the findings may hold implications for hair drug testing in research studies generally, the results should be interpreted cautiously in light of the particular sample and study limitations. Hair testing cannot be considered a panacea for drug detection in individuals with moderate-risk drug use due to potential under-identification, at least at the standard detection thresholds used in this study. Nevertheless, hair testing has significant utility as an independent biological measure of drug use given the problems of relying exclusively on self-report, and the considerable limitations of urine testing with respect to its short detection window. As noted by Donovan and colleagues , hair testing may best be used in combination with self-report, e. Even considering its shortcomings, future studies will be stronger if they include hair testing as a measure of drug use alongside self-report. We thank Ms. Kyra Walls for assistance with manuscript preparation. We also thank the staff of the community health centers where the study was conducted. NIDA had no role in the study design, analysis or interpretation of data, in the writing of this report, or in the decision to submit the manuscript for publication. JG supervised data collection, conducted the analyses, and drafted the manuscript. KOG contributed to the statistical analysis plan. All authors contributed to and have approved the final manuscript. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. As a library, NLM provides access to scientific literature. Drug Alcohol Depend. Published in final edited form as: Drug Alcohol Depend. Find articles by Jan Gryczynski. Find articles by Robert P Schwartz. Find articles by Shannon Gwin Mitchell. Find articles by Steven J Ondersma. Issue date Aug 1. All rights reserved. The publisher's version of this article is available at Drug Alcohol Depend. Open in a new tab. Conflict of Interest The authors report no conflicts of interest. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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These datasets underpin the analysis presented in the agency's work. Most data may be viewed interactively on screen and downloaded in Excel format. All countries. Topics A-Z. The content in this section is aimed at anyone involved in planning, implementing or making decisions about health and social responses. Best practice. We have developed a systemic approach that brings together the human networks, processes and scientific tools necessary for collecting, analysing and reporting on the many aspects of the European drugs phenomenon. Explore our wide range of publications, videos and infographics on the drugs problem and how Europe is responding to it. All publications. More events. More news. We are your source of drug-related expertise in Europe. We prepare and share independent, scientifically validated knowledge, alerts and recommendations. About the EUDA. Hair drug testing involves collecting hair samples from individuals and analysing them for traces of substances which may have been recently consumed. Although the method cannot assess the level of consumption, it can provide a temporal overview of substances used. Hair drug testing can be used in combination with surveys to validate self-reported information. Please note that we cannot provide individuals with hair drug analysis. Should you wish to avail of such a service we recommend that you contact a local service provider. Prevalence and patterns of drug use among the general population is one of the key epidemiological indicators used by the EMCDDA to assess the drug situation in Europe. This indicator helps us to understand various aspects of illicit drug use among the general population including patterns of use, risk perceptions, social and health correlates, as well as the consequences of the use of illicit drugs. The indicator makes use of a number of tools including drug surveys of the general and school populations, innovative new approaches such as wastewater-based drug epidemiology and targeted surveys including web surveys and hair testing. Hair sampling is non-invasive and non-embarrassing. The hair is usually taken from the back of the head, close to the neck in order not to leave any visible signs. Each collected hair sample is then screened for drug use. Drugs enter hair through the blood, by sweat and sebum and from the external environment. Hair analysis allows the recreation of the exposure history as, in hair, it is possible to find almost every compound which was ingested in a defined timeframe prior to the sampling. The technique can detect illicit drugs and their breakdown products metabolites. Hair drug testing is another approach for monitoring drug use in a specific setting. This method involves collecting hair samples from participants. For this study, each participant will need to provide a hair sample and fill in a web-based survey. The hair sample will be analysed and stored anonymously. It will be destroyed after the analysis and will not be used for any purpose other than this study. The web survey was built on the basis of the questionnaire used for the European Web Survey on Drugs. While not being representative of the general population, these complementary methods, when carefully conducted, nevertheless provide valuable additional information about variations in use among different groups of people who use drugs. In this initial phase, samples will be collected in drug-checking services and at music festivals in France, Italy and Portugal. Homepage Quick links Quick links. GO Results hosted on duckduckgo. Main navigation Data Open related submenu Data. Latest data Prevalence of drug use Drug-induced deaths Infectious diseases Problem drug use Treatment demand Seizures of drugs Price, purity and potency. Drug use and prison Drug law offences Health and social responses Drug checking Hospital emergencies data Syringe residues data Wastewater analysis Data catalogue. Selected topics Alternatives to coercive sanctions Cannabis Cannabis policy Cocaine Darknet markets Drug checking Drug consumption facilities Drug markets Drug-related deaths Drug-related infectious diseases. Recently published Findings from a scoping literature…. Penalties at a glance. Frequently asked questions FAQ : drug…. FAQ: therapeutic use of psychedelic…. Viral hepatitis elimination barometer…. EU Drug Market: New psychoactive…. EU Drug Market: Drivers and facilitators. Statistical Bulletin home. Quick links Search news Subscribe newsletter for recent news Subscribe to news releases. Breadcrumb Home Activities Hair drug testing. On this page. Hair drug testing.

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