How Much Cocaine Do You Have To Do To Register On A Hair Follicle Test

Drug Alcohol Depend. Author manuscript; bachelor in PMC 2015 Aug 1.

Published in final edited course as:

PMCID: PMC4080811

NIHMSID: NIHMS605567

Hair Drug Testing Results and Self-reported Drug Employ amid Primary Care Patients with Moderate-risk Illicit Drug Use

Jan Gryczynski

^aFriends Research Plant, Inc., 1040 Park Avenue, Suite 103, Baltimore, Maryland 21201, USA

Robert P. Schwartz

^aFriends Research Constitute, Inc., 1040 Park Avenue, Suite 103, Baltimore, Maryland 21201, United states of america

Shannon Gwin Mitchell

^aFriends Enquiry Plant, Inc., 1040 Park Avenue, Suite 103, Baltimore, Maryland 21201, United states of america

Kevin E. O'Grady

^bUniversity of Maryland, College Park, Department of Psychology, College Park, Maryland 20742, USA

Steven J. Ondersma

^cWayne Land University, 42 W Warren Ave, Detroit, MI 48202, U.s.

Abstruse

Background

This study sought to examine the utility of hair testing as a research measure out of drug use among individuals with moderate-chance drug use based on the internationally-validated Alcohol, Smoking, and Substance Interest Screening Test (ASSIST).

Methods

This report is a secondary analysis using baseline data from a randomized trial of brief intervention for drug misuse, in which 360 adults with moderate-risk drug use were recruited from two customs clinics in New Mexico, United states. The current study compared cocky-reported drug use on the Assistance with laboratory analysis of hair samples using a standard commercially-available 5-panel test with assay screening and gas chromatography/mass spectrometry (GC/MS) confirmation. Both cocky-report and hair testing covered a three calendar month catamenia.

Results

Overall cyclopedia between pilus testing and cocky-report was 57.5% (marijuana), 86.five% (cocaine), 85.8% (amphetamines), and 74.3% (opioids). Specificity of hair testing at standard laboratory cutting-offs exceeded 90% for all drugs, but sensitivity of hair testing relative to self-report was low, identifying just 52.iii% (127/243) of self-disclosed marijuana users, 65.ii% (30/46) of cocaine users, 24.2% (eight/33) of amphetamine users, and 2.9% (ii/68) of opioid users. Amidst participants who disclosed using marijuana or cocaine in the past 3 months, participants with a negative hair test tended to report lower-frequency use of those drugs (p< .001 for marijuana and cocaine).

Conclusions

Pilus testing can be useful in studies with moderate-run a risk drug users, only the potential for under-identification of low-frequency use suggests that researchers should consider employing depression detection cutting-offs and using pilus testing in conjunction with self-study.

Keywords: Hair testing, self-report, moderate-risk drug use, brief intervention, primary care

1. INTRODUCTION

Substance abuse handling 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 arbitrate before the onset of astringent disorders. The screening, brief intervention, and referral to handling (SBIRT) model promoted by the U.s.a. 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., 2009). Prioritization of behavioral health services inside the context of healthcare reform is further expected to broaden eligibility for substance misuse services and encourage their commitment in outpatient and chief care venues (Buck, 2011; Mechanic, 2012). The World Wellness Organization likewise supports the integration of substance misuse services into main intendance, and a multinational trial found that cursory intervention led to reductions in illicit drug utilize risks (Humeniuk et al., 2012).

Within master care settings, many patients who report illicit drug utilize may take risky but irregular use patterns, and may not require nor have specialized drug abuse treatment. Individuals with drug use patterns that place them at a moderate level of risk can be very unlike from individuals in specialized drug abuse treatment settings, and pose unique challenges for research. Clinical trials of drug abuse interventions frequently gauge changes in drug consumption using self-report, and rigorous studies ofttimes include a biological measure. Use of cocky-written report in addition to toxicology testing has been recommended (Donovan et al., 2012). Urine testing is the most mutual course of biological testing in drug corruption studies, due to its depression toll and widespread clinical utilize in treatment (Moeller et al., 2008). Although urine testing provides a valuable measure of drug use amid patients who apply drugs regularly, information technology has limited utility for those exhibiting more moderate apply patterns because of its short detection window (less than a few days for most drugs).

Hair testing is a promising culling to urine testing, and has found use in a range of clinical, workplace drug testing, and forensic toxicology applications (Curtis and Greenberg, 2008; Klein et al., 2000). Although non without limitations (e.k., variable hair availability/length; participant concerns about cosmetic visibility of sample collection; and higher relative price), pilus testing has several backdrop that get in potentially well-suited for moderate-risk populations. It has an extended detection window of approximately one month per half inch of hair. Thus, a 1.five inch section of hair captures a 90-24-hour interval window of drug use. This detection window makes hair testing particularly attractive for studies with individuals whose intermittent and lower frequency drug use patterns resist detection past 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 drove. Given these advantages, it is no surprise that some clinical trials of brief intervention for drug utilize have begun to use hair testing as an outcome measure (Bernstein et al., 2005; Ondersma et al., 2014; Schwartz et al., in press).

Previous research comparing hair testing to self-written report has documented substantial under-reporting of drug use in both youth and adults (Delaney-Black et al., 2010; Fendrich et al., 1999; Grekin et al., 2010; Magura and Kang, 1996). A large epidemiological study with heart-aged men found that hair testing identified more cocaine users, but fewer marijuana users, compared to self-study (Ledgerwood et al., 2008). Other studies accept examined the validity of hair testing in controlled settings. For case, a study with ten volunteers in a secure research ward establish that concentration of cocaine and its metabolites in hair was correlated with dose level, only affected by melanin content (Scheidweiler et al., 2005). A controlled methamphetamine administration study plant good prove of dose-related detection levels for hair, but noted substantial inter-private differences (Polettini et al., 2012). Another study with nine methamphetamine-dependent volunteers concluded that concentrations in hair more often than not reverberate self-reported patterns of usage well, although the authors cautioned against extrapolating findings to light or occasional methamphetamine users (Han et al., 2011). A study with marijuana users found that only seven of 13 participants who smoked cannabis in a controlled assistants setting had a positive hair test (Huestis et al., 2007). Few studies, withal, accept examined hair testing amongst 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 employ amid individuals who disclosed heroin utilise during an outpatient medical visit (Tassiopoulos et al., 2004, 2006).

The electric current report extends the literature on pilus testing and cocky-reported drug use by examining their agreement in a sample of adult primary care patients who reported moderate-risk drug utilize on an internationally-validated screening musical instrument. The overarching aim of the study is to examine the utility of hair testing as a research measure in this population. Individuals who employ drugs at a moderate-risk level have distinct service needs from those with severe substance use problems, and are poised to receive increased attending 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 fifty-fifty inside the same laboratory across dissimilar testing products. In the current written report, we examined a standard, commercially-bachelor 5-console pilus test.

2. METHODS

two.1 Parent Study

This study is a secondary analysis using baseline (pre-randomization) information collected for a clinical trial comparing computerized vs. in-person brief intervention for risky drug use. The study was approved past the Institutional Review Boards of Friends Research Institute and Christus Wellness. All participants provided written informed consent. Boosted details about the parent study have been described elsewhere (Schwartz et al., 2014).

2.2 Setting

The study was conducted at 2 rural health centers in New Mexico, United states of america.

2.3 Screening and Enrollment

Research administration approached patients in the dispensary waiting rooms and invited them to exist screened for a health written report. Patients were screened using the Alcohol, Smoking, and Substance Involvement Screening Test (Help), an musical instrument adult and widely disseminated by the Earth Health Organization. The ASSIST tin can be used to triage patients into low-, moderate-, and high-risk categories for tobacco, alcohol, cannabis, cocaine, amphetamine-blazon stimulants, inhalants, sedatives, hallucinogens, and opioids (Humeniuk et al., 2008; Newcombe et al., 2005).

Inclusion criteria were age 18 or older and illicit drug utilize (including non-medical apply of prescription drugs) at a "moderate-risk" level every bit defined by the Aid (i.eastward., a score of iv-26 for whatever substance other than tobacco or booze). Exclusion criteria were: "high risk" ASSIST score for alcohol or whatsoever drug other than tobacco, drug abstinence in the by iii months, enrollment in substance abuse treatment within the past year, recent receipt of a brief intervention for drug utilise at the dispensary, and plans to move out of state within a twelvemonth. Among patients eligible for the parent study, 25% declined to participate. Three hundred 60 participants were enrolled, one of whom was later on withdrawn due to current enrollment in substance abuse handling (an exclusion benchmark).

Several steps were taken to meliorate 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 exist shared with clinic staff or become part of their medical record.

2.iv Participants

The parent study included 359 participants with moderate-risk drug use, of whom 46% were female, 47% were Hispanic ethnicity, and ninety% were White. The mean age was 36.i years (SD=14.6).

2.v Measures

2.5.1 ASSIST

The ASSIST was administered during eligibility screening equally described above. The Assist has established validity for identifying substance use risks (Humeniuk et al., 2008; Newcombe et al., 2005). Past 3 month frequency of use is gauged for each substance, on a response calibration of Never, Once or Twice, Monthly, Weekly, and Daily or Almost Daily. Other items tap indicators of problem use (due east.g., failed attempts to quit/cut down).

2.5.ii Hair Testing

Hair samples were collected using laboratory-recommended procedures, whereby samples were measured to i.five inches from the scalp, corresponding to the 3 month time frame of cocky-study on the ASSIST. (Participants with insufficient head hair were asked to provide torso pilus). Hair samples were sent to a commercial laboratory (Confirm Biosciences/Omega Laboratories, Mogadore, OH) and analyzed for presence and quantity of marijuana, cocaine, amphetamines, and opioids (and phencyclidine, for which at that place were no positives). Although it did non test for all possible drugs, the standard 5-panel test was selected for the parent written report considering it was readily commercially-available and was idea to comprehend the nearly mutual drugs encountered in primary care. The laboratory analyzed samples using assay screening (Pujol et al., 2007) with confirmation of positives by gas chromatography/mass spectrometry (GC/MS), considered the criterion standard for biochemical verification of substance use (Moeller et al., 2008). To preclude adventure of external contagion, pilus samples were subjected to a standard wash procedure prior to GC/MS confirmation, and GC/MS was conducted for metabolites of some drugs (marijuana, cocaine, heroin). Screening cut-off levels followed the laboratory's standard practices for the 5-panel examination: 1 pg/mg for marijuana, 500 pg/mg for cocaine and amphetamines, and 300 pg/mg for opioids; GC/MS confirmation cut-offs were: 0.30 pg/mg for carboxy-tetrahydrocannabinol (THC) metabolite, 500 pg/mg for cocaine and 50 pg/mg for cocaine metabolites (benzoylecgonine; norcocaine), 500 pg/mg for amphetamines, methamphetamines, and iii,4-methylenedioxy-N-methylamphetamine (MDMA/Ecstasy), and 300 pg/mg for morphine, codeine, and heroin metabolite 6-monoacetylmorphine. Thus, the exam but covered morphine, codeine, and heroin. A test covering other opioids (e.m., oxycodone, methadone, etc.) was not offered at the time the written report was planned.

two.6 Analysis Sample

Three hundred thirty six hair specimens from 359 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 trunk vs. scalp hair. Of the 296 scalp hair samples candy by the laboratory, depending on the drug, between four.seven% and 7.1% of the samples could not be analyzed due to insufficient quantity, leaving n=275 samples for marijuana, n=282 samples for cocaine and amphetamines, and n=280 samples for opioids.

ii.7 Statistical Analysis

Overall agreement between hair exam results and self-reported use of marijuana, cocaine, amphetamines, and opioids was characterized by percent concordance and Kappa (κ) agreement statistics. Sensitivity, specificity, and surface area under the curve (AUC) were calculated comparison cocky-study against hair test results, and hair test results against self-study. Participants who denied drug employ but had a positive hair test were compared to their concordant counterparts on ethnicity, race, and gender using likelihood-ratio χ² tests, and on age using independent t-tests. Like comparisons were examined for participants who reported using a particular drug but had a negative hair test. Amidst participants who disclosed drug use, differences in self-reported frequency of use were examined based on pilus exam results, using Mann-Whitney U tests due to the ordinal nature of cocky-reported frequency of use (i.e., once or twice, monthly, weekly, daily or almost daily). Correlations between quantity of drug in hair and cocky-reported use frequency for marijuana and cocaine (the drugs with the highest prevalence in the sample by hair exam) were characterized using Spearman's rho (ρ).

3. RESULTS

three.1 Drug Use past Cocky-Study and Hair Testing

Tabular array 1 shows a detailed summary of drug utilise by self-report and pilus testing. Marijuana had the highest prevalence by either self-study or hair testing. Cocaine was the simply drug where more participants were identified equally positive past hair examination than past cocky-report. Overall cyclopedia was 57.5% for marijuana, 86.5% for cocaine, 85.eight% for amphetamines, and 74.iii% for opioids, while κ values for these drugs were .19, .53, .21, and <.01, respectively.

Tabular array 1

Comparing of drug use past self-report and pilus examination.

The hair examination identified but 52.3% (127/243) of participants who reported marijuana utilise in the past 3 months (self-written report +, hair +). In contrast, just 1/32 who denied marijuana use (three.1%) had a marijuana-positive hair test (self-report −, pilus +). Nigh participants with a negative hair exam for marijuana really reported using information technology in the past 3 months (78.ix%; 116/147; pilus−, self-report +). For drugs other than marijuana, most participants reported no past 3 calendar month employ, and this was confirmed past hair testing in near cases.

Amid participants who reported past 3 month cocaine use, 65.two% (30/46) had a cocaine-positive hair test, while 9.three% (22/236) of those who denied cocaine use had a cocaine-positive pilus test (self-report −, hair +). Among participants with a cocaine-negative hair test, 7.0% (xvi/230) reported past three calendar month cocaine use (hair−, self-report +).

For amphetamines, merely 24.2% (8/33) of participants who reported use had a positive hair test (self-report +, pilus +). Amid participants who denied amphetamine apply, 6.0% (15/249) had an amphetamine-positive hair test (cocky-written report −, pilus +). Amid participants with an amphetamine-negative hair exam, nine.vii% (25/259) disclosed using amphetamine-blazon stimulants (hair −, self-report +).

Only 2.ix% (2/68) of participants who reported opioid utilize had an opioid-positive hair examination (self-report +, hair +), while ii.8% (six/212) of those who denied opioid use had a positive pilus test (self-report −, hair +). Approximately one quarter (24.three%; 66/272) of participants with a negative hair exam reported not-medical opioid apply (hair −, cocky-report +).

There was considerable variability in sensitivity and specificity across drugs, and depending on whether the hair test or cocky-written report was considered the criterion standard. Assuming the hair test every bit the criterion standard, sensitivity of cocky-report was excellent for marijuana (99.two%), and poor for cocaine, amphetamines, and opiates (57.7%, 34.8%, and 25.0%, respectively), reflecting in part the high prevalence of self-reported marijuana use in the sample. If cocky-report is considered the criterion standard, pilus testing yielded poor sensitivity, ranging from a high of 65.2% (cocaine) to a low of ii.nine% (opiates). Specificity of hair testing against self-report exceed ninety% for all drugs.

iii.2 Characteristics of Participants with Discordant Self-Report and Hair Tests

3.ii.ane Self-Report −, Hair + vs. Concordant

Cocaine non-disclosers were more likely to be Hispanic than the cocaine-concordant (81.viii% vs. 41.viii%; p< .001). No other pregnant differences by race, ethnicity, gender, or historic period were identified between not-disclosers and the concordant.

3.2.2 Self-Report +, Hair Examination – vs. Concordant

In that location 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 (63.viii% vs. 44.9%; p= .002). Participants who reported using amphetamine-blazon stimulants but had a negative hair exam tended to be younger than amphetamine-concordant participants (hateful age= 28.0 vs. 35.9 years; p= .01), a pattern also evident for opioids (mean historic period= 30.4 vs. 37.iv years; p< .001).

3.3 Self-Reported Frequency of Use past Pilus Test Results

Among participants who reported using a particular drug, participants with a negative pilus test tended to report less frequent use than participants with a positive hair test (p< .001 for marijuana and cocaine). These differences were not-pregnant for amphetamines (p= .17) and opioids (p= .07), however, cell sizes were very modest. All 16 participants who reported cocaine use but tested negative reported using information technology only once or twice (north=14) or monthly (due north=2) in the by three months. For amphetamines, 22 of 25 who reported use just tested negative reported using once or twice (n=19) or monthly (north=3) over the by three months. For opioids, 52 of 66 participants who reported use simply tested negative reported using once or twice (n=30) or on a monthly basis (due north=12) in the past iii months.

3.four Quantity of Marijuana and Cocaine in Hair

The mean level of THC metabolite in hair increased with each category of self-reported frequency of use in a clear linear progression. The mean concentration of cocaine was highest for the "weekly" category (>50,000 pg/mg on average), which was driven by several outliers. Effigy ane shows scatterplots of levels of drug in pilus for marijuana and cocaine. Linear fitted lines are shown for the full sample (solid line) and the subsample of participants with a positive hair exam (dashed line). There was a significant correlation between concentration of drug in hair and self-reported frequency of apply for marijuana (Spearman'south ρ= .47; p< .001) and cocaine (Spearman's ρ= .58; p< .001) in the total sample. Due to the sizable number of negative pilus tests, the correlation was also tested in the subsamples with positive hair tests for each drug. In this analysis, level of THC metabolite in hair no longer correlated with self-reported frequency of use (Spearman's ρ= .05; p= .60). Concentration of cocaine in pilus continued to correlate with self-reported frequency of use (Spearman'due south ρ= .41; p= .003).

An external file that holds a picture, illustration, etc. Object name is nihms-605567-f0001.jpg

Concentration of drugs in hair past self-reported frequency of use for marijuana and cocaine.

Notes: Solid lines describe linear fitted lines for the full sample (including participants with negative self-written report and pilus tests). Dashed lines depict the linear fitted line for the subsample with positive hair exam results. Similar findings were obtained for cocaine metabolites benzoylecgonine and norcocaine (figures not shown).

4. Word

This study examined the utility of hair testing every bit a inquiry measure among community health center patients with moderate-risk drug utilize, as determined by an internationally-validated screening instrument (Humeniuk et al., 2008). 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. Relatively few participants who denied using a drug were positive by the hair test: 3-9% of self-reports of abstinence were refuted by the pilus test. Notwithstanding, self-report had depression 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 contempo use of those drugs. In a study comparing self-report to hair testing for cocaine among self-disclosed heroin users, Tassiopoulos and colleagues (2004) establish that many heroin users with positive hair tests for cocaine denied cocaine use. Compared to marijuana, apply of drugs like cocaine, amphetamines, and opioids may be perceived as more stigmatized, and therefore less subject to accurate disclosure.

However, the current study besides illustrates that the potential for inaccuracy cuts both ways: a large number of participants reported drug use only had negative pilus tests. For marijuana, merely about half of cocky-disclosed users had a positive pilus test. Under-identification of drug employ by hair testing (or over-reporting) was too widespread for cocaine, amphetamines, and opioids. A written report examining the veracity of self-reported heroin and cocaine use in an urban customs sample found that self-reports were commonly corroborated past hair analysis, and evidence of nether-reporting was more common (Fendrich et al., 1999). 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 employ was an inclusion criterion.

Although the extent of under-identification/over-reporting was surprising, the findings are not unprecedented. In a study with inmates, 43% who reported opiate use had a negative hair test, which the researchers attributed to participants falsely reporting utilize in hopes of gaining benefits such every bit entry into a rehabilitation programme (Vignali et al., 2012). However, a report with marijuana users constitute that 38% of hair samples tested negative for marijuana, and even 6/13 participants who smoked marijuana nether controlled laboratory weather tested negative (Huestis et al., 2007).

The first study of brief intervention for drug use to utilise hair testing found some show of over-reporting of heroin and cocaine utilise at baseline (Bernstein et al., 2005). There are several possible explanations for the inability to identify declared drug users via hair test. Ii explanations were put forth in the seminal study by the Bernstein group, which as well apply here. First, it is possible that participants were beingness untruthful in social club to proceeds entry into the study. However, the payment in the present study ($20) was not improvident, and participants were not told during screening what the study was specifically about or what the eligibility criteria were. Nevertheless, it is possible that information about the study spread to the population by word of rima oris. Another possibility is that participants did not accurately recall their drug use patterns, or that the pilus test did not overlap perfectly with the cocky-study time frame (eastward.thousand., due to slightly under-length pilus samples).

Another possible explanation is that some moderate-gamble drug users may consume drugs below the detection limits of the standard hair exam. Experts in pilus testing have noted that there is insufficient empirical information on minimum detectable dosages for some substances, and that a negative pilus examination does not necessarily guarantee lack of exposure (Kintz, 2012). Frequency of use is just 1 of several factors that counterbalance on the Aid's classification of risk categories. Thus, inside our moderate-adventure sample there is represented a range of use patterns and use-related issues. It is possible that hair testing at the standard cut-offs was non sufficiently sensitive to capture low levels of drug employ or use patterns that were intermittent or sporadic.

Nosotros do not believe that the results support replacing urine testing with pilus testing equally a research mensurate 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.

iv.1 Limitations

There are several limitations to the nowadays written report that should be considered when interpreting the findings. Get-go, marijuana use was highly prevalent in the sample, simply prevalence of other drug utilize was comparatively low. These low base of operations rates reduce conviction in inferences regarding cocaine, amphetamines, and opioids. Notwithstanding, these drug utilise patterns reflect those of the dispensary populations from which the sample was fatigued.

This study did non aim to place the best method of drug detection, but rather to evaluate the utility of a readily-bachelor pilus test as research measure in a moderate-risk population. Hence, we used the standard commercial v-panel pilus exam, with respective standard cut-offs for screening and GC/MS confirmation. Future enquiry 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 diverse substances (east.yard., benzodiazepines, various opioids, ethyl glucoronide every bit a marker of alcohol apply).

Possibly, newer and more advanced techniques for hair testing (due east.g., Montesano et al., 2014) could have yielded better detection and better concordance with self-report. All the same, these techniques were not offered by the laboratories we queried.at the time we planned the written report. While more advanced approaches are condign more available, the arroyo in the current study remains widely used, and our findings provide important information on this readily bachelor approach. Information technology may be of particular involvement to clinical drug abuse researchers due to the dissemination of drug misuse screening and brief intervention services beyond healthcare settings, and increased emphasis on behavioral health integration in primary care. In the coming years, these factors are likely to atomic number 82 to increased inquiry with individuals who employ drugs at a moderate-risk level, and our findings may exist of interest to clinical substance utilise researchers working with these populations.

The discrepancy between hair testing and self-report for opioids may exist due in part to the laboratory testing only for morphine, codeine, and heroin metabolites. Non-medical use of prescription opioids is a growing public wellness problem with massive societal costs, and is being encountered more often in primary care settings (Birnbaum et al., 2011; Manubay et al., 2011). Finally, the present study was conducted with community health center patients who disclosed moderate-run a risk drug use. Although the findings may hold implications for hair drug testing in inquiry studies more often than not, the results should be interpreted cautiously in light of the particular sample and study limitations.

4.2 Conclusions

Hair testing cannot be considered a panacea for drug detection in individuals with moderate-gamble drug use due to potential under-identification, at least at the standard detection thresholds used in this report. Challenges regarding toll, access to sufficient hair of consequent length, the likelihood that some samples will be of bereft quantity for analysis, and participants' cosmetic concerns must also be considered. Withal, hair testing has significant utility as an contained biological measure of drug apply given the problems of relying exclusively on self-report, and the considerable limitations of urine testing with respect to its short detection window. Equally noted by Donovan and colleagues (2012), hair testing may best be used in combination with self-report, e.g., to ostend reported abstinence. Even considering its shortcomings, future studies will be stronger if they include hair testing as a measure of drug apply alongside self-report.

Acknowledgements

We thank Ms. Kyra Walls for assistance with manuscript preparation. We also give thanks the staff of the community wellness centers where the report was conducted.

Function of Funding Source This enquiry was supported by the National Establish on Drug Abuse (R01 DA026003; PI: Robert P. Schwartz). 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.

Footnotes

Contributors JG, RPS, and SGM jointly conceptualized the study. JG supervised data collection, conducted the analyses, and drafted the manuscript. KOG contributed to the statistical analysis programme. RPS, SGM, KOG, and SJO critically revised the manuscript. All authors contributed to and have approved the final manuscript.

Conflict of Involvement The authors study no conflicts of interest.

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 volition undergo copyediting, typesetting, and review of the resulting proof before information technology is published in its final citable form. Please note that during the product process errors may be discovered which could affect the content, and all legal disclaimers that use to the journal pertain.

REFERENCES

Bernstein J, Bernstein E, Tassiopoulos 1000, Heeren T, Levenson S, Hingson R. Cursory motivational intervention at a clinic visit reduces cocaine and heroin use. Drug Booze Depend. 2005;77:49–59. [PubMed] [Google Scholar]
Birnbaum HG, White AG, Schiller M, Waldman T, Cleveland JM, Roland CL. Societal costs of prescription opioid abuse, dependence, and misuse in the U.s.. Pain Med. 2011;12:657–667. [PubMed] [Google Scholar]
Cadet JA. The looming expansion and transformation of public substance abuse handling under the Affordable Care Human activity. Wellness Aff. (Millwood) 2011;xxx:1402–1410. [PubMed] [Google Scholar]
Curtis J, Greenberg M. Screening for drugs of abuse: hair every bit an alternative matrix: a review for the medical toxicologist. Clin. Toxicol. (Phila) 2008;46:22–34. [PubMed] [Google Scholar]
Delaney-Black V, Chiodo LM, Hannigan JH, Greenwald MK, Janisse J, Patterson G, Huestis MA, Ager J, Sokol RJ. Just say "I don't": lack of concordance between teen study and biological measures of drug use. Pediatrics. 2010;126:887–893. [PMC gratis commodity] [PubMed] [Google Scholar]
Donovan DM, Bigelow GE, Brigham GS, Carroll KM, Cohen AJ, Gardin JG, Hamilton JA, Huestis MA, Hughes JR, Lindblad R, Marlatt GA, Preston KL, Selzer JA, Somoza EC, Wakim PG, Wells EA. Primary outcome indices in illicit drug dependence handling research: systematic approach to pick and measurement of drug employ stop-points in clinical trials. Addiction. 2012;107:694–708. [PMC free article] [PubMed] [Google Scholar]
Fendrich M, Johnson TP, Sudman South, Wislar JS, Spiehler V. Validity of drug use reporting in a high-risk community sample: a comparing of cocaine and heroin survey reports with hair tests. Am. J. Epidemiol. 1999;149:955–962. [PubMed] [Google Scholar]
Grekin ER, Svikis DS, Lam P, Connors V, Lebreton JM, Streiner DL, Smith C, Ondersma SJ. Drug utilise during pregnancy: validating the Drug Corruption Screening Test against physiological measures. Psychol. Addict. Behav. 2010;24:719–723. [PMC free commodity] [PubMed] [Google Scholar]
Han E, Paulus MP, Wittmann Thousand, Chung H, Song JM. Pilus analysis and self-report of methamphetamine utilise by methamphetamine dependent individuals. J. Chromatogr. B Analyt. Technol. Biomed. Life Sci. 2011;879:541–547. [PubMed] [Google Scholar]
Huestis MA, Gustafson RA, Moolchan ET, Barnes A, Bourland JA, Sweeney SA, Hayes EF, Carpenter PM, Smith ML. Cannabinoid concentrations in hair from documented cannabis users. Forensic Sci. Int. 2007;169:129–136. [PMC free commodity] [PubMed] [Google Scholar]
Humeniuk R, Ali R, Babor T, Souza-Formigoni ML, de Lacerda RB, Ling W, McRee B, Newcombe D, Pal H, Poznyak Five, Simon Due south, Vendetti J. A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Interest Screening Exam (ASSIST) in clients recruited from main health-care settings in four countries. Addiction. 2012;107:957–966. [PubMed] [Google Scholar]
Humeniuk R, Ali R, Babor TF, Farrell One thousand, Formigoni ML, Jittiwutikarn J, de Lacerda RB, Ling Westward, Marsden J, Monteiro M, Nhiwatiwa S, Pal H, Poznyak Five, Simon Southward. Validation of the Booze, Smoking And Substance Interest Screening Test (ASSIST) Addiction. 2008;103:1039–1047. [PubMed] [Google Scholar]
Kintz P. Value of the concept of minimal detectable dosage in human hair. Forensic Sci. Int. 2012;218:28–30. [PubMed] [Google Scholar]
Klein J, Karaskov T, Koren K. Clinical applications of hair testing for drugs of corruption--the Canadian feel. Forensic Sci. Int. 2000;107:281–288. [PubMed] [Google Scholar]
Ledgerwood DM, Goldberger BA, Adventure NK, Lewis CE, Price RK. Comparing betwixt cocky-report and hair analysis of illicit drug use in a community sample of middle-anile men. Aficionado. Behav. 2008;33:1131–1139. [PMC free article] [PubMed] [Google Scholar]
Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparing at intake and half dozen months subsequently. Drug Booze Depend. 2009;99:280–295. [PMC costless article] [PubMed] [Google Scholar]
Magura S, Kang SY. Validity of self-reported drug utilise in loftier hazard populations: a meta-analytical review. Subst. Use Misuse. 1996;31:1131–1153. [PubMed] [Google Scholar]
Manubay JM, Muchow C, Sullivan MA. Prescription drug abuse: epidemiology, regulatory bug, chronic pain management with narcotic analgesics. Prim. Care. 2011;38:71–90. vi. [PMC free article] [PubMed] [Google Scholar]
Mechanic D. Seizing opportunities under the Affordable Care Act for transforming the mental and behavioral health organisation. Health Aff. (Millwood) 2012;31:376–382. [PubMed] [Google Scholar]
Moeller KE, Lee KC, Kissack JC. Urine drug screening: applied guide for clinicians. Mayo Clin. Proc. 2008;83:66–76. [PubMed] [Google Scholar]
Montesano C, Johansen SS, Mielsen MKK. Validation of a method for the targeted assay of 96 drugs in hair by UPLC-MS/MS. J. Pharm. Biomed. Anal. 2014;88:295–306. [PubMed] [Google Scholar]
Newcombe DA, Humeniuk RE, Ali R. Validation of the World Health Organization Alcohol, Smoking and Substance Interest Screening Test (Help): written report of results from the Australian site. Drug Alcohol Rev. 2005;24:217–226. [PubMed] [Google Scholar]
Ondersma SJ, Svikis DS, Thacker LR, Beatty JR, Lockhart Due north. Computer-delivered screening and brief intervention (eastward-SBI) for postpartum drug use: a randomized trial. J. Subst. Abuse Treat. 2014;46:52–59. [PMC free article] [PubMed] [Google Scholar]
Polettini A, Cone EJ, Gorelick DA, Huestis MA. Incorporation of methamphetamine and amphetamine in human pilus following controlled oral methamphetamine administration. Anal. Chim. Acta. 2012;726:35–43. [PMC free article] [PubMed] [Google Scholar]
Pujol ML, Cirimele Five, Tritsch PJ, Villain M, Kintz P. Evaluation of the IDS Ane-Step ELISA kits for the detection of illicit drugs in hair. Forensic Sci. Int. 2007;170:189–192. [PubMed] [Google Scholar]
Scheidweiler KB, Cone EJ, Moolchan ET, Huestis MA. Dose-related distribution of codeine, cocaine, and metabolites into human hair following controlled oral codeine and subcutaneous cocaine administration. J. Pharmacol. Exp. Ther. 2005;313:909–915. [PubMed] [Google Scholar]
Schwartz RP, Gryczynski J, Mitchell SG, Gonzales A, Moseley A, Peterson TR, Ondersma SJ, O'Grady KE. Computerized 5. in-person brief intervention for drug misuse: a randomized clinical trial. Addiction. 2014 epub ahead of print. [PMC complimentary article] [PubMed] [Google Scholar]
Tassiopoulos K, Bernstein J, Heeren T, Levenson S, Hingson R, Bernstein East. Hair testing and self-report of cocaine use by heroin users. Addiction. 2004;99:590–597. [PubMed] [Google Scholar]
Tassiopoulos K, Bernstein J, Heeren T, Levenson S, Hingson R, Bernstein E. Predictors of disclosure of continued cocaine use. Addict. Behav. 2006;31:80–89. [PubMed] [Google Scholar]
Vignali C, Stramesi C, Vecchio Thousand, Groppi A. Hair testing and self-written report of cocaine use. Forensic Sci. Int. 2012;215:77–80. [PubMed] [Google Scholar]