Agreement between self-reported illicit drug use and biological samples: A systematic review and meta-analysis

Chrianna Bharat*, Paige Webb, Zachary Wilkinson, Rebecca McKetin, Jason Grebely, Michael Farrell, Adam Holland, Matt Hickman, Lucy Thi Tran, Brodie Clark , Amy Peacock, Shane Darke, Jih-Heng Li, Louisa Degenhardt

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

51 Citations (Scopus)

Abstract

Background and aims: Studies often rely on self-report and biological testing methods for measuring illicit drug use, yet evidence for their agreement is limited to specific populations and self-report instruments. We aimed to examine comprehensively the evidence for agreement between self-reported and biologically measured illicit drug use across all major illicit drug classes, biological indicators, populations, and settings.

Methods: We systematically searched peer-reviewed databases (Medline, Embase, and PsycINFO) and grey literature. Included studies reported 2x2 table counts or agreement estimates comparing self-reported and biologically measured use published up to March 2022. With biological results considered the reference standard and use of random effect regression models, we evaluated pooled estimates for overall agreement (primary outcome), sensitivity, specificity, false omission rates (proportion reporting no use that test positive) and false discovery rates (proportion reporting use that test negative) by drug class, potential consequences attached to self-report (i.e., work, legal or treatment impacts), and timeframe of use. Heterogeneity was assessed by inspecting forest plots. The study protocol was registered with PROSPERO, CRD42020182499.

Results: From 7,924 studies, we extracted data from 207 eligible studies. Overall agreement ranged from good to excellent (>0.79). False omission rates were generally low while false discovery rates varied by setting. Specificity was generally high but sensitivity varied by drug, sample type, and setting. Self-report in clinical trials and situations of no consequences was generally reliable. For urine, recent (i.e., past 1-4 days) self-report produced lower sensitivity and false discovery rates than past month. Agreement was higher in studies that informed participants biological testing would occur (diagnostic odds ratio: 2.9, 95% confidence interval: 1.2-6.9). The main source of bias was biological assessments (51% studies).

Conclusions: While there are limitations associated with self-report and biological testing to measure illicit drug use, overall agreement between the two methods is high, suggesting both provide good measures of illicit drug use. Recommended methods of biological testing are more likely to provide reliable measures of recent use if there are problems with self-disclosure.
Funding: The Australian Government.

Key words: self-report; illicit drug use; biomarkers; agreement; concordance; sensitivity; specificity; drug testing;
Original languageEnglish
Pages (from-to)1624-1648
Number of pages25
JournalAddiction
Volume118
Issue number9
Early online date2 Apr 2023
DOIs
Publication statusPublished - 1 Sept 2023

Bibliographical note

Funding Information:
C.B. reported receiving University of New South Wales Scientia and National Drug and Alcohol Research Centre PhD scholarships during the conduct of the study. M.H. reported receiving grants from National Institute for Health Research and Medical Research Council for analysis of the data set included in this review during the conduct of the study and speaker honoraria from Merck Sharp and Dohme and Gilead in the past 3 years outside the submitted work. J.G. reported receiving grants from AbbVie, Camurus, Cepheid, Gilead Sciences, Hologic, Indivior and Merck, and personal fees from AbbVie, Cepheid, Gilead Sciences and Merck outside the submitted work. M.F. reported receiving grants from the Australian Federal Government Department of Health National Centre Core Funding, an untied grant from Indivior to evaluate new opioid medications in Australia and grants from Seqirus United to evaluate new opioid medications in Australia outside the submitted work. L.D. reported receiving grants from National Health and Medical Research Council Fellowship, project funding and grants from the National Institutes of Health Project funding, grants from Indivior Untied to evaluate new opioid medications in Australia and grants from Seqirus United to evaluate new opioid medications in Australia outside the submitted work. A.H. reported the following unpaid roles in committees and advocacy organizations: Co‐Chair of the UK Faculty of Public Health Drugs Special Interest Group; membership of the senior research team for the Loop UK; and previously, in the last 36 months, he was Associate Director of International Doctors for Healthier Drug Policies. L.T.T. was supported by funding from a US National Institutes of Health grant (R01 AI47490‐01). All other authors declare no competing interests.

Funding Information:
We thank all the authors of the included studies, particularly the authors who answered our request and sent additional data. We are also very grateful for Dr Gabrielle Campbell, Dr Samuel Banister, and Professor Paul Dargan's advice and assistance in the early stages of this study. The NDARC is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Programme. Open access publishing facilitated by University of New South Wales, as part of the Wiley - University of New South Wales agreement via the Council of Australian University Librarians.

Funding Information:
We thank all the authors of the included studies, particularly the authors who answered our request and sent additional data. We are also very grateful for Dr Gabrielle Campbell, Dr Samuel Banister, and Professor Paul Dargan's advice and assistance in the early stages of this study. The NDARC is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Programme. Open access publishing facilitated by University of New South Wales, as part of the Wiley ‐ University of New South Wales agreement via the Council of Australian University Librarians.

Publisher Copyright:
© 2023 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

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