Reliability of reporting of drug use data by homeless populations is unknown. Underreporting of drug use might be expected to be considerable by homeless people. Reliability of reporting was examined with results of urine testing for drugs on 400 homeless individuals in a study of drug abuse services utilization in St. Louis, MO. Systematic screening selected 300 drug users and 100 non-users from a variety of public settings frequented by homeless people (shelters, day centers, and homeless rehabilitation programs) as well as from streets. The Composite International Diagnostic Interview/Substance Abuse Module (CIDI/SAM) provided detailed assessment of drug use and criterion symptoms for substance use disorders. Kappa and Yule's Y tests demonstrated fair to good reliability between self-report methods of ascertaining use (screener vs. interview question), but fair to poor reliability between self-report (screener) and urine testing. Approximately two-thirds of subjects with urine positive for drugs denied current drug use. Factors associated with denial of substance use despite a positive urine test were increased age, younger age at onset of homelessness, and greater number of years homeless. In detecting current drug users, self-report was only 48% sensitive, and urine screen was 84% sensitive. Adding urine testing to self-report doubled the yield of cases found; whereas, adding self-report to urine testing added little to identify users. These findings demonstrate the importance of urine screening in constructing the complete story of drug use in homeless populations.
Learning Objectives: 1. Describe reliability among different methods of ascertaining drug use in homeless populations. 2. Articulate the importance of urine testing in drug abuse studies and treatment programs for homeless populations. 3. Report sensitivity of self-report and urine testing in ascertaining current drug use in homeless populations. 4. List factors associated with denial of drug use in homeless populations.
Keywords: Homeless, Drug Use
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.