Denial of urinalysis-confirmed opioid use in prescription opioid dependence.

Although research has generally supported the validity of substance use self-reports, some patients deny urine-verified substance use. This study examined the prevalence and patterns of denying urinalysis-confirmed opioid use in a sample of prescription opioid dependent patients. It also identified characteristics associated with denial in this population of increasing public health concern. Opioid use self-reports were compared with weekly urinalysis results in the National Drug Abuse Treatment Clinical Trials Network’s 12-week multi-site treatment study for prescription opioid dependence (CTN-0030 Prescription Opioid Addiction Treatment Study (POATS)). Among those who used opioids during the trial (n=246/360), 44.3% (n=109) denied urinalysis-confirmed opioid use, although usually only once (78%). Overall, 22.9% of opioid-positive urine tests (149/650) were denied on self-report. Multivariable analysis found that initially using opioids to relieve pain was associated with denying opioid use.

Conclusions: The present study shows that, although the clear majority of self-reports were consistent with urine results, many participants denied urine-confirmed use, albeit infrequently, despite knowing they would be tested. This result, combined with the finding that 7% of the positive self-reports were provided in a week with a negative urine test, shows the importance of obtaining both self-report data and urine tests; neither one alone is adequate.

Related protocols: CTN-0030