Home > Agreement between self-reported illicit drug use and biological samples: a systematic review and meta-analysis.

Bharat, Chrianna and Webb, Paige and Wilkinson, Zachary and McKetin, Rebecca and Grebely, Jason and Farrell, Michael and Holland, Adam and Hickman, Matt and Tran, Lucy Thi and Clark, Brodie and Peacock, Amy and Darke, Shane and Li, Jih-Heng and Degenhardt, Louisa (2023) Agreement between self-reported illicit drug use and biological samples: a systematic review and meta-analysis. Addiction, 118, (9), pp. 1624-1648. doi: 10.1111/add.16200.

External website: https://onlinelibrary.wiley.com/doi/10.1111/add.16...

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.

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.

Item Type
Publication Type
International, Open Access, Review, Article
Drug Type
All substances
Intervention Type
Screening / Assessment
2 April 2023
Identification #
doi: 10.1111/add.16200
Page Range
pp. 1624-1648

Repository Staff Only: item control page