A Validation of Self-Reported Substance Use with Biochemical Testing Among Patients Presenting to the Emergency Department Seeking Treatment for Backache, Headache, and Toothache

Abstract

Purpose: This study tests the validity of self-reported illicit substance use against biochemical testing among Emergency Department (ED) patients seeking treatment with narcotics for backache, headache, and toothache and to characterize patients who provide false reports. Methods: Retrospective chart review comparing the self-reported drug use history obtained during an ED visit during a six-year period (1995–2001) with the results of a biochemical drug screen obtained the same day. Results: 248 patients met screening criteria, 79 (32%) of whom tested positive for unclaimed “drugs of abuse.” Patients with a history of “drug abuse” and chronic pain were significantly more likely to test positive for unclaimed drugs than were their counterparts (p =. 05 and p <. 0001, respectively). No significant difference was found in comparing those with and without multiple ED visits or those requesting a specific narcotic. Conclusion: Self-reported drug use is unreliable in this ED subpopulation. When this knowledge is critical for patient care, biochemical testing may be indicated.

Keywords:

• emergency department
• self-reported drug use
• biochemical drug screening