Under-reporting of risky drug use among primary care patients in federally qualified health centers

Curtis Bone, Lilian Gelberg, Mani Vahidi, Barbara Leake, Julia Yacenda-Murphy, Ronald M. Andersen

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Objective: The Affordable Care Act encourages integration of behavioral health into primary care. We aim to estimate the level of under-reporting of drug use in federally qualified health centers (FQHCs) among self-reported risky drug users. Methods: Adult patients in the waiting rooms of 4 FQHCs who self-reported risky drug use on the screening instrument World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (score 4-26), who participated in the "Quit Using Drugs Intervention Trial," submitted urine samples for drug testing. Under-reporters were defined as patients who denied use of a specific drug via questionnaire, but whose urine drug test was positive for that drug. Descriptive statistics, Pearson chi-square test, and logistic regression were used for analysis. Results: Of the 192 eligible participants, 189 (96%) provided urine samples. Fifty-four samples were negative or indeterminate, yielding 135 participants with positive urine drug tests for this analysis: 6 tested positive for amphetamines, 18 opiates, 21 cocaine, 97 marijuana. Thirty patients (22%) under-reported drug use and 105 (78%) reported drug use accurately. Under-reporting by specific substances was: amphetamines 66%, opiates 45%, cocaine 14%, and marijuana 7%. Logistic regression revealed that under-reporting of any drug was associated with history of incarceration and older age (odds ratios 2.6 and 3.3, respectively; P<0.05). Conclusions: Under-reporting of drug use is prevalent even among self-reported drug users in primary care patients of FQHCs (22%), but varied considerably based on the substance used. Further research is indicated to assess the extent of under-reporting among all primary care patients, regardless of their self-reported drug use status.

Original languageEnglish (US)
Pages (from-to)387-394
Number of pages8
JournalJournal of Addiction Medicine
Issue number6
StatePublished - 2016
Externally publishedYes


  • Addiction
  • At-risk drug use
  • Drug
  • Drug screen
  • Drug use
  • Federally qualified health center
  • Risky drug use
  • Substance use
  • Substance use disorder
  • Under-report
  • Urine drug screen
  • Urine toxicology

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)


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