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Background: Nondisclosure of drug use on surveys is common, and many drug users unknowingly ingest adulterant or replacement drugs, which leads to underreporting of use of these drugs. Biological testing can complement survey research, and hair testing is an appealing method, as many drugs are detectable for months post-use. We examined willingness to donate a hair sample to be tested among those surveyed in a population at high risk for consuming adulterated drugs-electronic dance music (EDM) party attendees. Methods: We surveyed 933 adults entering EDM parties in New York City in 2017. Hair donation response rates and reasons for refusal were examined from this cross-sectional study. Results: A third ( n  = 312; 33.4%) provided a hair sample. Lack of interest (21.0%), lack of time (19.8%), not wanting a lock of hair cut (17.7%), and disinterest in having hair cut in public (13.8%) were the main reported reasons for refusal; 4.7% refused because they could not receive results. Past-year drug users were more likely to fear identification than nonusers ( P  < .001). Asian participants were at lower odds of providing a hair sample (adjusted odds ratio [aOR] = 0.53, 95% confidence interval [CI] = 0.32-0.87), and those reporting past-year use of LSD (aOR = 1.62, 95% CI = 1.11-2.35), opioids (nonmedical; aOR = 1.93, 95% CI = 1.25-2.99), and/or methamphetamine (aOR = 3.43, 95% CI = 1.36-8.62) were at higher odds of providing a sample than nonusers of these drugs. Conclusions: Only a third of participants provided a hair sample, and we found individual-level differences regarding willingness to provide a sample. Factors contributing to refusal should be considered to increase response rates and generalizability of results.

Background: Prior studies have suggested that physicians and residents may not have sufficient knowledge to appropriately interpret urine drug tests (UDTs) in patients who are prescribed opioids or using illicit substances. Therefore, the aim of this study was to survey psychiatry residents and fellows about their confidence and knowledge in interpreting UDTs in patients with chronic pain or receiving office-based opioid treatment., Methods: All psychiatry residency and fellowship program directors in the New England states were approached to recruit their trainees to participate in an anonymous online survey including a 7-item knowledge test., Results: A total of 93 residents and fellows completed the survey. Only a minority (24.7%) reported any prior training in UDT interpretation. A majority (62.6%) felt confident about interpreting UDTs. The mean total score for the knowledge test was 3.5 (SD =1.1, range: 1-6). There were no significant differences in total score by confidence in UDT interpretation (3.7 vs. 3.4, t = -1.17, nonsignificant [NS]), nor by prior training in UDT interpretation (3.8 vs. 3.5, t = -1.22, NS)., Conclusions: Psychiatry residents and fellows infrequently receive training in UDT interpretation, score poorly on the knowledge test, and their confidence in UDT interpretation does not reflect their knowledge. Future research should evaluate educational interventions that improve UDT interpretation among psychiatry residents and fellows.

Background: Unhealthy alcohol use (UAU) is common among people who use other drugs; however, little information is available about UAU among patients who screen positive for drugs in primary care, where the clinical priority might be assumed to be drug use. This study aimed at describing the occurrence of UAU and its association with substance use-related outcomes in such patients., Methods: This cohort study is a secondary analysis of data from a randomized trial of brief intervention for primary care patients screening positive for drug use. UAU was assessed at baseline; the main independent variable was any heavy drinking day in the past month. Outcomes including drug use characteristics and substance use-related consequences were assessed at baseline and 6 months later., Results: Of 589 primary care patients with drug use, 48% had at least 1 past-month heavy drinking day. The self-identified main drug was marijuana for 64%, cocaine for 18%, and an opioid for 16%. Any heavy drinking at baseline was negatively associated with number of days use of the main drug at 6 months (incidence rate ratio [IRR] = 0.75, 95% confidence interval [CI]: 0.62-0.91), but positively associated with the use of more than 1 drug (IRR = 1.73, 95% CI: 1.17-2.55) and unsafe sex (odds ratio [OR] = 1.90, 95% CI: 1.21-2.98)., Conclusion: Unhealthy alcohol use is common among patients identified by screening in primary care as using other drugs. Unexpectedly, UAU was negatively associated with days of main drug use. But, as expected, it was positively associated with other drug use characteristics and substance use-related consequences. These findings suggest that attention should be given to alcohol use among primary care patients who use other drugs.

Trauma patient readiness-to-change score and its relationship to the Alcohol Use Disorder Identification Test (AUDIT) score were assessed in addition to the feasibility of computerized alcohol screening and brief intervention (CASI). A bilingual computerized tablet for trauma patients was utilized and the data were analyzed using Stata. Twenty-five percent of 1145 trauma patients drank more than recommended and 4% were dependent. As many Spanish-speaking as English-speaking males did not drink, but a higher percentage of Spanish-speaking males drank more than recommended and were dependent. Half of patients who drank more than recommended rated themselves 8 or higher on a 10-point readiness-to-change scale. CASI also provided personalized feedback. A high percentage of trauma patients (92%) found CASI easy and a comfort in use (87%). Bilingual computerized technology for trauma patients is feasible, acceptable, and an innovative approach to alcohol screening, brief intervention, and referral to treatment in a tertiary care university.