Cannabis use: consistency and validity of self-report, on-site urine testing and laboratory testing

Aims To evaluate the agreement between adolescent self-reported cannabis use, "on-site" qualitative urine screening, and quantitative laboratory testing. Design A cross-sectional study of intake and follow-up data from 248 adolescents entering substance abuse treatment for cannabis use disorders (abuse or dependence). This is part of the multi-site cooperative agreement Cannabis Youth Treatment study. Setting Data collected from adolescents randomly assigned to one of five outpatient treatments at four sites: Operation PAR, Inc., Florida; Chestnut Health Systems, Illinois; University of Connecticut Health Center, Connecticut; and Children's Hospital of Philadelphia, Pennsylvania. Participants The data represent 248 unique individuals from a sample of 297 adolescents ranging in age from 12 to 18 years. Measurements Prevalence, agreement. kappa, sensitivity, specificity, positive and negative predictive value. Findings The self-report rates were higher at intake than either urine test (82.4% vs. 77.0% vs. 52.7%), but both lower and higher at the 3-month follow-up (55.5% vs. 70.0% vs. 47.3%) and 6-month follow-up (60.2% vs. 73.5% vs. 55.8%). The disagreements went in both directions and the kappa coefficients were only in the moderate range (0.4). Over two-thirds of these frequent cannabis users tested positive when they said they had not used in 1 week and one-third tested positive even though they said it had been more than 4 weeks since last use. Conclusions The findings suggest both the advantages of multiple sources of information and the need for further work on the latency of cannabis metabolites in clinical populations.