Watson Dennis P, Clark Katie, Dennis Michael L, Grella Christine E, Hart M Kate
Chestnut Health Systems' Lighthouse Institute, Chicago, IL, USA.
Chestnut Health Systems' Lighthouse Institute, Bloomington, IL, USA.
Subst Use. 2025 Jan 31;19:29768357251316220. doi: 10.1177/29768357251316220. eCollection 2025 Jan-Dec.
Fentanyl, a highly potent synthetic opioid, is now involved in the majority of drug overdose deaths in the United States. Discrepancies between substance use self-reports and urine drug screens (UDS) are common, especially when users are unaware of fentanyl adulteration.
The objective of this study was to examine the cognitive processes underlying discrepancies between self-reported fentanyl use and UDS results, specifically focusing on participants unaware of their fentanyl exposure.
This was a cross-sectional qualitative study.
This study conducted cognitive interviews with 10 participants from a larger clinical trial who tested positive for fentanyl in a UDS but reported no fentanyl use. The interviews explored participants' understanding of survey questions about fentanyl use and their interpretation of UDS results. Responses were analyzed to identify themes related to self-report discrepancies.
Participants often underreported fentanyl use, not due to social desirability bias, but because they interpreted survey questions as asking about known, rather than suspected, fentanyl use. Many acknowledged their drugs were likely adulterated but only reported use when they were certain of fentanyl's presence.
The findings suggest that refining survey questions to capture both intentional and unintentional fentanyl exposure could improve the accuracy of self-reported data. These adjustments are critical to improve the accuracy of data collected to inform surveillance strategies, effective public health policies, and clinical interventions.
芬太尼是一种强效合成阿片类药物，目前在美国大多数药物过量死亡事件中都有涉及。物质使用自我报告与尿液药物筛查（UDS）之间存在差异很常见，尤其是当使用者未意识到芬太尼掺假时。
本研究的目的是检查自我报告的芬太尼使用情况与UDS结果之间差异背后的认知过程，特别关注未意识到自己接触过芬太尼的参与者。
这是一项横断面定性研究。
本研究对来自一项更大规模临床试验的10名参与者进行了认知访谈，这些参与者在UDS中芬太尼检测呈阳性，但报告未使用过芬太尼。访谈探讨了参与者对关于芬太尼使用的调查问题的理解以及他们对UDS结果的解读。对回答进行分析以确定与自我报告差异相关的主题。
参与者经常少报芬太尼的使用情况，这并非由于社会期望偏差，而是因为他们将调查问题理解为询问已知的芬太尼使用情况，而非疑似的使用情况。许多人承认他们的毒品可能掺有芬太尼，但只有在确定存在芬太尼时才报告使用情况。
研究结果表明，完善调查问题以涵盖有意和无意接触芬太尼的情况，可能会提高自我报告数据的准确性。这些调整对于提高所收集数据的准确性至关重要，以便为监测策略、有效的公共卫生政策和临床干预提供信息。
