Urine Testing for Drug Use Among Male Arrestees -- United States, 1989

Since 1986, the Drug Use Forecasting (DUF) program of the National Institute of Justice (NIJ) has monitored drug use among recently arrested persons in selected cities. Every 3 months, DUF staff obtain voluntary, anonymous urine specimens from a sample of arrestees in booking facilities.* The findings in this report reflect drug use among male arrestees from 14 cities during January-March 1989.

Urine specimens were screened by Enzyme Multiplied Immune Test (EMIT(TM))** for the following drugs and/or their metabolites: opiates, cocaine, phencyclidine (PCP), marijuana, amphetamines, methadone, barbiturates, propoxyphene, benzodiazepine, and methaqualone. Specimens positive for amphetamines were tested by gas chromatography to eliminate false-positive reactions by related drugs, such as ephedrine. Positive screening tests for other drugs were not confirmed.

Preference for enrollment in the program was given to persons charged with serious nondrug-related offenses. Attempts were made to limit the percentage of participants charged with sale or possession of drugs to less than or equal to 25%. Persons charged with traffic offenses or vagrancy were excluded.

Each arrestee was asked to participate in a brief, anonymous, and confidential interview regarding drug use, drug-treatment history, needle-sharing behaviors, and availability of new drugs "on the street." Following the interview, the arrestee was asked to provide a urine specimen. Of arrestees contacted, greater than or equal to 90% agreed to be interviewed; 80%-96% of those interviewed provided a urine specimen (Table 1).

Urine tests were positive for cocaine most commonly in arrestees in New York (76%), Philadelphia (74%), and the District of Columbia (65%), and least likely in the smaller cities of Indianapolis (26%) and San Antonio (24%) (Figure 1). In nine of the 14 cities, less than 10% of the arrestees had positive urine tests for opiates. Eighty-one percent of persons who tested positive for opiates also tested positive for cocaine. In five cities, no arrestee had a positive test for amphetamines, and the percentage of positive tests was greater than 7% in only one city, San Diego (35%).

Drug injection at some time during their lives was reported by 15%-38% of the male arrestees in each city (Table 2). Cocaine and heroin were the most frequently reported injected drugs. In 10 of the 14 cities, cocaine was more frequently reported to be injected than heroin. In eight cities, injection of amphetamines was reported by greater than or equal to 40% of the arrestees who injected drugs. In 11 cities, greater than or equal to 20% of injectors reported sharing needles. Reported by: ED Wish, PhD, JA O'Neil, MA, National Institute of Justice. R Stevens, Cleveland State Univ, Ohio. P McMillan, Dallas County Sheriff's Dept, Texas. T Mieczkowski, Wayne State Univ, Detroit. P Galloway, Marion County Justice Agency, Indianapolis. C Burnett, Univ of Missouri, Kansas City; S Decker, Univ of Missouri, St. Louis. W Hunter, Orleans Parish Criminal Sheriff's Dept, New Orleans. T Miller, Narcotic and Drug Research, Inc, New York. J Shanahan, Philadelphia Police Dept. R Rian, Treatment Alternatives to Street Crime of Phoenix, Arizona. P Clem, Treatment Alternatives to Street Crime of Portland, Oregon. S Soto, Youth Div, City of San Antonio, Texas. S Pennell, San Diego Assoc of Governments, San Diego. K Boyer, J Carver, District of Columbia Pretrial Services Agency. National Institute on Drug Abuse, Alcohol, Drug Abuse, and Mental Health Administration. Office of the Director, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: In 1987, 3,460,960, persons--or 1.9% of the adult population--were supervised by the correctional system in the United States (1). In 1988, there were 13.8 million arrests in the United States (2). The DUF program permits objective measurement of recent drug use among a sample of persons arrested in selected U.S. cities. Urine tests for cocaine, opiates, and amphetamines give positive results for as long as 3 days, 2 days, and 2 days, respectively, after the last use of the drugs (3). Therefore, DUF results measure drug use only for the 2-3 days before arrest. Because some persons who are charged with drug offenses are excluded from participation (even though they are more likely to be test-positive at the time of arrest), DUF data probably underestimate actual drug use among arrestees.

The prevalence of recent cocaine use (greater than or equal to 50%) among arrestees in seven of the 14 cities is striking. DUF reports for 1984-1986 documented the increasing proportion of arrestees testing positive for cocaine in that period (4,5). For 1987-1989, DUF data for New Orleans indicate that the near doubling of positive urine tests for cocaine coincided with substantial increases in reported use of crack (NIJ, unpublished data).

Because conditions in booking facilities make systematic random sampling difficult, convenience samples were taken with preferences given to persons charged with serious nondrug-related offenses. Screening for cocaine and opiates was based on the EMIT(TM), which can yield a positive result for opiates after a variety of legal medicines (e.g., cough medicines containing codeine or dextromethorphan) and foods containing poppy seeds are consumed. Because positive screens were not confirmed, the rates of opiate positives may overestimate the use of heroin and other illegally used opiates. The reliability of the opiate findings is supported by the fact that most (81%) of arrestees with positive opiate tests also had positive cocaine tests. False-positive screening tests for cocaine are unlikely.

At least two aspects of the procedures used by interviewers in recruiting participants in the booking facilities may limit the generalizability of the DUF findings. First, the participants are not a random sample of the arrestees. Second, the findings could be biased if selection methods increased the likelihood of selecting persons who had recently used drugs or if arrestees who had recently used drugs were more likely to give a urine specimen.

The finding that greater than or equal to 20% of the drug injectors in 11 cities reported sharing needles indicates that a substantial proportion of the arrestees engage in behaviors that put them at increased risk for transmission of human immunodeficiency virus (HIV) and other bloodborne infections (6).

Previous studies have identified the criminal justice system as a good setting for promoting HIV/acquired immunodeficiency syndrome (AIDS) prevention programs among intravenous-drug users (7). In the 1989 DUF study, 47%-95% of needle-sharing arrestees reported changing their injection practices because of concern about AIDS (8). Therefore, provision of counseling and education for arrestees should help prevent the transmission of HIV and other sexually transmitted diseases in this high-risk population.

References

1. US Department of Justice. Probation and parole 1987. Washington, DC: US Department of Justice, Bureau of Justice Statistics, 1988.

2. Federal Bureau of Investigation. Uniform crime reports for the United States. Washington, DC: US Department of Justice, Federal Bureau of Investigation, 1988.

3. Council on Scientific Affairs. Scientific issues in drug testing. JAMA 1987;257:3110-4.

4. Wish ED. Drug use forecasting: New York 1984-1986--research in action report. Washington, DC: National Institute of Justice, 1987.

5. Wish ED, O'Neil J. Cocaine use in arrestees: refining measures of national trends by sampling the criminal population--trends in cocaine use. Rockville, Maryland: Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Drug Abuse (in press). (NIDA research monograph).

6. CDC. Update: acquired immunodeficiency syndrome associated with intravenous-drug use-- United States, 1988. MMWR 1989;38:165-70.

7. CDC. Coordinated community programs for HIV prevention among intravenous-drug users --California, Massachusetts. MMWR 1989;38:369-74.

8. Wish ED, O'Neil J, Baldau V. Lost opportunity to combat AIDS: drug abusers in the criminal justice system--AIDS and IV drug users. Rockville, Maryland: Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Drug Abuse (in press). (NIDA research monograph). *The DUF system is presently operating in 22 cities. For further information on DUF contact Dr. Eric Wish, National Institute of Justice, 633 Indiana Avenue, N.W., Washington, DC 20531; telephone (202) 272-6127. **Use of trade names is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services.

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