Infectious Disease

Positive urine drug tests are not a reliable indicator of death from external causes in teenagers

January 28, 2022

2 minutes read

Source/Disclosures

Disclosure:
Markota reports that he received a training research grant from the National Institute on Drug Abuse and the American Academy of Child and Adolescent Psychiatry. The relevant financial information of all other authors can be found in the study.

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According to a population-based retrospective cohort study published in the Journal of Clinical Psychiatry, examining positive urine drug tests in teenagers was not a reliable predictor of risk of death from external causes.

“Current practices for estimating mortality risk in teenage drug users rely heavily on clinical intuition. There is an urgent need for evidence-based methods to stratify the risk of early mortality in adolescent drug abusers, including which specific substances are associated with the greatest risk.” Matej Markota, MD, from the Department of Psychiatry and Psychology at the Mayo Clinic in Rochester, Minnesota and colleagues wrote.

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Markota and colleagues sought to determine whether studies of positive urine-based drug tests in adolescents who needed medical care could be associated with a future risk of death from external causes such as overdose, suicide, homicide, or other accidents.

The study was drawn from a first cohort of 3,298 residents of Olmsted County, Minnesota, ages 12 to 18, when they underwent urine drug testing between January 1, 1999 and November 28, 2012. A total of 2,772 teenagers (47.2% male) aged 13 to 18 years were included in the final analysis. By the end of the follow-up interval, which was November 15, 2017, or the date of death, whichever came first, 26 participants had died from external causes.

Markota and colleagues assessed the relationships between a positive UDS result and external mortality adjusted for sex, race, age, alcohol exposure, ICD-9/ICD-10 psychiatric diagnoses, and drug screening setting. Analyzes were also performed to separate total UDS results, positive results for tetrahydrocannabinol (THC), and positive results for cocaine.

Results did not show a significantly increased overall risk of death from external causes among participants who tested positive for any of the illicit substances. Positive results for THC were associated with a statistically small, increased risk of death from external means (HR = 2.1; 95% CI, 1.0-4.7), but positive tests for cocaine carried a significantly increased risk of premature death (HR=7.0; 95% CI, 1.9-25.0) compared to those with negative UDS results.

“This population-based study of adolescents tested for drugs as part of their routine medical care found no statistically significant association between positive substance tests and external mortality,” wrote Markota and colleagues. “However, cohort members who tested positive for cocaine had a significantly increased risk of premature death.”

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