Remote Urine Toxicology Screening for Individuals with Co-Occurring Early Psychosis and Substance Use
Emma Whitmarsh (1), Patrick Kelly (1), Julie M. McCarthy (1,2)
1. Division of Psychotic Disorders, McLean Hospital, Belmont, MA
2. Department of Psychiatry, Harvard Medical School, Boston, MA
Background: Telehealth is a valuable tool in treating substance use and psychiatric disorders. Telehealth benefits include convenient scheduling and eliminating transportation costs. An important extension of telehealth is implementation remote urine toxicology screening to biologically verify substance use, which has high completion, low falsification, and high satisfaction among clients with substance use disorders. However, the feasibility and utility of remote urine screening has not been studied in individuals with co-occurring psychosis and substance use.
Methods: Twenty-five participants with early psychosis (first episode psychosis <6 years) and alcohol, cannabis, or nicotine use within the last 90 days were recruited from an ongoing clinical trial. Participants completed the Timeline Followback of past 30-day substance use at baseline, ~4 weeks, and ~8 weeks. Participants were mailed a urine drug test to complete remotely at each timepoint and virtually shared the results with research staff. Descriptive statistics evaluated completion rates and Cohen’s Kappa statistics assessed the concordance between self-reports and urine toxicology results.
Results: Completion rates for remote urine toxicology screenings were 73.9% at baseline (n=17/23), 84.2% at ~4 weeks (n=16/19), and 83.3% at ~8 weeks (n=15/18), excluding in-person tests for two participants. Concordance between self-reports and urine toxicology screenings for cannabis, the most commonly reported substance, ranged from Cohen’s Kappa 0.60 to 0.87 across timepoints.
Conclusion: The high completion rates of the remote urine toxicology screenings support the acceptability and feasibility of using this technology to remotely screen for substance use in persons with early psychosis. The concordance between self-reports and urine toxicology screenings suggests relatively truthful self-reporting of substance use, but sufficient baseline discordance to warrant the use of an independent measure of the behavior. Remote toxicology screenings offer significant potential to reduce burden in clinical and research settings while maintaining strong completion rates for individuals with co-occurring psychosis and substance use.