It is similar in effect to barbiturates, a general CNS depressant. It was used in the 1960s and 1970s as an antianxiolytic, for the treatment of insomnia, and as a sedative.

Usual effects include relaxation, euphoria, and drowsiness, also reducing heart rate and respiration. Larger doses can bring about depression, muscular miscoordination, and slurred speech.

An overdose can cause delirium, convulsions, hypertonia, hyperreflexia, vomiting, renal insufficiency, coma, and death through cardiac or respiratory arrest. It resembles barbiturate poisoning but with increased motor difficulties and a lower incidence of cardiac or respiratory depression. Toxicity is treated with diazepam and sometimes an anticonvulsant.

Methaqualone was discovered by the Indian researcher M. L. Gujiral in 1955 during an anti-malaria research program. It was marketed as a sleeping pill during the 1960s under a number of tradenames including Renoval and Melsed and in combination with an antihistamine as Mandrax. From 1965 it was sold on the US market as Quaalude, Sopor and Parest, by 1972 it was the sixth most popular sedative in the US. The name Quaalude was apparently derived from the phrase 'quiet interlude' with an added 'aa' by the manufacturers in order to elicit a more positive public recognition, as was done with the drug Maalox. It was hoped that it was a 'safer' drug than barbiturates to use for sedation; however, it was found to have similar problems of tolerance and dependence.

Quaaludes became increasingly popular as a recreational drug during the 1960s. The drug was more tightly regulated in Britain under the Misuse of Drugs Act 1971 and in the US from 1973. With its addictive nature clear, it was withdrawn from many developed markets in the 1980s, being made a Schedule I drug in the US in 1984. Up until the fall of Nicolae Ceausescu's Communist regime in the early 1990s, methaqualone (along with other sedatives) was used to pacify orphans in Romania's state-run orphanage system. Internationally, Methaqualone is a Schedule II drug under the Convention on Psychotropic Substances.

Smoking marijuana laced with methaqualone has become a major problem in South Africa, rivalling crack cocaine as the most abused hard drug. Its low price (R30.00 average against R150.00 for crack) means it is the prefered hard drug of the large low-income section of society. When smoked, usually mixed with marijuana, it causes an intensely euphoric rush.

Although methaqualone cannot be legally manufactured in the U.S. outside of research due to its Schedule I status, it is produced in other parts of the world as a legitimate pharmaceutical. It is available by prescription in Canada.

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Reassessing the need for urinalysis as a validation technique
From Journal of Drug Issues, 4/1/00 by Yacoubian, George S Jr

Urinalysis is utilized routinely as a tool to validate self reported drug use. Past research has been inconclusive, however, in confirming strong correlations between urinalysis and self reported drug use. In the current study, correlation estimates for cocaine and heroin use are derived from adult arrestees surveyed through the Arrestee Drug Abuse Monitoring (ADAM) Program between 1990 and 1997. While the strength of agreement between urinalysis and self report data varies by both substance and jurisdiction, correlation estimates are consistent over time. These findings suggest that the need for urinalysis should be reassessed.

THEORETICAL FRAMEWORK

Surveys involving personally invasive topics, such as drug use and sexuality, are often criticized on the premise that respondents underreport the extent and nature of their involvement in these activities. Underreporting becomes even more prevalent for respondents under criminal justice supervision (e.g., arrestees). Despite guarantees of confidentiality, offenders are often reluctant to divulge deviant practices for fear of aggravating their present circumstances.

Without an objective tool, validating offender responses to sensitive topics is an arduous assignment. As Rosenfeld and Decker (1993) state, "the validity of self reports is often difficult to establish...because researchers seldom have the opportunity to compare offenders' accounts of illegal behavior against an independent yardstick that is not subject to the same sources of error as those affecting self reports." For the purposes of validating self reported drug use, urinalysis does indeed provide such a yardstick. Despite the existence of such an objective measure, however, recent analyses have been inconclusive in confirming strong correlations between urinalysis and self reported drug use data (Wish et al. 1997; Harrison 1995; Rosenfeld and Decker 1993; Mieczkowski et al. 1991 ).

Mieczkowski et al. ( 1991 ), for example, compared self reports of cocaine use with urinalysis and hair samples from a sample of booked arrestees in Florida. They discovered that individuals were less likely to accurately report previous use in the past 48 hours and more likely to report previous use over longer periods of time (30 and 60 days). Self report was most reliable for marijuana, less reliable for opiates, and most unreliable for cocaine (Mieczkowski et al. 1991 ). Of those with a positive urinalysis, 76 percent failed to self report cocaine use in the previous 48 hours (Mieczkowski et al. 1991). These findings clearly illustrate strong underreporting of serious drugs of abuse.

Rosenfeld and Decker (1993) utilized cross-sectional and longitudinal data from the Drug Use Forecasting (DUF) Program to examine cocaine use among arrestees. The cross-sectional analysis was based on 1989 data from 13 DUF cities. While the cross-city comparisons indicate significant underreporting of cocaine use, the reporting rate was stable interjurisdictionally (Rosenfeld and Decker 1993). That is, "the ratio between the percent of arrestees who reported that they used cocaine during the previous 48-72 hours and the percent with a positive urine test for cocaine was fairly stable across cities" (Rosenfeld and Decker 1993). The longitudinal data, collected between 1989 and 1991, yielded similar results. As Rosenfeld and Decker (1993) state, "In spite of large discrepancies between the alternative indicators of drug use observed in each quarter, the urinalysis and self report data were highly correlated over time (r = .92)." Rosenfeld and Decker ( 1993) argued, therefore, that the relationship between self report and urinalysis is close enough to allow the estimation of one measurement based on the actual value of the other.

Wish et al. (1997) compared self reports of cocaine and opiate use with urine specimens and hair samples from 487 clients appearing at a diagnostic treatment unit in Washington, DC. Self report questions involved lifetime use, frequency of use, and recent use (within the previous 30 days) of cocaine and opiates. The findings were mixed. The urine specimen and hair sample results for opiates were 91 percent and 83 percent respectively, with 91 percent self reporting opiate use within the previous 30 days (Wish et al. 1997). For cocaine, however, the urine specimen and hair sample results were 69 percent and 93 percent respectively, with 71 percent self reporting cocaine use with the previous 30 days (Wish et al. 1997).

The aforementioned studies illustrate that correlations between urinalysis and self reported drug use are not consistently weak, moderate, or strong. This discrepancy is likely due to a number of factors including, for example, the population being studied, interviewing conditions, and the types of drugs under investigation. For the purpose of assessing the need for urinalysis as a validation technique, however, the issue of strong versus weak correlations would seem to be an inappropriate inquiry. Rather, the need for urinalysis should instead be based on the consistency of correlations over time. If correlations are, irrespective of their strength, consistent over time, then the collection of urine specimens may be unnecessary. As such, the current study explores whether consistent correlations over time between two measures of drug use - self report and urinalysis - may reduce the necessity for urinalysis as a validation technique. With this preliminary framework, the methodology of the Arrestee Drug Abuse Monitoring (ADAM) Program is described below.

METHODS

The National Institute of Justice (NIJ) established the ADAM Program formerly the Drug Use Forecasting (DUF) Program - in 1987 (NIJ 1997; Wish 1995). The six primary goals of ADAM are: identifying the levels of drug use among arrestees; tracking changing drug-use patterns; determining what drugs are being used in specific jurisdictions; alerting local officials to trends in drug use and the availability of new drugs; providing data to help understand the drugcrime connection; and serving as a research platform upon which a wide variety of drug-related-initiatives can be based (Decker et al. 1997; Wish 1995; NIJ 1996, 1993, 1992).

During the time frame under scrutiny, the type of data collected by ADAM was relatively limited. Arrestees were first asked several demographic questions, including education level, marital and employment status, and income level. Participants were then asked to report whether they had ever used a number of specific drugs. For those drugs the arrestees reported having ever tried, they were asked to indicate their age of first use, whether they had used the drug within the past twelve months, the number of times used within the past thirty days, and whether they had used the drug within the past three days. Participants who admitted to drug use were also asked whether or not they considered themselves drug-dependent, and whether they were under the influence or in need of drugs at the time of arrest (Yacoubian and Kane 1998). Several questions also focused on treatment - whether the person had ever received treatment, was currently in a treatment program, or perceived a need for treatment (Yacoubian and Kane 1998).

In addition to the survey, a urine sample is obtained to measure recent drug use and to validate self report data. The Enzyme Multiplied Immunoassay Test (EMIT) screens for ten drugs: opiates, marijuana, metabolite (crack and powder) cocaine, phencyclidine (PCP), methadone, benzodiazepines (e.g., Valium and Xanax), methaqualone (Quaaludes), propoxyphene (Darvon), barbiturates (e.g., Phenobarbital) and amphetamine (NIJ 1999a, 1998). All positive results for amphetamine are also analyzed by gas chromatography to eliminate any over-thecounter (OTC) look-alike medications.

For no more than 14 consecutive days in a single facility every calendar quarter, research personnel in local jurisdictions obtain voluntary and confidential interviews and urine specimens from a sample of arrestees who have been in custody for no more than 48 hours (NIJ 1999a, 1998, 1997). Between 1990 and 1997, several methodological requirements influenced the ADAM protocol. First, all sites operated according to a charge priority system, where non-drug felons, drug felons, non-drug misdemeanants, and drug misdemeanants were prioritized hierarchically (NIJ 1997; Wish 1995). That is, the program emphasized non-drug serious offenders. Second, the number of drug offenders surveyed during a data collection period could not exceed 20% ofthe total sample (NIJ 1999b; GAO 1993). This prevented the oversampling of drug offenders, who, presumably, would report more frequent drug use than their non-drugoffending counterparts. Third, all arrestees were eligible to be interviewed except for those whose primary charges involved vagrancy, loitering, or traffic offenses (NIJ 1999b, 1997). These arrestees were excluded from the sample a priori.

In the current study, the twenty-three ADAM sites for which longitudinal data are available are examined between 1990 and 1997. Two preliminary methodological issues should be noted. First, the time frame for the current analysis is eight years. Given the short time frame, the likelihood that the derived correlations could be utilized for a predictive model is minimal. The number of data points in the current analysis - eight - cannot support prediction. Second, it must be reiterated that all interviewed arrestees were selected according to the established crime-charge priority system. There was, therefore, no process of random selection. Given this methodological limitation, the external validity of the present findings is clearly an issue. Without further research, an assumption that the current findings by themselves are generalizable to other ADAM and/or nondeviant populations would be a precarious one. With these two methodological cautions, data analyses and findings are presented below.

DATA ANALYSIS AND FINDINGS

In the present study, the Spearman method of statistical correlation was estimated on all drugs identified by the data collection instrument. Spearman correlation is a non-parametric version of the Pearson correlation and is used typically when the data do not meet the assumption of normality (Babbie 1995). That is, the Spearman correlation is based on the ranks of the data rather than on their actual values. The absolute value of the correlation coefficient represents the strength of the association between the two variables.

For a panel of drugs that respondents report having ever tried, they are asked to indicate whether they have used the drug within the past twelve months and within the past three days. For the purposes of the present analysis, the three-day self report indicators were correlated with urinalysis counterparts for both cocaine and heroin. Table 1 illustrates the bivariate relationships between the self report and urinalysis cocaine measures for the twenty-three ADAM sites between 1990 and 1997.

While the results displayed in Table 1 suggest low to moderate levels of agreement for cocaine across the twenty-three jurisdictions, the correlations are nevertheless stable over time. The weakest agreement (.104) occurred in Detroit in 1993, while the strongest (.589) occurred in San Jose in 1997. More importantly, however, is the range of agreement, which fluctuates from a low of .079 in Detroit to a high of only .209 in Chicago. These findings indicate consistent rates of agreement over time between urinalysis and self report for cocaine among those ADAM jurisdictions included in the current study.

Table 2 illustrates the bivariate relationships between the self report and urinalysis heroin measures across the 23 ADAM sites between 1990 and 1997.

While the results displayed in Table 2 suggest moderate levels of agreement for heroin across the 23 jurisdictions, the correlations are again stable over time. The weakest agreement (.188) occurred in Fort Lauderdale in 1993, while the strongest (.838) occurred in San Diego in 1995. Again, however, the range of agreement, which fluctuates from a low of .101 in Philadelphia to a high of .252 in Atlanta, reveals consistent rates of agreement over time between urinalysis and self report for heroin among those ADAM jurisdictions included in the current study.

An examination of several specific sites illustrates the stable correlations more explicitly. Figure 1, for example, demonstrates cocaine correlation estimates for Detroit and Chicago, the sites with the most narrow and widest range of urinalysis and self report agreement. As shown, Detroit's data indicate a range of .079, with a low of .104 in 1993 and a high of .183 in 1992. In contrast, Chicago's data indicate a range of .209, with a low of .142 in 1993 and a high of .351 in 1990. Similarly, Figure 2 illustrates correlation estimates for Philadelphia and Atlanta, the two sites with the most narrow and widest range of urinalysis and self report agreement for heroin. As shown, the range in Philadelphia is only .101, with a low of .626 in 1997 and a high of .727 in 1992. In contrast, Atlanta's data indicate a range of .252, with a low of .416 in 1991 and a high of .668 in 1992. These data suggest that even among those sites with relatively wide correlation ranges between 1990 and 1997, the estimates remain stable temporally.

DISCUSSION

In the current study, correlation estimates for cocaine and heroin are derived from adult arrestees surveyed through the Arrestee Drug Abuse Monitoring (ADAM) Program between 1990 and 1997. The analyses illustrate that the correlations between self reported cocaine and heroin use and their urinalysis counterparts are consistent over this eight-year period. Given this lack of fluctuation, the need for urinalysis as a validation technique may be unnecessary.

Urinalysis is not an inexpensive validation technique. While the costs of urinalysis vary by virtue of several factors, including types of drugs screened, specific tests employed, and volume of specimens processed, costs typically range between $8 and $25 per specimen. For the 23 sites in the current study, a total of 250,820 urine specimens were analyzed between 1990 and 1997. Based on an approximate cost of $10 per specimen, total expenditures for urinalysis testing during this time frame were $2,508,200. This computes to an average of approximately 1,212 urine specimens processed annually. Multiplied by 35 (the current number of ADAM sites), program expenses for urinalysis exceed $420,000 annually. Furthermore, these costs would increase to over $900,000 annually if the ADAM Program was to expand to 75 sites, as is intended (NIJ 2000). Given the consistent correlations illustrated by the current study, such expenditures would seem to be unnecessarily excessive.

Several methodological cautions should be reiterated. First, the ADAM protocol for the time frame under scrutiny required no process of random selection for inclusion in the study. As previously articulated, arrestees were selected according to the established crime-charge priority system. Given this methodological limitation, the external validity of the study is clearly an issue. Without further research, an assumption that the current findings by themselves are generalizable to other ADAM and/or non-deviant populations would be a precarious one. It is recommended, therefore, that similar analyses be conducted with additional populations to confirm the consistent correlations delineated in the current study.

Second, the current study was limited in that only cocaine and heroin were examined. The rationale for exploring these substances alone is that they are generally considered to be the two most serious drugs of abuse (Inciardi and McElrath 1998; Walker 1998). It was hypothesized, therefore, that if self report/urinalysis correlations were inconsistent over time, the inconsistencies would be more aggravated with the two substances that arrestees would be least likely to self report. Clearly, however, without further research, a presumption that temporal consistencies exist for other drugs, such as marijuana, barbiturates, and methamphetamine, would be an unsubstantiated one. It is recommended, therefore, that the current study be replicated with less serious drugs of abuse to assess generalizability.

Third, the short time frame within which the analyses were conducted is restrictive. Given the small number of data points, the likelihood that the derived correlations could be utilized for a predictive model is improbable. The findings, however, should not be ignored solely because of the temporal limitations. While the consistent correlations derived in the current study are less consequential because predictive models are inappropriate, they are nevertheless important. The findings can indeed be used as a springboard to conduct analyses with a data set comprised of a significantly larger number of data points.

While the current findings would seem to support the proposition that urinalysis may be unnecessary, their discontinuation would likely not be a practical solution. As Rosenfeld and Decker (1993) state, ". . . it is essential to retain urinalysis . . . to recalibrate the relationship between the indicators across populations." Clearly, however, urinalysis does not have to be undertaken for all respondents in a given time period. The ADAM protocol requires that arrestees be interviewed quarterly. If urinalysis was reduced to a smaller number of specimen collections each quarter, two goals would be accomplished. First, correlations could be tracked for the consistent patterns that have been identified in the current study. This would lend further support to the hypothesis that self report/urinalysis correlations are consistent over time. Second, costs would diminish. If urine specimens were collected for only a fraction of respondents, costs would decrease proportionally. The current findings, amalgamated with future research, will hopefully allow drug researchers to ascertain conclusively whether urinalysis is a cost-effective technique for validating responses to self report drug use.

NOTES

1 Albuquerque, Anchorage, Atlanta, Birmingham, Chicago, Cleveland, Dallas, Denver, Des Moines, Detroit, Fort Lauderdale, Houston, Indianapolis, Laredo, Las Vegas, Los Angeles, Manhattan, Miami, Minneapolis, New Orleans, Oklahoma City, Omaha, Philadelphia, Phoenix, Portland, Sacramento, Salt Lake City, San Antonio, San Diego, San Jose, Seattle, Spokane, St. Louis, Tucson, and Washington, DC.

REFERENCES

Babbie, E.

1995 The Practice of Social Research. California: Wadsworth Publishing Company.

Decker, S., S. Pennell, and A. Caldwell

1997 Illegal Firearms: Access and Use by Arrestees. National Institute of Justice Research in Brief. Washington, DC: United States Department of Justice.

Government Accounting Office

1993 Drug Use Measurement: Strengths, Limitations, and Recommendations for Improvement. Washington, DC: United States General Accounting Office.

Harrison, L.

1995 The validity of self-reported data on drug use. Journal of Drug Issues 25:91-111.

Inciardi, J.A., and K. McElrath

1998 The American Drug Scene. California: Roxbury Publishing Company. Mieczkowski, T., D. Barzelay, B. Gropper, and E. Wish

1991 Concordance of three measures of cocaine use in an arrestee population: Hair, urine, and self report. Journal of Psychoactive Drugs, 23: 241-246. National Institute of Justice

2000 Arrestee Drug Abuse Monitoring (ADAM) Home Page. Internet availability - www.adam-nij.net.

National Institute of Justice

1999a. 1998 Arrestee Drug Abuse Monitoring (ADAM) Annual Report. Washington, DC: United States Department of Justice.

National Institute of Justice

1999b 1998 Annual Report on Opiate Use among Arrestees. Washington, DC: United States Department of Justice.

National Institute of Justice

1998 1997 Arrestee Drug Abuse Monitoring (ADAM) Annual Report. Washington, DC: Department of Justice.

National Institute of Justice

1997 1996 Drug Use Forecasting (DUF) Annual Report. Washington, DC: United States Department of Justice.

National Institute of Justice

1996 1995 Drug Use Forecasting (DUF) Annual Report. Washington, DC: United States Department of Justice.

National Institute of Justice

1993 NIJ's Drug Use Forecasting Program. Washington, DC: United States Department of Justice.

National Institute of Justice

1992 1991 Drug Use Forecasting (DUF) Program Annual Report. Washington, DC: United States Department of Justice.

Rosenfeld, R., and S. Decker

1993 Discrepant values, correlated measures: Cross-cities and longitudinal comparisons of self reports and urine tests of cocaine use among arrestees. Journal of Criminal Justice 21:223-230.

Walker, S.

1998 Sense and Nonsense About Crime and Drugs. California. Wadsworth Publishing Company.

Wish, E.D., J.A.-Hoffman, and S. Nemes

1997 The validity of self reports of drug use at treatment admission and at follow-up: Comparisons with urinalysis and hair assays. In The Validity ofSelf Reported Drug Use. Improving the Accuracy of Survey Estimates, ed. L. Harrison and A. Hughes, 200-226, Rockville, MD: National Institute of Drug Abuse.

Wish, E.D.

1995 The Drug Use Forecasting (DUF) Program. In Encyclopedia of Drugs and Alcohol, ed. J.H. Jaffe, 432-434. New York, NY: Simon and Schuster MacMillan.

Yacoubian, G., and R. Kane

1998 Identifying a drug use typology of Philadelphia arrestees: A cluster analysis. Journal of Drug Issues 28(2): 559-574.

George S. Yacoubian Jr. is a research associate at the Center for Substance Abuse Research (CESAR) and a doctoral student in the Department of Criminology and Criminal Justice at the University of Maryland. Any inquiries can be made to George S. Yacoubian Jr., CESAR, 4321 Hartwick Road, Suite 501, College Park, Maryland 20740: (301) 403-8329; yacoubiang@cesar.umd.edu.

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