CDE Detailed Report

Disease: Huntington's Disease
Sub-Domain: Epidemiology/Environmental History
CRF: Non-prescribed Drug Use Questionnaire

Displaying 1 - 16 of 16
CDE ID CDE Name Variable Name Definition Short Description Question Text Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C17691 Non-prescribed controlled psychoactive drug substance other text NprscrCntrPschacDrgSubOthTxt The text specifying the drugs within the 'Others: (non-perscribed, non-over-the-counter)' categoryas an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. The text specifying the drugs within the 'Others: (non-prescribed, non-over-the-counter)' category as an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. List Alphanumeric

For each class of drug, list specific drug(s) used. Non-perscribed and non-over-the-counter.

No references available Adult Supplemental 3.00 2013-08-30 17:06:52.8 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History 255

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C08234 Drug or substance last illicit use date and time DrgSubLastIllicitUseDateTime Date (and time if applicable and known) of the participant's/subject's last use of an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. Date (and time if applicable and known) of the participant's/subject's last use of an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. Last Used Date or Date & Time

Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.).

No references available Adult Supplemental 3.00 2013-07-22 09:34:41.527 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History

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C18670 Subscribed drug or substance illicitly used other text SbscrbdDrgSubIllctUseOTH The free-text field related to 'Drug or substance illicitly used category' specifying other text. Category of illegal drugs, prescription, or over-the-counter drugs the participant/subject used for purposes other than those for which they are meant to be used, or in large amounts Drug or substance illicitly used category' specifying other text. Category of illegal drugs, prescription, or over-the-counter drugs the participant/subject used for purposes other than those for which they are meant to be used, or in large amounts Other, specify Alphanumeric

For each drug class, list specific drug(s) used. Include drugs used at any time in life, but do not include drugs prescribed by doctor.

No references available Adult;Pediatric Supplemental 1.00 2014-05-27 13:34:46.0 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History 4000

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3171797
C08235 Drug or substance illicit use frequency DrgSubIllicitUseFreq The subject's/participant's average or typical use frequency during the year of greatest use of an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. The subject's/participant's average or typical use frequency during the year of greatest use of an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. Frequency of Use Alphanumeric

If a class of drug was never used (except if prescribed), then leave years and frequency of use blank and go to the next line in the table Average or typical frequency during the year of greatest use. List number of uses per day (_/d), week (_/w), month (_/m), or year (_/y), as applicable.

No references available Adult Supplemental 3.00 2013-07-22 09:34:41.527 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History 255

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C17683 Non-prescribed controlled psychoactive drug substance marijuana text NprscrbContrPschacDrgSbMrjTxt The text specifying the drugs within the Marijuana: hash, THC category as an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. The text specifying the drugs within the Marijuana: hash, THC category as an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. List Alphanumeric

For each class of drug, list specific drug(s) used

No references available Adult Supplemental 3.00 2013-08-30 17:06:52.8 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History 255

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C17684 Non-prescribed controlled psychoactive drug substance stimulant cocaine text NprscrCntrPschacDrgSbStmCocTxt The text specifying the drugs within the Stimulants: cocaine/crack category as an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. The text specifying the drugs within the Stimulants: cocaine/crack category as an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. List Alphanumeric

For each class of drug, list specific drug(s) used

No references available Adult Supplemental 3.00 2013-08-30 17:06:52.8 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History 255

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C17685 Non-prescribed controlled psychoactive drug substance stimulant amphetamine text NprscrCntrPschacDrgSbStmAmpTxt The text specifying the drugs within the 'Stimulants: ampletamine, Benzedrine, Methedrine, Dexadrine, Preludin, Ritalin, uppers, speed,' category as an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. The text specifying the drugs within the 'Stimulants: amphetamine, Benzedrine, Methedrine, Dexadrine, Preludin, Ritalin, uppers, speed,' category as an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. List Alphanumeric

For each class of drug, list specific drug(s) used

No references available Adult Supplemental 3.00 2013-08-30 17:06:52.8 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History 255

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C17686 Non-prescribed controlled psychoactive drug substance sedative tranquilizer text NprscrCntrPschacDrgSbSedTrnTxt The text specifying the drugs within the 'Sedatives/minor tranquilizers/muscle relaxants-benzodiazepines and others: Valium/diazepam, Librium, Halcion, Xanax, Dalmane, Flexeril,' category as an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. The text specifying the drugs within the 'Sedatives/minor tranquilizers/muscle relaxants-benzodiazepines and others: Valium/diazepam, Librium, Halcion, Xanax, Dalmane, Flexeril,' category as an unprescribed, controlled psychoactive drugs or substances us List Alphanumeric

For each class of drug, list specific drug(s) used

No references available Adult Supplemental 3.00 2013-08-30 17:06:52.8 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History 255

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C17687 Non-prescribed controlled psychoactive drug substance sedative barbiturate text NprscrCntrPschacDrgSbSedBrbTxt The text specifying the drugs within the 'Sedatives-barbiturates and others: phenobarbital, Seconol, Nembutol, Dorieden, Quaalude, Amytal, Fiorinal, downers,' category as an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. Text specifying the drugs within the 'Sedatives-barbiturates and others: phenobarbital, Seconol, Nembutol, Dorieden, Quaalude, Amytal, Fiorinal, downers,' category as an unprescribed, controlled psychoactive drugs or substances used by the participant List Alphanumeric

For each class of drug, list specific drug(s) used

No references available Adult Supplemental 3.00 2013-08-30 17:06:52.8 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History 255

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C00712 Subscribed drug or substance illicitly used category SbscrbdDrgSubIllctUseCat Category of illegal drugs, prescription, or over-the-counter drugs subscribed by the participant/subject, and used for purposes other than those for which they are meant to be used, or in large amounts Category of illegal drugs, prescription, or over-the-counter drugs subscribed by the participant/subject, and used for purposes other than those for which they are meant to be used, or in large amounts If YES, specify illicit drug type(s) used Sedatives (e.g., sleeping pills, barbiturates, Seconal, Quaaludes, or Chloral Hydrate);Marijuana, hash, THC, or grass;Hallucinogens (e.g., Ecstasy, LSD, mescaline, psilocybin, PCP, angel dust, or peyote);Inhalants or Solvents (e.g., amyl nitrate, nitrous oxide, glue, toluene, or gasoline;Other, specify (e.g., Methadone, Elavil, steroids, Thorazine, or Haldol);Stimulants: cocaine/crack;Stimulants: amphetamine, Benzedrine, Methedrine, Dexadrine, Preludin, Ritalin, uppers, speed;Narcotics: heroin, opium, morphine, methadone, codeine, Darvon, Percodan, Oxycontin, Dilaudid, Demerol/meperidine;Tranquilizers or anti-anxiety drugs (e.g., Valium, Librium, muscle relaxants, or Xanax) Sedatives (e.g., sleeping pills, barbiturates, Seconal, Quaaludes, or Chloral Hydrate);Marijuana, hash, THC, or grass;Hallucinogens (e.g., Ecstasy, LSD, mescaline, psilocybin, PCP, angel dust, or peyote);Inhalants or Solvents (e.g., amyl nitrate, nitrous oxide, glue, toluene, or gasoline;Other, specify (e.g., Methadone, Elavil, steroids, Thorazine, or Haldol);Stimulants: cocaine/crack;Stimulants: amphetamine, Benzedrine, Methedrine, Dexadrine, Preludin, Ritalin, uppers, speed;Narcotics: heroin, opium, morphine, methadone, codeine, Darvon, Percodan, Oxycontin, Dilaudid, Demerol/meperidine;Tranquilizers or anti-anxiety drugs (e.g., Valium, Librium, muscle relaxants, or Xanax) Alphanumeric

For each drug class, list specific drug(s) used. Include drugs used at any time in life, but do not include drugs prescribed by doctor.

No references available Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History

Multiple Pre-Defined Values Selected

3171797
C17688 Non-prescribed controlled psychoactive drug substance narcotic text NprscrCntrPschacDrgSbNarcTxt The text specifying the drugs within the 'Narcotics: heroin, opium, morphine, methadone, codeine, Darvon, Percodan, Oxycontin, Dilaudid, Demerol/meperidine,' category as an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. The text specifying the drugs within the 'Narcotics: heroin, opium, morphine, methadone, codeine, Darvon, Percodan, Oxycontin, Dilaudid, Demerol/meperidine,' category as an unprescribed, controlled psychoactive drugs or substances used by the participant List Alphanumeric

For each class of drug, list specific drug(s) used

No references available Adult Supplemental 3.00 2013-08-30 17:06:52.8 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History 255

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C00716 Drug or substance illicit use duration DrgSubsIllctUseDur Duration, in years, the participant/subject has used unprescribed, controlled psychoactive drugs or substances. Duration, in years, the participant/subject has used unprescribed, controlled psychoactive drugs or substances. Total Years Used Numeric Values

If a class of drug was never used (except if prescribed), then leave years and frequency of use blank and go to the next line in the table Count all years in which some use occurred.

No references available Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

0 99 Year 2004152
C17689 Non-prescribed controlled psychoactive drug substance inhalant text NprscrCntrPschacDrgSbInhlntTxt The text specifying the drugs within the 'Inhalants: glue, toluene, gasoline, aerosols, paint thinner, nitrous oxide, amyl nitrite,' category as an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. The text specifying the drugs within the 'Inhalants: glue, toluene, gasoline, aerosols, paint thinner, nitrous oxide, amyl nitrite,' category as an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. List Alphanumeric

For each class of drug, list specific drug(s) used

No references available Adult Supplemental 3.00 2013-08-30 17:06:52.8 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History 255

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C08232 Drug or substance illicit use ever indicator DrgSubIllicitEverUseInd Indicator of participant's/subject's use of illegal drugs, prescription or over-the-counter drugs at any point in his/her lifetime for purposes other than those for which they are meant to be used, or in large amounts Indicator of participant's/subject's use of an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. at any point in his/her lifetime Ever used Yes;No;Unknown Yes;No;Unknown Alphanumeric

Do not include substances prescribed by doctor or available over-the-counter

No references available Adult Supplemental 3.00 2013-07-22 09:34:41.527 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C17690 Non-prescribed controlled psychoactive drug substance hallucinogen text NprscrCntrPschacDrgSbHalcnTxt The text specifying the drugs within the 'Hallucinogens: ecstasy/MDMA, LSD, mescaline/peyote, psilocybin/mushrooms, PCP/phencylidine/angel dust, MDA/STP/DOM,' category as an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. Text specifying the drugs within the 'Hallucinogens: ecstasy/MDMA, LSD, mescaline/peyote, psilocybin/mushrooms, PCP/phencylidine/angel dust, MDA/STP/DOM,' category as an unprescribed, controlled psychoactive drugs or substances used by the participant List Alphanumeric

For each class of drug, list specific drug(s) used

No references available Adult Supplemental 3.00 2013-08-30 17:06:52.8 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

C08233 Drug or substance first illicit use date and time DrgSubFirstIllicitUseDateTime Date (and time if applicable and known) the participant/subject first used the category of illegal drugs, prescription or over-the-counter drugs Date of the participant's/subject's first use of an unprescribed, controlled psychoactive drugs or substances used by the participant/subject. First Used Date or Date & Time

Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.).

No references available Adult Supplemental 3.00 2013-07-22 09:34:41.527 Non-prescribed Drug Use Questionnaire Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

CSV