title: High prevalence of recent cocaine use and the unreliability of patient self-report in an inner-city walk-in clinic.
abstract: OBJECTIVE
  To determine the prevalence of recent cocaine use and the reliability of patient self-reported cocaine use.
  
  
  METHODS
  A survey with blinded comparison to a criterion standard.
  
  
  METHODS
  Walk-in clinic of a large public hospital in metropolitan Atlanta, Ga.
  
  
  METHODS
  Male patients, aged 18 to 39 years, presenting to the triage desk for immediate care during weekdays. Of the 415 eligible men who agreed to participate (acceptance rate, 82%), the average age was 29.5 years, 91.6% were black, and 89% were uninsured.
  
  
  METHODS
  None.
  
  
  METHODS
  Comparison of self-reported illicit drug use with results from urinary immunoassays for benzoylecgonine, a major cocaine metabolite. Determination of which drug history questions produce the most accurate responses using anonymous urine testing as the criterion standard.
  
  
  RESULTS
  Thirty-nine percent of patients tested positive for the presence of benzoylecgonine and were statistically more likely to be older, black, and have a prior history of sexually transmitted disease (P less than .01). Seventy-two percent of men with positive urinary assays denied illicit drug use in the 3 days prior to sampling. When queried with several formats, subjects with positive urine assays were more likely to admit to "any illegal drug" use (87.5%) than to the more specific "any form of cocaine" use (60.6%) within the prior year (P less than .0001).
  
  
  CONCLUSIONS
  These results underscore the magnitude of cocaine abuse among black, inner-city men. Patient self-report of illicit drug use is highly inaccurate. Accuracy of self-report may be increased by asking less specific questions.
authors.affiliation: Division of General Internal Medicine, Emory University School of Medicine, Atlanta, GA 30303.
authors.forename: S E
authors.initials: SE
authors.lastname: McNagny
authors.forename: R M
authors.initials: RM
authors.lastname: Parker
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D003042:Cocaine / Q000652:urine; D006801:Humans; D008297:Male; D015995:Prevalence; D012650:Self Disclosure; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000208:ethnology; D014504:Urban Health
chemical_list: D003042:Cocaine