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Inner-city men who use cocaine may not report their drug use accurately to health care workers. Of 415 men between 18 and 39 years old who were patients at an inner-city emergency clinic, 160 (39%) had a positive urine test for cocaine use. Among these men who tested positive for cocaine use, 87.5% admitted non-specific illegal drug use within the last year, but only 60.6% admitted cocaine use during that time. Thirty-five men (21.9%) with positive urine tests admitted cocaine use within the prior 48 hours, and 45 of these men (28%) reported cocaine use in the prior 72 hours. Men who had positive urine tests were more likely to be older and black with history of a prior sexually transmitted disease than were those who tested negative. The abuse of cocaine among inner-city men may be much higher than reported., Objective.--To determine the prevalence of recent cocaine use and the reliability of patient self-reported cocaine use. Design.--A survey with blinded comparison to a criterion standard. Setting.--Walk-in clinic of a large public hospital in metropolitan Atlanta, Ga. Participants.--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. Intervention.--None. Main Outcome Measures.--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

To ascertain the prevalence of self-medication with antimicrobial agents among patients attending a clinic for treatment of sexually transmitted diseases (STDs), we administered a questionnaire to and collected a urine specimen for antimicrobial testing from 551 patients before treatment. We defined self-medication as an antimicrobial agent taken on the patient's own initiative by self-report during the week before the visit to the clinic or a positive urine assay for antimicrobial agents at the time of the clinic visit. We tested urine for the presence of antimicrobial agents by a disk diffusion method using Sarcina lutea as the test organism. A total of 75 (14%) of the 551 participants were self-medicators: 19 reported antimicrobial use and had a positive urine test, 27 reported antimicrobial use but had a negative urine test, and 29 denied antimicrobial use but had a positive urine test. Thus, 29 (60%) of the 48 patients with antimicrobial agents detected in their urine at the time of the clinic visit denied self-medication. Self-medicators acquired their antibiotics either from their medicine cabinet (44%) or from a family member or friend (56%). Self-medication was associated with self-report of prior use of unprescribed antimicrobial agents (P < .0001). We concluded that use of unprescribed antimicrobial agents (usually β-lactam agents or tetracyclines) among STD clinic attendees in our study was common and that self-reporting was not a reliable method of screening for self-medicators. [ABSTRACT FROM PUBLISHER]