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John Rich, MD
Boston City Hospital

JudyAnn Bigby, MD
Brigham and Women's Hospital Boston, Mass

JAMA. 1992;268(17):2375.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—We are disturbed about several aspects of the study of cocaine use and self-report recently published in JAMA.¹

We disagree with the authors' statement that the study situation replicates a patient-physician interaction. The interaction lacked personal physician-patient contact and an explanation about why the questions on drug use were relevant to the study on STDs and the presenting complaints. Patients had no reason to believe that the question about cocaine use was relevant to their clinical problem or to the STD study in which they consented to participate by submitting a urine sample. Since cocaine use is illegal, the study population could not be sure how an admission of cocaine use might affect their clinical care.

The authors conclude that self-report of cocaine use is unreliable. However, the interaction specifically does not replicate the appropriate way to obtain a substance abuse history since questions about quantity . . . [Full Text PDF of this Article]

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