Drug use self-reports were compared with urinalysis for 248 clients in four methadone treatment programs. The validity of self-reporting based on urinalysis as a criterion depended on the type of drug examined. Opiate reporting was least valid, while benzodiazepine and cocaine reporting were moderately and highly valid, respectively. EMIT urinalysis was far more useful as a criterion of validity than TLC urinalysis. Self-reports helped identify drug users who were missed by urinalysis because of the latter's limited detection period, but urinalysis in turn detected an equal number of drug users missed by the interviews. The age of clients and the type of interviewer directly affected the rate of underreporting. Some respondents systematically denied disvalued behaviors (i.e., drug use and criminality), leading to a spurious correlation between these behaviors. This has important implications for future research.

Using data gathered on 368 current methadone clients and 142 narcotics users not in treatment in structured interviews and through ethnographic fieldwork, the study examines the image of methadone maintenance treatment in the drug-using community and discusses the effect of that image on recruitment of addicts into methadone treatment. The results indicate that the image of the methadone client as a "loser," fear of the long-term effects of methadone, and the perception of treatment as an intrusion in the user's daily life make addicts often difficult to recruit and, once in treatment, ambivalent about their participation. The image of methadone is based on both misinformation about treatment and the user's contrasting of a treatment status with the stereotypic ideal of the "righteous dope fiend." Policy implications and suggestions derived from the data are discussed.

This paper examines the nature and extent of methadone diversion, drawing on interviews and ethnographic data collection with methadone maintenance clients and current narcotics users not in treatment. We explore the social as well as the economic role of diversion in the drug world and find that it is a more complex phenomenon than the simple monetary transaction it is often portrayed to be. Our data indicate that selling or sharing of methadone by methadone clients, though still uncommon, is the primary source of street methadone. We find that removal of take-home dosages from the client population would have deleterious effects on retaining in treatment many otherwise compliant clients and would have minimal effect on diversion. A flexible and differentiated approach might help to reduce diversion while a singular, punitive administrative approach is unlikely to do more than simply contain the situation on the surface and drive it underground.

Social researchers and epidemiologists, as well as their major institutions and the general public, have been slow to address the racial and ethnic aspects of the AIDS epidemic. Whether measured by categories associated with major routes of infection, age level, gender, or by diminished length of survival, blacks and Hispanics are disproportionately affected by AIDS. Education, care, and outreach efforts based upon stereotypes of gay white males will have to yield to greater attention to cultural differences--and potential strengths--within each of the special "communities at risk." Evidence indicates areas of social resistance along with unique possibilities for change.

This paper examines sniffing as a mode of administration among three subgroups who sniff heroin: those who had never injected. those who were also injecting. and those who had ceased injection. Modified life-history interviews were conducted in 1994 with 26 people currently sniffing but not injecting, recruited in street-based settings in conjunction with an ongoing study of risk behavior and seroprevalence among drug injectors. These were supplemented by survey interviews and brief open-ended interviews with 23 people who combined heroin injecting with heroin sniffing, recruited from a parallel component of the ongoing study, based at a hospital detoxification ward. Not merely a brief precursor to heroin injecting, heroin sniffing can continue for long periods, and persist during and after periods of injection. Each subgroup uses heroin sniffing to regulate different perceived risks: heroin tolerance and financial expenditure (among those who have never injected). situational risks (among current injectors), and personal crises (among former injectors). These findings suggest the importance of personal factors over syringe availability or fear of HIV in use of modes of heroin administration.