Research involving drug users and treatment evaluations continue to rely extensively on self-reports of drug use. This paper presents a meta-analytical review of 24 studies published since 1985 that examined the validity of drug self-reports in high risk populations. Only studies employing a biological criterion of validity (e.g., urinalysis, hair analysis) are included. Coefficients of chance-corrected agreement between self-reports and the validity criteria are calculated from published data to facilitate cross-study comparisons. The median conditional kappa (kappa c) was .42, considerably below the level of kappa c = .80 that represents acceptable reporting accuracy. The magnitude of drug use underreporting documented in this review could seriously bias prevalence estimates and treatment outcome studies.

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Intervention services are needed that target mobile populations who are coming from an environment of high-risk behavior to one of low-risk behavior.

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A sample of 1,038 patients newly admitted to 15 methadone clinics in New York City were studied for up to three years in treatment or until discharge. Cluster analysis identified distinct patient groups with very different heroin and cocaine usage patterns during treatment. About 80% either started in or transitioned to a low heroin use group and 50% either started in or transitioned to a low cocaine use group during treatment. One-third of patients used cocaine extensively during treatment. Other "high risk" groups, such as those not recently employed, younger, or involved with criminal justice, could benefit from special interventions very early in treatment.

The increase in the use of pharmacies and other ESAP syringe sources in this sample has been accompanied by a decline in receptive sharing.

This study examined mobility on the airbridge between New York (NY) and Puerto Rico (PR) for Puerto Rican drug users and its relationship to HIV risk. Over 1,200 Puerto Rican injection drug users (IDUs) and crack smokers were recruited by outreach workers in NY and PR; interview data included questions on mobility (lifetime residences and recent trips). Two-thirds of the NY sample had lived in PR; one-quarter of the PR sample had lived in NY; the most commonly sited reasons for moving were family-related. Fewer than 10% had visited the other location in the prior 3 years. Variables related to risk were number of moves, recent travel, and having used drugs in PR (all with p G 0.05). Implications included the need to enhance risk reduction efforts for IDUs in PR and address sexual risk among mobile drug users.

We tested serum samples collected in 1997 and 1998 from a cohort of 204 injection drug users (IDUs) recruited from Central and East Harlem, New York City, New York, for antibodies reactive with seven rickettsial or Bartonella spp. antigens. Rodent-associated Bartonella elizabethae and Rickettsia akari were the primary etiologic agents of interest. The testing panel also included Bartonella henselae, Bartonella quintana, Rickettsia prowazekii, Rickettsia rickettsii, and Rickettsia typhi. The highest prevalence of seroreactive serum samples (46%) was found with B. elizabethae antigens; 10% of the samples reacted with B. henselae antigens, while 2% reacted with B. quintana antigens. Reactivity to the latter two antigens was likely due to cross-reactivity with B. elizabethae antigens in most instances. Among the spotted fever group rickettsiae, 18 (9%) samples reacted with R. akari, including 10 samples (5%) that also reacted with R. rickettsii. Cross-adsorption studies demonstrated that most of the spotted fever group rickettsiae antibodies were due to R. akari infections. Among the typhus group rickettsiae, 5 samples reacted weakly to R. prowazekii antigens, and no samples reacted with R. typhi antigens. These findings suggest that Harlem IDUs are commonly exposed to two rodent-associated zoonotic agents. Further study of IDU populations may help elucidate transmission cycles of these agents in inner cities where higher levels of transmission occur.