The study setting was a walk-in clinic of a large public hospital in Atlanta. Study participants included male patients between 18 and 39 years of age who presented to the triage desk for immediate care during weekdays. Of 415 eligible men who agreed to participate, the average age was 29.5 years, 91.6 percent were black, and 89 percent were uninsured. Outcome measures involved a comparison of self-reported illicit drug use with results from urinary assays for benzoylecgonine, a major cocaine metabolite. The study sought to determine which drug history questions produced the most accurate responses using anonymous urine testing as the criterion standard. Findings showed that 39 percent of patients tested positive for the presence of benzoylecgonine and were statistically more likely to be older, and black, and to have a prior history of sexually transmitted disease. About 72 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 urinary assays were more likely to admit to any illegal drug use than to the more specific any form of cocaine use within the prior year. The authors conclude that cocaine abuse among black, inner-city men is significant and that patient self-report of illicit drug use is highly inaccurate. 21 references and 2 tables