The difficulty of getting good data on heroin use

Heroin use is getting more public attention but how exactly can researchers go about measuring its use?

For as long as it’s been around, the NSDUH has provided a pretty good picture of marijuana use in the U.S., and is a reliable source for annual stories about teens and pot (a perennial sticking point in the debate over marijuana legalization). But the NSDUH data on hard drug use seldom makes as big a splash. In a new report from the RAND Corporation, researchers suggest that one reason for this disparity may be that the NSDUH survey underestimates heroin use by an eye-boggling amount. “Estimates from the 2010 NSDUH suggest there were only about 60,000 daily and near daily heroin users in the United States,” drug policy researchers Beau Kilmer and Jonathan Caulkins, both of the RAND Corporation, wrote in a recent editorial. “The real number is closer to 1 million.”…

Kilmer and Caulkins came up with their much higher figures for heroin and hard-drug use by combining county-level treatment and mortality data with NSDUH data and a lesser known government survey called the Arrestee Drug Abuse Monitoring Program. Instead of calling people at home and asking them about their drug use, the ADAM survey questions arrestees when they’re being booked and tests their urine. “ADAM goes where serious substance abuse is concentrated — among those entangled with the criminal justice system, specifically arrestees in booking facilities,” Kilmer and Caulkins write. The survey also asks questions about street prices, as well as how and where drugs are bought. The data collected by the ADAM Program enabled RAND to put together a report looking at what Americans spent on drugs between 2000 and 2010.

In short, ADAM is a crucial tool for crafting hard-drug policy. Which is why researchers are alarmed that after being scaled back several times (including a brief shutdown between 2004 and 2006), funding for ADAM has completely run out. “Folks in the research world have known that this was coming,” Kilmer writes in an email. “I wanted to use the attention around our new market report to highlight the importance of collecting information about hard drug users in non-treatment settings. ADAM was central to our estimates for cocaine, heroin, and meth.”

Despite providing a wealth of information since the early 2000s, the budget for ADAM has slowly been chipped away. The survey was originally conducted in more than 35 counties, then 10, then five. The program disappeared completely between 2004 and 2006, but was revived by the Office of National Drug Control Policy in 2006. At its most expensive, ADAM cost $10 million a year.

For a variety of reasons, including public health and the resource-intensive war on drugs, this information is important. But, illegal activities are often difficult to measure. This requires researchers to be more creative in finding reliable and valid data. Even then, two other issues emerge:

1. How much do the researchers feel like they are estimating?  What are their margin of errors?

2. This can become a political football: is the data being collected worth the money it costs? For bean counters, is this the most efficient way to collect the data?

I wonder if this could be part of arguments for legalizing certain activities: it would be much easier for researchers (and governments, the public, etc.) to get good data.

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