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.

Of food trucks and lawbreaking

It’s no secret that the U.S. economy continues to struggle, particularly on the jobs front.  It’s not surprising, therefore, that lots of people are getting in touch with their inner entrepreneur and are seeking employment via their own small businesses.  Food trucks, although looked down on by some, clearly are a part of this self-starter trend, particularly in certain urban areas like Portland and New York.

Which is why I found a recent NPR Planet Money podcast on food trucks in NYC so interesting. From the transcript:

[T]he city sets lots of rules about where food trucks are not allowed — then lets the truck owners duke it out over the scraps.

You have to be 20 feet away from subway stations and building entrances. Two hundred feet from schools (call it the ice-cream truck provision). And the NYPD just started giving out tickets for selling food from metered parking spots.

“Following all the regulatory constraints that are currently enforced at this moment, there really is not any place for a food truck to park,” says David Weber [author of the Food Truck Handbook].

In other words, NYC on one hand licenses an activity (vending from food trucks) and on the other hand makes this activity illegal (through parking regulations that provide literally no legal spots from which to vend).  Of course, what this really means is (1) that food trucks continue to operate but (2) that they do so in technical violation of the law and subject to the whims of law enforcement’s discretion.

As a lawyer, this infuriates me.  It undermines the rule of law in a number of ways:

  • It tells citizens that one has to break the law simply in order to run a business.
  • It implies that there are two classes of law (laws one must obey and laws one need not) without providing a clear principle on which is which.
  • It institutionalizes an incentive for corruption and discrimination since every food truck operator is now a technical lawbreaker subject to law enforcement’s “discretion” (and thus harassment, solicitation for bribes, etc.).

To be clear:  I do not know whether any corruption or discrimination is taking place, and I am not accusing anyone of anything.  (Indeed, I have no direct knowledge of the situation on the ground and do not live in NYC.)  Taking David’s assertion at face value, however, it is clear that such facts would incentivize corruption and discrimination at the institutional level.