or more sensitive than the confidentiality of information about an individual’s past use of a specific drug.

It also is instructive to note that, in a particular episode, the CDC’s surveillance systems were capable of identifying a drug-related toxicity very early in the course of an epidemic, and they also were successful in mounting a public health intervention campaign that ended the epidemic within 12 months of its detection. The story of this late 20th century public health success has been told by Anthony and Van Etten (1999), who stress that the credit for reporting the first cases belongs to a single physician health care provider who noticed a possible connection between an idiopathic syndrome of eosinophilia myalgia and his patients’ extramedical use of nutritional supplements. These nutritional supplements were being taken by the patients, without medical prescription, for some of the reasons illegal drug users give for their use of such drugs as marijuana (e.g., to relieve tension, for calming purposes, to aid sleep). The consequences of consuming apparently contaminated supplies of the nutritional supplement (l-tryptophan) included the serious and potentially fatal eosinophilia myalgia syndrome. CDC officials recognized the similarities in clinical and epidemiological features of the reported cases with the clinical features reported for fatalities in a rapeseed oil epidemic in Spain some years before. The federal officials’ recognition of these similarities led them to increase their efforts to identify possible cases and to launch small clinical case-control studies to test alternative causal hypotheses. Within nine months of the first case report, the several small case-control studies allowed tracing of the etiologic agent back to contaminated batches of l-tryptophan imported from Japan; manufacturers and sellers complied with a voluntary ban on sales of the product, and the epidemic stopped. Follow-up laboratory investigation traced the contamination to a change in production methods used in some factories in Japan.

Hence, the CDC’s method of surveillance by collecting and collating reports of notifiable diseases and other health-related conditions and events provides a model that might be emulated in the nation’s efforts to gain a capacity for more timely and locally targeted drug intervention efforts. These methods are not necessarily suitable for evaluation of national policy or even local area policies. Nonetheless, they may prove to be an important element in a national plan for gathering of data about drug-taking, and the consequences of drug-taking in the U.S. population.

Against this background, the committee makes the following conclusions and recommendations:

The nation’s capacity for early warning of drug epidemics is quite limited, except perhaps in the areas already covered by the Community Epidemiology Work Group and Pulse Check techniques, or in the local areas surveyed for DUF/ADAM and MTF. Even when these surveys have

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