Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

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Almost 10 years ago, a National Research Council committee surveyed the data and research supporting the nation’s drug policy. The subtitle of the report, What We Don’t Know Keeps Hurting Us, accurately summarized the committee’s pessimistic assessment. The available datasets, though numerous, provided inadequate coverage and the existing research in many areas was thin in quantity and weak in quality.

This more modest report, focused on just research needs to better understand the demand for drugs, unfortunately reinforces that pessimistic message. None of the major recommendations of the earlier report has been implemented. Though some data sets have been strengthened, particularly the National Survey on Drug Use and Health, others have deteriorated, notably the Arrestee Drug Abuse Monitoring and the Drug Abuse Warning Network. There has been no expansion of research on the effects of enforcement, the major approach by which the United States attempts to control both the supply and demand for drugs.

The starting point for the current project is that, despite continued heavy investment in drug control, the demand for illegal drugs continues to be substantial. Within the bounds of very limited resources, the current committee has set out to identify what we do know about the sources of the continued demand and about how to improve that knowledge. It identifies what should be done to improve that knowledge. The commitment of the director of the Office of National Drug Control Policy to strengthening the science base for policy making and the designation of

drug-related morbidity and mortality as principal targets for policy making, give hope that the situation can be improved in the future.

This project would not have been possible without the cooperation and assistance of many individuals. The committee extends its appreciation and thanks especially to all the presenters and discussants who participated in our workshop: see the Appendix at the end of this report.

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the National Research Council (NRC). The purpose of this independent review is to provide candid and critical comments that assist the institution in making the published report as sound as possible and ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their participation in the review of the report: Linda B. Cottler, Epidemiology and Prevention Research Group, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO; Louisa Degenhardt, National Drug and Alcohol Research Centre, University of New South Wales, Australia; Lee D. Hoffer, Department of Anthropology, Case Western Reserve University; Robert MacCoun, Goldman School of Public Policy, University of California, Berkeley; Charles P. O’Brien, Department of Psychiatry, University of Pennsylvania; Maureen O’Connor, Department of Psychology, John Jay College, and Doctoral Programs in Psychology, Graduate Center, City University of New York; and William Rhodes, Principal Scientist, Abt Associates.

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Charles E. Phelps, University of Rochester (emeritus). Appointed by the NRC, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring panel and the institution.

Peter Reuter, Chair

Committee on Understanding and Controlling the Demand for Illegal Drugs