Understanding the Demand for Illegal Drugs

Committee on Understanding and Controlling the Demand for Illegal Drugs

Peter Reuter, Editor

Committee on Law and Justice

Division of Behavioral and Social Sciences and Education



Washington, D.C.

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Understanding the Demand for Illegal Drugs Committee on Understanding and Controlling the Demand for Illegal Drugs Peter Reuter, Editor Committee on Law and Justice Division of Behavioral and Social Sciences and Education

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Gov- erning Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engi- neering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This project was supported by Contract Grant No. 2001-MU-MU-0007 between the National Academy of Sciences and the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-15934-0 International Standard Book Number-10: 0-309-15934-2 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet http://www.nap.edu. Copyright 2010 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Research Council. (2010). Understanding the Demand for Illegal Drugs. Committee on Understanding and Controlling the Demand for Illegal Drugs, P. Reuter, Ed. Committee on Law and Justice. Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

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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 govern - ment 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 char- ter of the National Academy of Sciences, as a parallel organization of outstand - ing 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 fed - eral 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 engineer- ing 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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COMMITTEE ON UNDERSTANDINg AND CONTROLLINg THE DEMAND FOR ILLEgAL DRUgS 2007 PETER REUTER (Chair), School of Public Policy and Department of Criminology, University of Maryland JAMES C. ANTHONY, Department of Epidemiology, Michigan State University College of Human Medicine RICHARD J. BONNIE, Institute of Law, Psychiatry and Public Policy, University of Virginia DONALD KENKEL, Department of Policy Analysis and Management, Cornell University TERRIE E. MOFFITT, Department of Psychology and Neuroscience, Duke University HAROLD POLLACK, School of Social Service Administration, University of Chicago MAXINE L. STITZER, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine CAROL PETRIE, Study Director LINDA DePUgH, Administratie Assistant BARBARA BOYD, Administratie Associate 

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COMMITTEE ON LAW AND JUSTICE 2010 JAMES Q. WILSON (Chair), Clough Center, Department of Political Science, Boston College and Pepperdine University PHILIP J. COOK (Vice Chair), Stanford Institute of Public Policy, Duke University CARL C. BELL, Community Mental Health Council, Inc., Chicago, IL ROBERT D. CRUTCHFIELD, Department of Sociology, University of Washington, Seattle gARY LaFREE, Department of Criminology and Criminal Justice, University of Maryland JANET L. LAURITSEN, Department of Criminology and Criminal Justice, University of Missouri gLENN C. LOURY, Department of Economics, Brown University CHARLES F. MANSKI, Department of Economics, Northwestern University TRACEY L. MEARES, Yale Law School, Yale University TERRIE E. MOFFITT, Department of Psychology, Duke University RUTH D. PETERSON, Department of Sociology, Criminal Justice Research Center, Ohio State University ROBERT J. SAMPSON, Department of Sociology, Harvard University JEREMY TRAVIS, John Jay College of Criminal Justice, City University of New York DAVID WEISBURD, Department of Administration of Justice, George Mason University PAUL K. WORMELI, Integrated Justice Information Systems Institute, Ashburn, VA JANE L. ROSS, Director BARBARA BOYD, Administratie Associate i

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Preface A lmost 10 years ago, a National Research Council committee sur- veyed 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 pessi- mistic 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 com- mitment of the director of the Office of National Drug Control Policy to strengthening the science base for policy making and the designation of ii

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iii PREFACE drug-related morbidity and mortality as principal targets for policy mak- ing, 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 apprecia- tion and thanks especially to all the presenters and discussants who par- ticipated 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 mak - ing 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 Alco- hol 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 Califor- nia, 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 conclu - sions 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

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Contents SUMMARY 1 1 INTRODUCTION 7 Background, 8 Study Project and Goals, 9 Program Concepts, 11 A Dynamic and Heterogeneous Process, 12 References, 14 2 MARkETS FOR DRUGS 17 Framework: Supply-and-Demand Model, 18 Beyond the Basic Model: Distinctive Features of Drug Markets, 23 Drug Supply and Elasticities, 29 Conclusion, 33 References, 34 3 MEASURING THE DEMAND FOR DRUGS 37 Population Surveys, 38 Datasets for Research, 44 Estimates of Prevalence and Quantities Used, 49 Prices, 51 Changes in Drug Markets Since 1990, 54 Conclusion, 59 References, 60 ix

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x CONTENTS 4 TREATMENT 65 Natural History of Drug Use, 66 Treatment Availability, Effectiveness, and Use, 70 Treatment Expansion, 71 Conclusion, 80 References, 82 5 FINDINGS AND RESEARCH RECOMMENDATIONS 89 Previous Recommendations and Current Data Use, 90 Recommendations for Data Systems, 91 Indicator Systems, 96 Recommendations for Research, 99 References, 105 APPENDIx: WORkSHOP AGENDA AND PARTICIPANTS 107