Informing America's Policy on Illegal Drugs What We Don't Know Keeps Hurting Us (2001) / Chapter Skim
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3 Data Needs for Monitoring Drug Problems
3 Data Needs for Monitoring Drug Problems
Pages 75-123
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From page 75... ...
The types of data discussed here are essential to inform drug control policy, but they do not suffice. Richer data aiming to shed light on specific aspects of drug use and detailed features of drug markets are needed to support research evaluating particular drug control instruments.
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lithe committee invited officials at a number of public agencies and private organizations to comment on the accuracy of descriptions of their programs that are discussed in the rest of this report. These agencies and organizations include: the Office of National Drug Control Policy, the National Institute on Drug Abuse, the National Institute of Justice, the Bureau of Justice Statistics, the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention, and the Institute for Defense Analyses.
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surveys school students, and the National Household Survey of Drug Abuse (NHSDA) surveys the noninstitutionalized residential population age 12 and over.
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The surveys also include various levels of detail on the respondent's demographics, health status, insurance, drug treatments, illegal activities, perceptions, and geographic location. The National Household Survey of Drug Abuse (NHSDA)
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It assesses the prevalence of and trends in self-reported drug use among school students. It also asks questions concerning peer norms regarding drugs, beliefs about the dangers of illegal drugs, and perceived availability of drugs (Johnston et al., 1993, 1998~.
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. Drug Abuse National representative sample Medical Probability Through Warning of more than 600 nonfederal, record sample of the year Network short-stay emergency abstraction emergency (DAWN)
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To track the illegal drug use among arrests. To track emergency department cases and medical examiner deaths caused by the use of illegal drugs or the abuse of prescription and over-the-counter drugs.
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These data in particular, and longitudinal data on drug consumption in general, may provide essential information for evaluating the efficacy of alternative drug policies. Two features about illegal drug control policy make longitudinal data uniquely important.
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The committee recommends that the Office of National Drug Control Policy and the granting agency (currently the National Institute on Drug Abuse) establish an oversight committee of statisticians and other experts, knowledgeable in procedures for balancing the needs for public access with the goal of confidentiality, to establish guidelines for providing access and for monitoring whether access to the data is quickly and easily provided.
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From page 84... ...
In any case, the committee recommends that the granting agency require that the contractors who gather data for Monitoring the Future move immediately to provide appropriate access to the longitudinal data. Finally, the committee recommends that if access is not provided in accordance with the guidelines of the oversight committee, the Office of National Drug Control Policy and the granting agency consider whether the public interest requires relocating the grant in another organization that will provide the level of access necessary for the data to be most useful for purposes of informing public policy on illegal drugs.
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From page 85... ...
Hospitals outside these 21 areas are sampled to allow for national estimates based on a probability sample. The survey covers episodes involving persons age 6 and older who were treated in the hospital's emergency department with a presenting problem that medical staff decide was induced by or related to the nonmedical use of a legal drug or any use of an illegal drug.
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From page 86... ...
Even if drug users cannot provide precise information on the weight and purity of their drug purchases, they may be able report valuable data related to consumption. In particular, they may be able to report their expenditures on drugs and to give informal descriptions of the quantity consumed (see the section below on drug prices)
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From page 87... ...
Similarly, the data cannot provide reliable estimates for subpopulations that are surveyed but for whom the effective sample sizes are small.5 Thus, these surveys cannot be used to draw precise inferences about variation in drug use across important 4Also excluded are active military personnel who are less likely to use drugs. The Worldwide survey of Substance Abuse and Health Behaviors among Military Personnel covers active military personnel See, for example, Bray et aL, 1995; sachman et aL, 1999; Mehay and Pacula, 1999)
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From page 88... ...
With only 63 past-year heroin users in the 1998 NHSDA survey, little can be learned about the demographic or socioeconomic characteristics of this group. The committee recommends that methods be developed to supplement the data collected in the National Household Survey of Drug Abuse and Monitoring the Future in order to obtain adequate coverage of subpopulations with high rates of drug use.
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From page 89... ...
In fact, federal agencies responsible for gathering data to monitor trends in drug use demonstrate a clear appreciation of the importance of linking data samples collected at different times. Careful linkage of data from one reporting period to the next promotes ready interpretation of upward or downward trends when warranted by the validity and precision of the data (e.g., see Substance Abuse and Mental Health Administration, 1999; National Household Survey on Drug Abuse Series: Hell; Tables 2.2-2.10~.
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From page 90... ...
Louis, MO-IL Washington, DC x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Note: NHSDA = National Household Survey on Drug Abuse; DUF/ADAM = Drug Use Forecast/Arrestee Drug Abuse Monitoring Program; DAWN = Drug Abuse Warning Network; CEWG = Community Epidemiology Work Group; Pulse Check = key informant surveillance. To be sure, there are isolated examples of integration across multiple drug data sources to characterize individual metropolitan areas.
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From page 91... ...
There are in place several federally coordinated systems of state-administered data on illegal drugs that might usefully be studied as models.7 The Drug and Alcohol Services Information System of the Substance Abuse and Mental Health Administration is compiled from information provided by state substance abuse agencies. The Center for Substance Abuse Treatment sponsors State Needs Assessment Studies, conducted by selected state substance abuse agencies.
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From page 92... ...
Linking NHSDA with Treatment Databases. It has also been suggested that the NHSDA data be linked with DAWN and with surveys of populations receiving treatment in an effort to produce national estimates of the high-risk subpopulation in need of and who receive treatment.8 The feasi~Many of these people are included in the universe covered by general population surveys, such as the NHSDA, which includes treatment clients who are in ambulatory settings or those who receive short detoxification in a clinic or hospital setting.
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rather than of persons. The Substance Abuse and Mental Health Administration, working cooperatively with state substance abuse agencies, compiles lists of treatment facilities and periodically collects information about the number and characteristics of persons receiving treatment.
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Data from the NHSDA indicate that the annual prevalence rates of use for adolescents ages 12 to 17 increased from 13 percent in 1991 to 19 percent in 1997.ll Both series suggest that from 1991 to 1997, the fraction of teenagers using drugs increased by nearly 50 percent. Does the congruence in the NHSDA and MTF series for adolescents imply that both surveys identify the trends, if not the levels, or does it merely indicate that both surveys are affected by response problems in the same way?
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Then the reported prevalence of illegal drug use is 19/75 = 25.3 percent. How12The 25 percent nonresponse rate for the NHSDA includes both unit (household)
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If between O and 25 nonrespondents used illegal drugs, then true prevalence is between 19 and 44 percent. Thus, in this example, nonresponse causes true prevalence to be uncertain within a range of 25 percent.
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The upper bound results if all nonrespondents use illegal drugs. True prevalence is within these bounds.
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Desires to fit into a deviant culture may lead some respondents to falsely claim to consume illegal drugs. Thus, despite considerable resources devoted to reducing misreporting in the national drug use surveys, invalid response remains an inherent concern.
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evaluated denial rates using panel data on illegal drug use from the National Longitudinal Survey of Youth (NLSY) , a nationally representative sample of individuals who were ages 14 to 21 in the base year of 1979.
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On occasion, this surveillance network also has functioned quite well to detect and to disrupt epidemics of noninfectious origin, but not for such drugs as cocaine, crack, MDMA ("ecstasy") , or other illegal drugs.
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From page 101... ...
This overview of basic public health concepts may come as a surprise to readers who are accustomed to thinking about drug abuse surveillance in terms of the data collection systems discussed in this chapter. None of these data systems is especially timely, and none has a fine-grained coverage of local areas within the nation.
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From page 102... ...
Partly in response to a recognition that the nation's large data systems lack the timeliness and local area coverage of standard public health surveillance systems, the National Institute on Drug Abuse has fostered development of a Community Epidemiology Work Group (CEWG) initiative, and the Office of National Drug Control Policy has fostered development of Pulse Check.
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From page 103... ...
The report is remarkable for its scope and depth, but it is striking that it does not discuss the integration of surveillance activities or information on the use of illegal drugs, one of the foremost public health challenges that faces the nation. At first, one might ask whether this omission is due to the highly sensitive and confidential nature of information about an individual's drug use.
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From page 104... ...
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)
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The committee recommends that the Office for National Drug Control Policy and the Centers for Disease Control and Prevention undertake to develop principles and procedures for information and surveillance systems on illegal drug-taking and its associated hazards. DATA ON DRUG PRICES Data on prices of illegal drugs are important for many drug policy studies.
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From page 106... ...
These features make the STRIDE data highly attractive to policy analysts who study factors that affect or are affected by the prices of illegal drugs. Policy analyses involving drug prices often begin by using STRIDE or, occasionally, other data to construct a price index (see, for example, Abt Associates, 1999; Grossman et al., 1996; Crane et al., 1997; Chaloupka et al., 1998; Saffer and Chaloupka, 1995; Caulkins, 1994; Rhodes et al., 1994; DiNardo, 1993~.
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From page 107... ...
While it is sometimes recognized that the STRIDE price data are not accurate measures of the prices paid by consumers of and traffickers in illegal drugs, their use is often defended as being "realistic" or at least reasonably accurate, perhaps containing a small and hopefully constant multiplicative error. This view is based on the assumption that prices paid by Drug Enforcement Administration
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From page 108... ...
STRIDE Data STRIDE records drug acquisitions made in support of criminal investigations by the Drug Enforcement Administration and the Metropolitan Police of the District of Columbia. A criminal investigation by the Drug Enforcement Administration begins when the staff of a DEA field office learn of a drug shipment or marketing operation.
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Thus, most purchases of drugs by DEA agents and informants are of larger-than-retail quantities. In summary, the STRIDE data are gathered according to criteria that serve the law enforcement objectives of DEA field offices.
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However, in the absence of independent evidence on the extent to which the STRIDE price data are accurate indices of the prices of illegal drugs at either the wholesale or retail level, the committee concludes that the STRIDE price data are of questionable reliability for use in estimating demand functions, in estimating the effects of policy interventions that may cause modest price changes, and in carrying out other economic and policy analyses that require accurate measures of price variations. The inadequacy of the existing STRIDE price data is a major impediment to reliable assessments and research on illegal drugs.
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In addition, ADAM surveys only arresters, who are not necessarily representative of the entire population of drug users in the cities that participate in the ADAM program. The National Household Survey of Drug Abuse does not ask questions about expenditures on drugs.
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The price collection effort could be undertaken collaboratively with other government statistical agencies who have experience in collecting price data and doing surveys on illegal drugs. Price Indices A price index is an indicator of the price of a unit of a commodity or of a group of commodities.
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From page 113... ...
show that the STRIDE data produce different price functions for powder cocaine and cocaine base in the same city and that price functions that are estimated from the STRIDE data are different in different cities. When different cities and commodities have different price functions, then a price index that is estimated from pooled data can exhibit fluctuations and trends that do not exist in any of the markets whose data were pooled.
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From page 114... ...
In this example, the range of variation is approximately +$20.16 Suppose that a price index series is constructed by pooling the data from the two cities. In each year, the data from the two cities are combined and a price function is estimated from the combined data.
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1 1 0 x c' . _ 90 A/ A \/ o 5 Year 10 FIGURE 3.3 Price index series obtained from pooled city 1 and city 2 price data.
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For example, the Bureau of Labor Statistics uses standard and well-tested procedures to construct retail and wholesale price indices, taking into account regional differences, seasonal variation, and other factors. The committee recommends that a major effort be devoted to "importing" standard procedures on constructing price indices into the development of price indices for illegal drugs.
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Improving price data requires immediate and high-level attention from the agencies involved in producing accurate and timely information on illegal drugs. DEVELOPMENT OF A SET OF NATIONAL DRUG ACCOUNTS One of the major shortcomings of current information systems on illegal drugs is the lack of a systematic set of accounts that track the dollar flows in this sector.
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From page 118... ...
Indeed, it seems unlikely that empirical economic analyses of the illegal drug industry can be carried out without moving toward a rudimentary set of national illegal accounts. Third, a set of National Drug Accounts, together with existing data and accounts on other addictive substances, could help researchers better understand a number of major policy issues in the drug market.
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REFERENCES Abt Associates 1999 The Price of Illicit Drugs: 1981 through the Second Quarter of 1998. Report prepared for the Office of National Drug Control Policy.
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Biemer, P., and M Witt 1996 Estimation of measurement bias in self-reports of drug use with applications to the national household survey on drug abuse.
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Parsley 1997a Studies of nonresponse and measurement error in the national household survey on drug abuse.
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Office of Applied Studies 1997 Substance Abuse in States and Metropolitan Areas: Model Based Estimates from the 1991-1993 National Household Surveys on Drug Abuse Summary Report. Washington, DC: U.S.
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1997 Substance Abuse in State and Metropolitan Areas: Model Based Estimatesirom the 1991 1993 National Household Surveys on Drug Abuse Summary Report. Washington, U.S.
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