According to the
National Survey on Drug Use and Health (NSDUH), about 620,000
Americans used heroin in 2010. But according to a
new report commissioned by the Office of National Drug Control
Policy, something like 1.5 million Americans were “chronic heroin
users” that year. That group includes anyone who has consumed
heroin on four or more days in the previous month.
This dramatic discrepancy results from the report’s attempt to
count heroin users missed by NSDUH, whether because they did not
respond honestly, because they did not respond at all, or because
they were not part of the household population sampled by the
survey. To adjust for such undercounting, Beau Kilmer and eight
other drug policy analysts at the RAND Corporation rely mainly on
data from the
Arrestee Drug Abuse Monitoring Program (ADAM), which includes
urinalysis as well as a survey. Because it focuses on arrestees,
ADAM is more likely than NSDUH to identify heavy drug users. But
its sample, unlike NSDUH’s, is not nationally representative, so
Kilmer and his colleagues must perform a series of calculations to
convert ADAM numbers into total male arrestees testing postive for
heroin and divide those users by frequency of use. Then they add
estimates for men who were not arrested as well as for women and
teenagers, based partly on NSDUH and information about overdoses,
emergency room episodes, and treatment admissions.
The RAND researchers convert their estimate of heroin users into
estimates of total consumption and spending. They use similar
methods to estimate the size of the cocaine, methamphetamine, and
marijuana markets. In the case of marijuana, a drug for which NSDUH
seems to be a better guide, Kilmer et al. rely mainly on numbers
from that survey, inflated by 25 percent and supplemented by ADAM
data for respondents with criminal records. It is an impressive,
headache-inducing feat, but one that is subject to “great
uncertainty” because of the assumptions involved and the limits of
the data, as the authors repeatedly acknowledge. “In many cases,”
they say, “the extent of the uncertainty cannot be bounded or
quantified.” They do not really know, for example, “the extent to
which one can trust arrestees’ self-reports about their spending on
illegal drugs” or “how to extrapolate just ten urban areas’ arrest
records to the country as a whole.”
The RAND estimate for frequent heroin users is much higher than
the one reported by NSDUH. In a recent USA Today
op-ed piece, Kilmer and one of his collaborators, Jonathan
Caulkins, say “estimates from the 2010 NSDUH suggest there were
only about 60,000 daily and near daily heroin users”—i.e., people
who used heroin on 21 or more days in the previous month. They
argue that “the real number is closer to 1 million.”
Yet whether you look at NSDUH data or at the RAND estimates, the
trend from 2000 through 2010 looks similar. “Heroin consumption
remained fairly stable throughout the decade,” Kilmer et al. write,
“although there is some evidence of an increase in the later
years.” They note that “there was a steady increase in the amount
of heroin seized within the United States and at the southwest
border from 2007 through 2010,” but they caution that seizure
levels may reflect enforcement efforts and traffickers’ tactics
rather than consumption. The RAND estimates of heroin consumption
indicate “essentially no change” from 2000 to 2010. The report does
not cover the two subsequent years, when NSDUH reported
an increase in
the number of past-month heroin users, from 239,000 in
2010 to 335,000 in
2012.
The trends for the other drugs are also similar to what the
NSDUH data suggest. “Multiple indicators are consistent with an
increasing trend in meth consumption over the first half of the
decade and a subsequent decline through 2008,” Kilmer et al. write.
“From 2002 to 2010, the amount of marijuana consumed in the United
States likely increased by about 40 percent while the amount of
cocaine consumed in the United States decreased by about 50
percent.” Throughout the period covered by the report, estimated
annual spending on the four drugs in the United States totaled
about $100 billion, although the breakdown changed substantially.
“In 2000,” say the RAND researchers, “much more money was spent on
cocaine than marijuana; in 2010 the opposite was true.”
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