In order to adequately measure the scale and scope of illegal drug use in the U.S. — and properly determine how much funding and treatment is needed — organizations and agencies have to have first-rate information available.
But one of those measures — one of the best, according to experts in the field — has been defunded, and now the country is without a way to accurately count its drug users.
The Arrestee Drug Abuse Monitoring System, or ADAM, ended in March. The program provided detailed data on cocaine, heroin and methamphetamine use drawn from arrestees in criminal booking. The program conducted anonymous interviews with detainees, then gave them an optional urine test, which detected a range of narcotics use.
The disparity means underestimating the problem’s scope and, potentially, inadequately funding and handling treatment. The disparity also means being unable to properly gauge how effective treatment programs have been.
“How can we make sensible decisions about treatment funding without knowing how many people are suffering from dependence on drugs and whether the number is rising or falling?” wrote Beau Kilmer, who co-directs the RAND Drug Policy Research Center, and Jonathan Caulkins, Stever professor of Operations Research and Public Policy at Carnegie Mellon University, in an op-ed in USA Today.
Other estimates, for example, the National Survey on Drug Use and Health, which relies on surveys in which those surveyed may be less than honest, fall far short of ADAM’s objective, test-based accuracy.
As a case in point, Kilmer and Caulkins point out, while the NSDUH estimated 60,000 daily and near daily heroin users, other, more accurate research revealed a far more stunning statistic: close to 1 million users.
While survey takers aren’t shy about reporting their more socially acceptable use of marijuana, heroin and other hard-drug use is much less likely to be acknowledged.
Heroin, in particular, has become an increasing problem in Frederick County, as it has nationwide. Prescription drug users are turning to heroin as a cheaper alternative. In Maryland, more than 760 people died in 2012 because of alcohol or drug intoxication, an increase of 15 percent compared with the previous year, according to state data. The rise was largely driven by growth in heroin use, state statistics show.
Local law enforcement, schools, elected officials and others are struggling to find ways to grapple this epidemic. In one example of trying to understand this rise in heroin abuse, Delegate Kelly Schulz, a Frederick Republican, authored a bill to enable a greater sharing of information between agencies such as law enforcement, medical and social services in an effort to study drug overdoses. Many times, details about overdose cases are off-limits, and total fatalities and drug types are the only pieces of information available, she said.
"We want to be able to know what happened, how we got here, how this individual got to this point," Schulz, R-District 4A, told a panel of lawmakers during the session. Her bill now goes to the governor for his signature.
Detainees, those being arrested and booked, are a key constituency for drug-treatment services, Kilmer told the Daily Beast’s Abby Haglage.
“Some senator in 2019 is going to say ‘Why don’t we have a good idea about the number of heavy drug users in the U.S.?’ Then they’ll look back at this decision of cutting ADAM. If you care about treatment planning and making sure we’re efficiently allocating our resources, you need to know about the number of heavy users in the states,” Kilmer said. “This data system had so much potential. This is the population that allows us to really understand what is happening."
ADAM, which cost $10 million a year at its peak, was relatively cheap to operate, but the data invaluable. The public clearly wants government to focus on treatment: 67 percent of those who responded to a Pew Research Center poll conducted in February. If Maryland is serious about tackling heroin and other use of hard drugs, this may be a program it wants to adopt.