Summary/Abstract

Current drug abuse trend data published by the government is incomplete, lacks uniformity and reveals that enforcement and treatment priorities are misguided.

Content

I recently had the displeasure of reviewing  the Epidemiological Trends in Drug Abuse Executive Summary for June  2014, a semi-annual publication compiled by the National Institute of Drug Abuse (NIDA) epidemiology work group (Community Epidemiology Work Group), that assesses indicators that are theoretically correlated with substance use and abuse and was disturbed to discover that this alleged executive summary omitted several indicators included in previous reports that are critical in understanding current drug abuse trends and that are essential for understanding and strategically addressing the drug abuse problem. The data contained in this summary is restricted to treatment admissions and drug seizures data analyzed by substance while omitting significant indicators that allow the reader to gain a true perspective of the human toll of current policies and practices and preclude the possibility of getting a clear perspective of the patterns and trends on a national or even a regional level.  These missing indicators include mortality data, price/purity data, emergency room data, blood borne disease (Hepatitis C, Hepatitis B and HIV) incidence and prevalence data and specific socio-demographic data. They do however correlate with the published Drug Control budget that allocates resources to prevention, treatment and law enforcement.  While individual area reports contain some of the data for these indicators, uniformity of indicator data across all areas is hampered by the lack of data availability at a reporting area level.

What was particularly disturbing was to see that Marijuana was the number one substance seized and analyzed at the National Forensic Laboratory in twelve of the 23 areas reporting and overall it ranked number 1 nationally.  In a period when our country is experiencing an unprecedented opioid and heroin epidemic, the main priority should be to target the greatest threats to human life and to society. Marijuana is not that threat.  There is no direct mortality data associated with it nor is there any known correlation with its use and the transmission of potentially fatal blood borne diseases. Simply put, no one dies from marijuana use and therefore it should not be a law enforcement nor a treatment priority.  It has been legalized in some form in twenty three states of which it is approved for recreational use in four states and Alaska and Oregon legalization for recreational use will become effective in 2015. Washington DC legalization has been passed and is pending congressional approval. Seven other States, including California, are considering legalization. Hopefully, the year end 2014 data will reflect that marijuana treatment and enforcement dollars have been reallocated to prevention and treatment of the substances that comprise the greatest health risk. It seems appropriate, as it is the 21^st, century to discard the Calvinistic moral crusade that has claimed hundreds of thousands of lives and allocate the financial and human resources to sustainable healthcare policies that will save rather than take lives.

On a more granular level, it was particularly disconcerting to discover that in the areas with the highest incidence and prevalence of heroin, prescription opioid and crack/cocaine users, marijuana remained the focus of law enforcement.  This finding, contrary to the hyperbole published by the government and propagated by the media,  suggests there is either a major disconnect between Washington and American Law Enforcement or that the administration position on drug abuse is merely political propaganda. The recently announced 2016 Drug Control Budget indicates that Washington  will continue to rely on the criminal justice model for addressing the drug abuse problem.   An article published by the Drug Policy Alliance in 2013, “One Million Police Hours: Making 440,000 Marijuana Possession Arrests in New York City, 2002- 2012” clearly illustrates the obscene waste of financial and human resources. The study conducted by Dr. Harry Levine, Professor ofnSociology at Queens College reported that 85% of the individuals arrested for possession of marijuana were black or Latino and 50% were under 21 years of age. The study cited that marijuana use was higher amongst the white population which highlights the necessity of socio-demographics data collection and analysis in law enforcement, prevention and treatment.

Table 1.  Drug Seizures by Drug by Area.

Another disturbing statistic reported is that Marijuana ranked within the top three substances for primary drug of abuse for treatment admissions.  For every “marijuana addict “ in treatment a heroin, opioid addict, cocaine dependent individual or alcoholic is dying in the streets. It certainly explains why the treatment industry has lost credibility amongst the medical, scientific and insurance communities.  Has our substance abuse treatment industry discarded its original mission to save lives and become obsessed with margins that its primary mission has become to put “heads in beds”?  Recent merger and acquisition activity in this sector would suggest that economic interests have corrupted industry ethics.

The success of our national drug abuse strategy cannot be measured unless a uniform epidemiological assessment methodology is established and a standardized reporting system put into effect. Data collection and submission procedures from law enforcement, government and healthcare agencies need to be implemented to insure data reliability. The current system is deficient which prevents local and regional healthcare agencies from implementing meaningful and effective practices that are capable of reacting to changing trends in a timely fashion. An example of current data availability can be found in the lack of current price/purity data available to the public. The last published report is 2011. Policy makers, law enforcement, government and healthcare agencies need to work together collaboratively with a common health oriented mission that is time sensitive and priority driven.  All data collected must be accessible and current in a centralized data repository to prevent contamination by economic and/or political influences.  The medical triage method should be adopted for allocating funding to support prevention, treatment and enforcement priorities.

Finally, federally mandated standards for data collection and reporting should be instituted for all areas receiving federal funds for substance abuse and law enforcement initiatives.  The inconsistent current data sets and data collection methodologies compromise the validity and reliability of meaningful analysis of the current drug abuse problem, hampers forecasting for strategic healthcare planning and impedes the ability for informed legislation and policy transformation.

Tim Cheney is a founding partner at Chooper’s Guide and a former member of the Community Epidemiology Work Group (formerly known as the Community  Correspondents Group). He currently serves as the President of Floridians for Recovery and is a board member of Faces and Voices of Recovery and a member of the Maine Harm Reduction Alliance. He has been an advocate for substance use and child welfare for 32 years and has received the Lifetime Achievement Award from the President (2013), a Congressional Award and an advocay award from the Governor of the State of Florida. He has been in recovery for over 33 years.