Chapter 7. Improve Information Systems for Analysis, Assessment, and Local Management
Chapter Table of Contents
Introduction
Over time, the application of science to drug problems has improved, relying on better research methods for data planning, collection, and analysis. Yet gaps in research make it difficult for policy makers to respond to emerging drug threats. For instance, national data that are available regarding our fastest growing drug threat—prescription drug abuse—are sometimes several years old, discounting their usefulness. Many other data gaps remain in the areas of prevention, recidivism, and drugged driving, to name a few. Also, with the evolution of drug policy, there are often innovations in one system that save money in another, such as family-based treatment. These impacts are valid and must be captured.
The consequences of drug use to society are important to measure to better understand both the scope of the problem and the scale of response required. In today’s difficult fiscal environment it is especially important to accurately understand the full impact of drug use. Drug problems intersect with, and contribute to, many other social ills, including child abuse and neglect, school failure, poverty, mental illness, criminal activity, and a wide array of health problems in addition to addiction. Drug use also has tremendous implications for health care in America. With healthcare reform comes both a great opportunity to provide coverage for needed treatment services but also greater scrutiny of the effectiveness of treatment for substance abuse and dependence and increased demands for improving quality and assuring measurable results.
As the volume of prescriptions for medicines has increased dramatically in recent years, so too has abuse of pain relievers and other medications. Abuse of prescription drugs brings forth new data and research challenges regarding prescribing policies, consequences of abuse and misuse, and the relative effectiveness of prevention, treatment, and law enforcement approaches. The scale and complexity of the prescription drug problem demonstrate the need to secure quality data in a timely manner to fully understand the threat and ensure an appropriate national policy response to address it.
Principle 1. Existing Federal Data Systems Need to Be Sustained and Enhanced
Enhancing the Drug Abuse Warning Network System
The Drug Abuse Warning Network (DAWN) system provides national and local-area estimates of drugrelated emergency department visits and drug-related mortality. Unfortunately, there have been several challenges to enrolling emergency departments into the DAWN sample, including reluctance on the part of the emergency departments to open their patient files to review and the cost associated with this review. These challenges have resulted in low response rates (i.e., less than 50 percent of the selected emergency departments have agreed to participate in the sample) and, consequently, concerns about the accuracy of the resulting estimates). To address these challenges, SAMHSA has initiated discussions with the CDC and FDA to develop a collaborative survey design built upon the existing National Ambulatory Care Survey (NACS) that will enable the DAWN system to continue to be capable of providing critical and accurate data on the health consequences of illicit drug use, including the misuse of medications. The NACS is an existing survey of nearly 500 emergency departments. Under the proposed plan, the NACS will incorporate drug-related variables currently collected by DAWN. By utilizing the NACS’ larger and more stable sample, the problem of DAWN’s low response rates will be resolved. (Action Item 7.1A)
Drug Abuse Warning Network
According to DAWN, which provides national estimates on individuals who experience drug-related medical emergencies that are severe enough to require treatment in an emergency department, there were approximately 1.2 million visits by individuals to hospital emergency rooms involving pharmaceutical drugs in 2009. This is nearly a doubling in such visits over the past 5 years—from 627,000 visits in 2004. In contrast, in 2009, there were 974,000 visits involving illicit drugs; these visits have been relatively stable since 2004. Visits to emergency departments involving pharmaceutical drugs do not include adverse reactions to such drugs taken as prescribed or indicated.
Improving the National Survey on Drug Use and Health
SAMHSA’s NSDUH is the Federal government’s primary survey on substance use among the U.S. population. Over time, much has been done to improve NSDUH, including expanding the sample size to permit state-level estimates; introducing computer-assisted self-interviews to improve confidentiality and response rates; and including questions to better estimate treatment need, methamphetamine prevalence, and drug market characteristics. Opportunities to improve the NSDUH remain, however, so SAMHSA has begun a review to identify areas and means by which it can be enhanced or redesigned. (Action Item 7.1B)
Trends in the Price and Purity of Illegal Drugs
DEA maintains the System To Retrieve Information on Drug Evidence (STRIDE) as an inventory of drug specimens obtained through seizures or undercover purchases. DEA uses the STRIDE data for support of investigations and court cases; however, they are also useful to analysts for tracking trends in the price and purity of specific drugs, yielding important strategic data on drug markets. DEA is working directly with ONDCP to enhance the functionality of STRIDE. (Action Item 7.1D)
Arrestee Drug Abuse Monitoring Program
In 2007, ONDCP revived the Arrestee Drug Abuse Monitoring (ADAM) program to survey recently booked arrestees in 10 U.S. counties. The survey includes collection of a urine specimen for drug testing. This criminal justice population is under-studied. The ADAM II data provide critical information on the nexus between drug use and crime. In 2010, NIJ and BJS sought to identify ways to improve cost-efficiency through survey techniques that enhance data quality and information utility. However, ONDCP continues to have principal responsibility for funding and managing ADAM II data collection and dissemination of data and reports. (Action Item 7.1E)
Developing Measures of Drug-related Crime
This study, to be conducted via a contract currently under solicitation, will develop a methodology to estimate drug-involvement and test the methodology using data from Uniform Crime Reports, the National Incident Based Reporting System, and other relevant data sources.
Principle 2. New Data Systems and Analytical Methods to Address Gaps Should Be Developed and Implemented
Drugged Driving Data
ONDCP is highlighting the issue of drugged driving and educating the public about the inherent dangers of driving after using drugs. We have partnered with DOT and NHTSA to raise the level of awareness about this problem which was highlighted by the findings in NHTSA’s 2007 Roadside Survey. This survey found that 1 in 8 weekend night time drivers tested positive for illicit drugs. In addition to the Roadside Survey, data are needed to better inform Federal and state policy makers about the extent of the problem and how best to respond to this often underestimated problem. For example, the Fatality Analysis Reporting System documents the circumstances of fatal traffic crashes, including whether alcohol or drugs were involved. Unfortunately, however, many states do not routinely test drivers involved in these crashes for the presence of drugs. A recent study by NHTSA found that one-third of the drivers killed in traffic crashes, and who were tested for drugs and whose results were known, tested positive for drugs. A promising approach to countering the drugged driving problem is administrative per se laws, which provide for drug testing to detect the presence of illicit drugs (or in some states, medications that can impair driving) in drivers’ bodies. Such detected presence is sufficient proof for violation of the law; it is not required that a level of impairment be established, as with alcohol, since the substance being tested for is illegal (or, in the case of medications, should not be taken prior to driving a motor vehicle). (Action Item 1.5B)
NHTSA is accelerating the schedule for the next National Roadside Survey to provide more timely data on the prevalence of drugged driving. In addition, ONDCP is supporting SAMHSA in assessing whether laboratory toxicology standards for detecting the presence of drugs or drug metabolites in oral fluids can be established. This project will assist prosecutors to successfully bring drugged driving cases to court.
ONDCP is also supporting NIDA in conducting a driving simulator study to determine the behavioral impact on driving after consuming marijuana. Results from the research will assist law enforcement in determining whether drivers using marijuana are impaired.
ONDCP’s Federal partners also are leading projects that have advanced the goals of the 2010 Strategy, such as the transitioning of drug seizure tracking to the National Seizure System (NSS). DEA, EPIC, and ONDCP are committed to ensuring all existing seizures in the Federal Drug Seizure System (FDSS) are included in the NSS. Further, all new seizures and related information will go directly to the NSS, which will allow for the retirement of the FDSS. This effort will evaluate the inclusion of additional drug information to the NSS and will result in more robust statistical and analytical products for NSS customers. By engaging in this effort, DEA can assist in streamlining intelligence dissemination and provide its Federal, state and local partners with information that is crucial for their success. (Action Item 7.2B)
Constructing a Composite Index of Drug Use Consequences
Several of the Strategy goals focus on reducing the consequences of drug use, including drug-induced deaths, drug-related mortality, and drugged driving. ONDCP is currently funding a project with the University of South Carolina to assess data on these consequences and others (e.g., crime, economics, quality of life) to develop national and state-level composite indexes of drug consequences that can be used by policymakers, analysts, and consumers.
Studies Designed to Improve the Field of Available Data on Drug Matters
• • Increasing our knowledge about the effectiveness of Hawaii’s HOPE probation. To learn about the long-term outcomes of HOPE probationers, NIJ is conducting a follow-up of the 2004 through 2006 cohort of HOPE probationers. The study will examine long-term outcomes including successful completion of probation, absconding, rearrest, revocation, and incarceration outcomes. NIJ is also exploring the possibility of conducting a rigorous multi-site replication of HOPE to test the effectiveness of the program in other jurisdictions.
• • Evaluating Delaware’s Decide Your Time Program for Drug-Using Offenders Under Community Supervision. In consultation with the NIDA, and with funding from ONDCP, the NIJ is supporting a test of deterrence while under community supervision. The Decide Your Time program employs the principles of certain apprehension and swift response using graduated sanctions and incentives to reduce relapse, violations, and recidivism among drug-using offenders.
• • Content analysis of drug and alcohol depiction on social media sites. More and more, teens are spending their free time on the Internet where may be potentially exposed to a wide variety of messages that present drug use as normal. ONDCP is currently soliciting for a study to assess how drugs and drug use are depicted on social networking web-based sites.
• • Drug indicator data purchases. ONDCP is currently planning a project to acquire either data and/or analyses of prescriptions for controlled substances from a commercial vendor’s tracking system to assist in the assessment of the diversion of these substances into illicit markets. These data will afford insight into the quantities of prescription that are diverted and, subsequently, abused.
• • Enhancing data regarding global illicit drug markets. Working with interagency counterparts including DHS, DEA and DOD, ONDCP continues to improve the analyses of various data sets such as the Consolidated Counterdrug Database (CCDB) for a better understanding of the magnitude and trends in illicit drug supply and demand, and the Interagency Assessment of Cocaine Movement (IACM), which estimates cocaine flow from South America toward the United States and other markets. Improvements include the following: providing subject matter expertise in drafting a charter for the CCDB, a key information source for the IACM; updating CCDB’s business rules to improve efficiency; expanding the scope of the database and implementing methodological improvements; and expanding interagency participation in the IACM analytical process. Another example of data improvements is enhanced forensic analyses of illicit drug specimens to provide a better understanding of the time between cocaine production and its arrival in U.S. retail markets. ONDCP will also be updating two past reports that estimate illicit drug availability in the United States: one using a demand-based approach by estimating consumption, and the other using a supply-based approach of calculating the net drug supply after subtracting drug removals from production estimates. To further advance the world-wide effort to reduce illicit drug demand and supply, data and analyses from these efforts are shared with the world community through the completion of UNODC’s Annual Report Questionnaire. (Action Item 7.2C)
Principle 3. Measures of Drug Use and Related Problems Must Be Useful at the Community Level
While many policymakers look at the drug problem nationally, communities understand their problems locally, based on whatever evidence is available. National indicators may bear only slight resemblance to drug problems in any particular community. Yet all too often, quality data are limited or missing altogether, leaving communities with little empirical basis for determining their focus, and even greater challenges in evaluating the worth of policies and programs they employ. Solutions to the drug problem must be focused locally, involving local approaches, but supported by a national strategy that is based on the best-available science.
The mix of law enforcement, prevention and treatment strategies require a careful balance, and the basis for such decisions should be based not only on epidemiological data but also on evidence of effectiveness, which is still all-too-scarce. The National Drug Control Strategy places a priority on improving the system for data collection and analysis, both to spot emerging drug threats and to allow communities to identify their drug problems and design approaches that will work.