Fail

04.08.14

Gov't Abandons Best Survey for Counting U.S. Drug Users

The Arrestee Drug Abuse Monitoring survey (ADAM) was terminated in March, and not one congressmen tried to save it. Now the U.S. is without an accurate estimate of its drug users. That means less funding for research and treatment.

A new study revealing 67 percent of Americans want the government to focus on treatment for drug abusers was met with joy last week. A “truce” in the war on drugs, experts opined, may be just around the corner.

But while the public looks poised to make good, the government is quietly quitting. In March, the nation’s richest source of information about cocaine, heroin, and methamphetamine abuse was terminated. Not one congressman tried to save it.

Pioneered by Eric Wish in the 1970s, The Arrestee Drug Abuse Monitoring survey (ADAM II)—cancelled as a result of budget cuts—went into what has become the virtual hub of America’s drug war: prison. Originally known as Drug Use Forecasting (DUF), it revolved around the practice of interviewing prisoners and taking urine samples. The procedure was simple: Researchers would speak with arrestees in booking facilities and ask them questions about their drug use. Which ones. How often. For what cost. Who else likes it, too.

Promised (and delivered) confidentiality and anonymity, arrestees had nothing to lose—and, therefore, tons to offer. A urine test offered at the end, always optional, was the final step. It was an objective test that, for the first time, let the enormity of the drug problem in America rear its ugly head.

Instead of filling a hole in the National Survey on Drug Use and Health (NSDUH)—which doesn’t account for the homeless or prisoners—ADAM’s numbers blew it out of the water. The only large-scale measuring system to rely on an objective measure of recent drug use, it provided more accurate information than any survey in history. Anyone that disagreed need only look at the numbers.

In 2010, NSDUH reported just 60,000 daily or near daily heroin users in American; the number, according to the RAND Corporation (a nonprofit research organization that improves policy through research), was closer to 1 million. Month-to-month reports exposed an even more alarming inconsistency. In 2010, NSDUH estimated roughly 239,000 monthly heroin users; the RAND Corporation counted 1.5 million.

While the NSDUH’s numbers on marijuana came close to those represented in ADAM, its estimates on hard drugs were a mere fraction of the real picture. Those taking NSDUH’s voluntary survey either don’t use hard drugs, or don’t tell the truth about it. Without an accompanying urine sample, the lie becomes the truth. ADAM picked up where it left off. Reaching people without cell phones, permanent residences, or any residence at all. Underprivileged. Homeless. Addicts. Criminals. In the eyes of drug policy experts: the causalities of the war on drugs. In the eyes of everyone else: the problem.

“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.”

ADAM hit its peak in the 2000s, surveying arrestees in 35 counties and inspiring international survey of the same kind. But as the economy suffered, ADAM did too. Decreasing to ten counties, then ultimately, five. After disappearing for two years from 2004-2006, The Office of National Drug Control Policy (ONDCP) rounded up the funding needed to resurrect it. But this year, amid severe budget cuts in Washington; it once again went to the chopping block.

This time, no one could save it.

Beau Kilmer, co-director of the drug policy research center at RAND Corporation, calls the decision “extremely frustrating.” Tasked with providing the White House a comprehensive look at the drug landscape in America each year, Kilmer refers to ADAM as a “central” source of information about the drug landscape. “The national surveys only provide a tiny bit of information on hard drug use,” he tells me. “The individuals getting arrested and booked are the individuals who need the most help and services. It’s the population we need to know the most about.”

Without ADAM, Kilmer is unsure what a picture of hard drug use would look like. “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,” he says. “This data system had so much potential. This is the population that allows us to really understand what is happening."

Mark Kleiman, a drug policy expert and professor at UCLA, wrote about the decision in a post titled The Dumbest Move You’ll See This Week. “It’s a really bad thing that ADAM is dying. Our knowledge about drug abuse, as opposed to casual drug consumption, disappears,” he tells me. “Drug abusers end up in prison so they don’t make the survey. Essentially, we lose the ability to know what’s happening in the group of people using the most drugs.”

In Kleiman’s eyes, it’s a lack of science—not funding—that killed ADAM in the end. Since it’s a survey of people who get arrested, it’s not exactly a proportionally sound sample. Arrests are determined by a variety of factors, which can change based on police tasks. “People of the Bureau of Justice Statistics…they’re fancy statisticians. They sneer at it. It means nothing to them,” he explains. “It is a very imprecise estimate of what you really want to know. But they let precision trump relevance.”

Rafael Lemaitre, communications director for the ONDCP, admits that ADAM was a very valuable resource. “The illegal drug problem is a tough one to get a firm grasp on for obvious reasons. It’s an illegal market. It’s not like drug traffickers provide receipts,” he tells me. “When it comes to the world of drug policy it’s really important to have as much science research and evidence as possible. There’s a whole wide variety of survey instruments and research institutions that we rely on. One of them is ADAM which has been a very valuable resource for us.”

While the ONDCP will continue its other studies, Lemaitre admits that something will be missing without this one. “What ADAM filled the plug was capturing underrepresented populations. People going in and out of the criminal justice system,” he says. “Capturing a different segment of the population to make a fuller picture.”

The man behind ADAM itself, Eric Wish, sounds defeated when I reach him by phone. “Is it a bad thing that ADAM went? Absolutely,” he says with audible frustration. Now director of the Center for Substance Abuse Research (CESAR), he’s trying to move forward, now heading a new program to track emerging drug trends like synthetic marijuana.

Still, ADAM was Wish’s “life work,” a program for which he went door-to-door in the 80s to show policymakers why it worked. Losing his “baby” undoubtedly stings. But its what the death of ADAM signifies, not simply the loss of it, that discourages Wish.

“It used to be that drugs were seen as the biggest problem; not anymore. Drug addiction lost its importance,” he says. “People are tired of the drug war: It’s old news.”