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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us Executive Summary The consumption of illegal drugs and the design of efforts to control drug use pose some of the most difficult and divisive problems confronting the American public. As a public health and social problem, illegal drugs are responsible for numerous ills, including the premature death of some drug users. The country has borne the weight of the violence and crime that seem to inevitably accompany illegal drug distribution. As a practical problem, recurring drug epidemics have overwhelmed the nation’s treatment resources and plagued police forces and a judicial system struggling to maintain order and credibility. It is little wonder, then, that Americans have turned to public officials at all levels—local, state, and federal—to reduce illegal drug use and mitigate its effects. The most recent figures available from the Office of National Drug Control Policy (ONDCP) indicate that, in 1999, federal expenditures on control of illegal drugs surpassed $17 billion; combined expenditures by federal, state, and local governments exceeded $30 billion. What is more, the nation’s so-called “drug war” is a protracted one. The country has spent roughly this amount annually throughout the 1990s. (In comparison, the United States contributed a total of $7.5 billion to the allied effort in the war in the Persian Gulf in 1991.) Adequate data and research are essential to judge the effectiveness of the nation’s efforts to cope with its illegal drug problem. Given the importance of the illegal drug problem and the continuing controversy about how best to confront it, there is a pressing need for the nation to assess the existing portfolio of data and research and to initiate stronger efforts
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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us where necessary. Accordingly, at the request of the U.S. Office of National Drug Control Policy, the National Research Council established the Committee on Data and Research for Policy on Illegal Drugs. The committee was given the charge to: assess existing data sources and recent research studies that support policy analysis; identify new data and research that may enable the development of more effective means of evaluating the consequences of alternative drug control policies; and explore ways to integrate theory and findings from diverse disciplines to increase understanding of drug abuse and the operation of drug markets. The committee’s general findings are presented in this, its final report. An earlier Phase I report presented the committee’s technical assessment of two studies of cocaine control policy that have played prominent roles in recent policy discussions. Some of the committee’s recommendations, discussed below, are addressed to specific government agencies; it is important to understand, from the outset, how the committee went about assigning responsibility to certain agencies in some instances. As the committee formulated each of its many recommendations, we deliberated about how the recommendations might best be implemented. In particular, we considered which of the numerous existing federal statistical and research agencies might most appropriately be charged with the task of implementing the recommendations. The committee was informed in these deliberations by the presentations of agency representatives in committee-sponsored workshops as well as by the familiarity of committee members and staff with the operation of the relevant agencies. In some cases, the committee had sufficient institutional understanding to be able to recommend that a particular agency or group of agencies be charged with a particular task. In other cases, the committee has not named implementing agencies because it would be too speculative and perhaps even counterproductive for it to do so. Overall the committee finds that the existing drug use monitoring systems and programs of research are useful for some important purposes, yet they are strikingly inadequate to support the full range of policy decisions that the nation must make. The central problem is a woeful lack of investment in programs of data collection and empirical research that would enable evaluation of the nation’s investment in drug law enforcement. We begin with this most critical matter and then turn to other
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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us important aspects of drug data and research. A complete list of the committee’s recommendations appears in Table 1.1 at the end of Chapter 1. IMPROVING DATA AND RESEARCH ON ENFORCEMENT Enforcement activities include enforcement of domestic drug laws that prohibit the manufacture, sale, possession, or use of illegal drugs. They also include international efforts to reduce the supply of drugs through crop eradication and disruption of drug transport. Measured by spending, enforcement activities now constitute the major component of U.S. drug control policy; between 1981 and 1999, expenditures on enforcement increased more than tenfold. The escalation in domestic enforcement is manifest in an inventory of criminal justice processing facts: in 1998, 1.6 million people were arrested for drug offenses, 3 times as many as in 1980, and 289,000 drug offenders were incarcerated in state prisons, 12 times as many as in 1980 (23,900). The benefits and costs of current law enforcement policy and the possibility of alternative strategies continue to be the subject of heated public debate. Yet, because of a lack of investment in data and research, the nation is in no better position to evaluate the effectiveness of enforcement than it was 20 years ago, when the recent intensification of enforcement began. The committee concludes that the nation’s ability to evaluate its enforcement activities is severely hampered by two major data deficiencies: the absence of adequate data on drug consumption and reliable data on drug prices. Current estimates of illegal drug consumption are derived from simple measures of prevalence and frequency of use. Current information on price is derived from data collected for the purpose of providing evidence in criminal trials. As this report demonstrates, these data do not suffice for evaluating enforcement policy. Consumption data are critical to assess the responsiveness of drug use to enforcement. The committee recommends that work be started to develop methods for acquiring consumption data. Existing surveys of drug use collect information on frequencies of use but not on the quantity of drugs that users consume. Data on drug consumption are essential for understanding the operation of drug markets; the dynamics of initiation, intensification, and desistance; the response of drug users to changes in price; and the public health and economic consequences of drug use. A second key gap in existing data is information on drug prices. It may seem that the accuracy of estimates of the prices of illegal drugs is a technical concern of importance only to a small community of researchers. But accurate drug price data are critical for measuring the success of enforcement policy, a primary aim of which is to increase the retail price
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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us of drugs and, thereby, to reduce consumption. Existing price information is collected by the Drug Enforcement Administration and other law enforcement agencies for operational purposes and does not provide reliable indicators of retail price movements in actual drug markets. Nor does it provide an adequate foundation for analysis of the causes and consequences of price changes. For example, there is a broad consensus that current enforcement policy has increased drug prices relative to what they would be otherwise. However, the country does not know the magnitude of this increase, which aspects of current policy have had this effect, the amount by which it has decreased consumption, or which consumers have been most affected. Similarly, the nation is poorly informed about trends in the prices of illegal drugs, short-run fluctuations in prices, and the effects on prices of law enforcement operations and other policy interventions. All of these questions must be answered if the United States is to judge the effectiveness of its drug control policies or develop policies of greater effectiveness. The committee recommends that work be started to develop methods for improving existing data and acquiring more reliable drug price data. Until accurate price data are constructed, the nation will be poorly informed about long-term trends and short-term fluctuations in prices of illegal drugs, about the magnitude of expenditures on illegal drugs, and about the efficacy of interventions. In the committee’s view, planning activities for better data and research on drug consumption and drug prices could be begun immediately and implemented as soon as a suitable infrastructure and level of funding is in place. Improved consumption and price data alone will not suffice to strengthen the country’s understanding of drug enforcement policy. New empirical research will also be required. Inquiry into supply reduction aspects of enforcement policy has used two methodologies: impulse-response analysis, which strings together events to connect a hypothesized cause (the impulse) to the suspected effect (the response), and systems research, which develops a formal model of a complex system and then applies the model to predict outcomes. The committee concludes that the complex dynamics connecting enforcement to domestic drug prices, compounded by the severe limitations of existing data, creates difficult obstacles for the successful use of impulse-response analysis to measure the effects of supply-reduction policies. Even if, as the committee hopes, adequate data should be obtained, the multiplicity of events that affect drug prices, coupled with other forces that affect the time path from a given enforcement action to a response in drug price, makes this type of analysis untenable except in very tightly controlled circumstances.
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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us The committee recognizes that thus far systems research has had to rely on fragile empirical foundations. Scrutiny of current systems models reveals particularly strong needs for empirical research on three questions: Geographic substitution: To what extent can producers and traffickers thwart enforcement in one geographic area by moving production or smuggling routes elsewhere? Deterrence: How can the deterrent effects of supply-reduction activities be measured? How large are they? Adaptation: What is the time lag between successful enforcement operations and adaptive responses on the part of producers and traffickers? While answers to these questions will not come easily, it is the committee’s judgment that systems research has potential to inform supply-reduction policy and should therefore be fortified with research support. The committee recommends that the Office of National Drug Control Policy should encourage research agencies to develop a sustained program of information gathering and empirical research aiming to discover how drug production, transport, and distribution respond to interdiction and domestic enforcement activities. The committee strongly recommends that empirical research address the three critical issues of geographic substitution, deterrence, and adaptation. Not all of enforcement policy is directed toward reduction of the supply of illegal drugs. An important component of such policy, especially recently, has been to attempt to reduce the demand for drugs by deterring use and by incapacitating users. Using sanctions to reduce demand can also facilitate treatment of arrested users. A rational drug control policy must take appropriate account of the benefits and costs of enforcing sanctions against drug users. Here too, research is sorely lacking. The committee recommends that the National Institute of Justice and the National Institute on Drug Abuse collaboratively undertake research on the declarative and deterrent effects, costs, and cost-effectiveness of sanctions against the use of illegal drugs. Particular attention should be paid to the relation between severity of prescribed sanctions and conditions of enforcement and the rates of initiation and termination of illegal drug use among different segments of the population. The committee recognizes that improvement of data on drug consumption and prices, strengthening the empirical foundation for systems research, and assessment of enforcement policy aimed at drug users pose a set of challenging tasks whose accomplishment will require new re-
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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us sources. However, we view these enhancements of data and research as neither impossible to accomplish nor prohibitive in cost. It is worth keeping in mind how little is currently spent on drug data and research relative to the country’s expenditure implementing its drug policy. The federal government, according to the ONDCP, currently invests approximately $780 million each year to monitor illegal drug use and conduct research on drug policy, but less than 15 percent of this amount goes for research on enforcement. Funding for research on enforcement policy is minimal, particularly when compared with the amount spent on carrying out enforcement policy. In 1999, only $1 was spent on enforcement research for every $107 spent on enforcement itself. Moreover, in any given year, the greater part of enforcement research funds go to support criminal justice system operations (i.e., crop eradication research, crime analysis for investigations, analysis of case-loads in the federal courts) technology development, and drug testing, rather than data collection and social science research (Office of National Drug Control Policy, 2000). The committee has concluded that effective research on enforcement policy requires not only the necessary funding but also creation of the appropriate research infrastructure. Other government examples are relevant here. The Department of Labor is called on to make sophisticated projections regarding the economy and employment. In order to do so, it created the Bureau of Labor Statistics (BLS). The BLS is a statistical agency separate from the operational programs of the department, a circumstance that enables it to concentrate on its charge and command the services of the relevant academic researchers. In the drug treatment research arena, the National Institute on Drug Abuse (NIDA) serves a similar purpose. In the committee’s view, creating an infrastructure to support enforcement research is essential to the design of sound data collection systems and to the development of an integrated research program. Yet we understand the difficulty of creating a new agency to perform even this very important work. Therefore, in order to facilitate collection of better drug enforcement data and the implementation of a strong research program, the committee recommends that the National Institute of Justice, the National Science Foundation, and the Bureau of Justice Statistics should be assigned joint responsibility and given the necessary funding to build the scientific infrastructure for research on illegal drug markets and the effects of drug control interventions. The suggested organization takes advantage of the specific expertise of the National Institute of Justice in law enforcement research, the statistical expertise of the Bureau of Justice Statistics, and of the specific expertise of the National Science Foundation in economic research. In our judgment, Congress should provide new funds for this effort. While
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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us determining specific costs was beyond the committee’s charge, funding levels provided to NIDA for data and research on treatment may serve as an instructive example. In sum, the committee recommends a four-part approach for improving data and research on drug law enforcement: (1) development of new data collection systems on illegal drug consumption and the price of illegal drugs, (2) support for strengthening the empirical foundations of systems research, (3) support for research on the effectiveness of enforcement policy aimed at drug users, and (4) establishment of an infrastructure to facilitate the work. OTHER MAJOR RECOMMENDATIONS The committee was asked to review the entire range of data and research that might inform policy on illegal drugs. The discussion above identifies the most obvious shortcomings of the present portfolio. Existing programs that monitor the prevalence of drug use and those that study treatment and prevention receive more resources and are therefore further developed. Still, the committee makes a number of major recommendations whose implementation should further strengthen the nation’s data and research on illegal drug use and policy. We arrived at these recommendations through a review of selected data collection systems and research literature and through analysis that revealed limitations in present knowledge. Monitoring Drug Use The committee examined the four major systems that collect annual data on large samples to monitor patterns and trends in drug use in the United States. Two of these, the National Household Survey of Drug Abuse (NHSDA) and Monitoring the Future (MTF), are national surveys based on probability samples of known populations, respectively: people who live in households and people who attend schools. The two other data systems sample events rather than people: arrests in the Arrestee Drug Abuse Monitoring program (ADAM) and emergency room visits and some deaths in the Drug Abuse Warning Network (DAWN). We draw several conclusions regarding data gaps and the need to improve these programs. First, the committee concludes that the subpopulations established by research to be at highest risk for drug abuse that causes serious harm— people in prisons and jails, hospitals, residential treatment centers, homeless people, and school dropouts—are not adequately covered by any of these four surveys. The committee recommends that methods be devel-
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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us oped to supplement the data collected in the National Household Survey of Drug Abuse and Monitoring the Future in order to obtain adequate coverage of subpopulations with high rates of drug use. Second, the chronic problem in survey research of inaccurate response is particularly acute in surveys of drug abuse, since illegal drug use is a stigmatized behavior and respondents are reluctant to report it accurately. Without a better estimate of inaccurate response, researchers and policy makers can not be confident in the inferences drawn from existing data monitoring illegal drug use. The committee is encouraged by a recent project to evaluate inaccurate response in the NHSDA, but this project is only a first step. The committee strongly recommends a systematic and rigorous research program (1) to understand and monitor inaccurate response in the national use surveys and (2) to develop methods to reduce reporting errors to the extent possible. Third, longitudinal data—examining a set of variables in the same subjects or population over time—regarding causes and patterns of drug use, the effects of drug use on behavior, and the effects of policies on drug use are critical to an assessment of drug policy. Existing data that are federally supported in the Monitoring the Future survey have not been shared with the research community because of unresolved problems of protecting the confidentiality of such data. Therefore, the quality of the data cannot be assessed objectively, nor can judgments about whether to collect additional longitudinal data be made. In the committee’s judgment, these data must be made available to the broader research and policy community. The committee recommends that the Office of National Drug Control Policy and the granting agency (currently the National Institute on Drug Abuse) establish an oversight committee of statisticians and other experts, knowledgeable in procedures for balancing the needs for public access with the goal of confidentiality, to establish guidelines for providing access and for monitoring whether access to the data is quickly and easily provided. Prevention of Drug Use Prevention encompasses an array of noncoercive activities intended to prevent, reduce, or delay illegal drug use. The committee reviewed the research literature on the effectiveness of a wide range of prevention activities and found mixed results. Some prevention activities appear to be effective at delaying the initiation or reducing the frequency of marijuana use, as well as tobacco and alcohol use by minors. However, because most evaluations are of school-based approaches, the success of many other approaches is unknown. Popular programs, such as “zero tolerance” strategies, have not been evaluated at all, or as in the case of
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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us project D.A.R.E., have been found to have little impact on illegal drug use. Large amounts of public funds are therefore being allocated to programs whose effectiveness is unknown or known to be limited. In light of these findings, the committee recommends a major increase in current efforts to evaluate drug prevention efforts. Further research is needed to better understand (1) effects of the entire spectrum of plausible approaches to prevention proposed or in use, rather than those that are most easily evaluated; (2) effects of drug prevention programs implemented under conditions of normal practice, outside the boundaries of the initial tightly controlled experimental tests of program efficacy under optimal conditions; (3) effects of different combinations of prevention programs, for example, how they complement each other or detract from one another when used in combination, as they most often are; and (4) the extent to which experimentally induced delays in tobacco, alcohol, and marijuana use yield reductions in later involvement with cocaine and other illegal drugs specifically, and long-term effects of prevention programming more generally. Treatment of Drug Use Official guidelines for research-based treatment, as well as numerous scholarly reviews of drug treatment programs, have been published over the past decade. Their findings are not repeated here. Rather, this report presents recommendations for improvement in the science of drug treatment evaluation. In particular, there is a need for better information on the potential benefits and costs of drug treatment as an adjunct or alternative to criminal justice sanctions and coercive treatment policies. In the committee’s view, development of more effective treatments, as well as more accurate information on variations in treatment effectiveness for different groups of recipients, would be facilitated by performance of successive, randomized controlled clinical trials. A sequence of studies featuring random assignment of clients to different treatment conditions would increase the likelihood and rapidity with which improved treatments could replace less effective ones, and it would help avoid introducing costly innovations that may later be found to be ineffective or even cause harm. Because treatment availability is limited and some drug users lack motivation, only a small proportion of all drug-dependent individuals receive treatment. Moreover, results derived from self-selected patients who remain in treatment optimistically skew findings in favor of effectiveness. Because of ethical problems with randomly assigning patients requesting treatment to a no-treatment condition, existing studies do not
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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us provide data on addiction in the absence of any treatment. In our judgment, researchers miss opportunities for randomized trials with no-treatment controls in settings in which such trials would be practical and ethical—for example, criminal justice settings, in which many drug-involved offenders otherwise go untreated. The committee recommends that treatment researchers take greater advantage of possible opportunities for randomization to no-treatment control groups. For example, we strongly encourage studies of incarcerated and postincarcerated prisoners as outlined in this report. The committee urges federal and state agencies and private institutions to minimize organizational obstacles to such studies, within ethical and legal bounds. Organizational Improvements In our review of data and research on drug use and drug policy, the committee found important gaps. Some data are missing altogether, while other data need improvement in order to be truly useful for supporting policy design and evaluation. Many of these problems emanate from a lack of funding support and from the fragmentation of drug data collection over a large number of federal agencies. Each of the major statistical collections reviewed herein is managed by a different agency, none of which has statistical reporting as its major focus. We reiterate our concern regarding the lack of data and research on drug enforcement policies and, in conclusion, we dwell especially on a need overall for strengthening the professional staffs and capabilities of organizations responsible for data collection and analysis, and for increasing the independence of their operations. The numerous substantive recommendations in this report cannot be implemented without improvements in the practices of statistical agencies and a consolidation of the federal effort. In particular, two key steps are necessary for improving the quality of data on illegal drugs: Efforts should be taken to strengthen the professional staffs and capabilities of the organizations responsible for data collection and analysis and to increase the independence of their operations. Data collection should over the long run be consolidated into a small number of statistical agencies, perhaps two, which would take a leadership role in organizing and collecting statistical data at the federal level. Upgrading collection efforts in existing agencies and consolidation of data collection are essential tasks for improving the scope and quality of data on illegal drugs. Unless these organizational goals are achieved, the
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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us nation will continue to be poorly informed and policies on illegal drugs will be operating largely in the dark. But the committee recognizes that these steps require determined and effective leadership. Our final recommendation therefore concerns the need for leadership in organizational improvements and reorganization. The committee recommends that the Office of National Drug Control Policy place organizational improvements for data high on its agenda in the immediate future. If it does not move quickly to implement the changes required to improve statistical data the President and Congress should find other ways to ensure that the substantive and organizational changes are swiftly and effectively achieved. THE CHALLENGE AHEAD Three decades ago, Congress decided to diversify the federal response to drug problems, investing in surveillance, biobehavioral and etiological research, and education and treatment. As a result, the nation has the data systems and research infrastructure needed to assess the effectiveness of preventive and therapeutic interventions. Although further improvements are needed in these areas, as explained in this report, the data and research capacity are in place. In stark contrast, neither the data systems nor the research infrastructure needed to assess the effectiveness of drug control enforcement policies now exists. It is time for the federal government to remedy this serious deficiency. It is unconscionable for this country to continue to carry out a public policy of this magnitude and cost without any way of knowing whether and to what extent it is having the desired effect. REFERENCES National Research Council 1999 Assessment of Two Cost-Effectiveness Studies on Cocaine Control Policy. Committee on Data and Research for Policy on Illegal Drugs. C.Manski, J.V.Pepper, and Y. Thomas, eds. Washington, DC: National Academy Press. Office of National Drug Control Policy 2000 National Drug Control Strategy: Performance Measures of Effectiveness; FY 2001 Budget Summary. Washington, DC: Government Printing Office.
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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us This page in the original is blank.
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