Part I
Introduction and Background



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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us Part I Introduction and Background

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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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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us 1 Introduction Our nation employs a variety of means to reduce the consumption of illegal drugs and mitigate their adverse consequences. Choosing the right mix of instruments presents a complex policy decision; there are many different lines of attack. To manage this complexity, policy makers and the public have often adopted simple dichotomies, contrasting law enforcement approaches with medical approaches and supply-reduction approaches with demand-reduction approaches. Everyone seems to agree that the nation ought to use a portfolio of instruments that appropriately balances these broad categories, yet views on how close the nation now is to the optimal balance differ a great deal. The sharp disagreements about drug control policy that persist in U.S. society have both normative and empirical components. On the normative side, people in America vary in their moral judgment of drug use and in their concern with the collateral consequences of drug control activities. On the empirical side, people vary in their assessment of the effectiveness of the drug abuse prevention, drug treatment, domestic law enforcement, and foreign interdiction activities that have formed the elements of U.S. drug control policy. The continuing debate about drug control policy manifests itself in many ways, among which is an annual battle within the federal government on the allocation of funding across different instruments. Data and research cannot resolve disagreements about the morality of drug use, but they may be able to narrow the divergence of views on the effectiveness of drug control policy today and contribute to the forma-

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us tion of more effective policy tomorrow. With this in mind, the White House Office of National Drug Control Policy (ONDCP) requested the National Research Council (NRC) to convene a committee to study the data and research needed to inform national policy on illegal drugs. The Committee on Data and Research for Policy on Illegal Drugs was formed in early 1998 under the aegis of the NRC’s Committee on Law and Justice and Committee on National Statistics. Its charge was 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. This report represents the results of the committee’s work. As part of its work, the committee earlier assessed in depth two studies that evaluated the cost-effectiveness of alternative drug control instruments in reducing domestic consumption of cocaine—one by analysts at RAND (Rydell and Everingham, 1994) and the other by analysts at the Institute for Defense Analyses (IDA) (Crane, Rivolo, and Comfort, 1997). These two studies, which have drawn considerable attention, used very different methodologies and drew sharply different conclusions. The committee’s evaluation of the two studies was transmitted to the Office of National Drug Control Policy in April 1999 as its Phase I report, Assessment of Two Cost-Effectiveness Studies of Cocaine Control Policy.1 The Executive Summary of the Phase I report, which describes the committee’s main findings, is included in this volume as Appendix C. CHANGING PERSPECTIVES ON DRUG CONTROL POLICY As a prelude to discussion of the scope and themes of the report, we think it helpful to review how the prevailing perspectives on drug control 1   Points of view different from that of the committee regarding its Phase I Report are expressed in comments received from some of the authors of the Institute for Defense Analyses (IDA) and RAND studies. These comments are available to the public in the NRC public access file for this project. All references in both the Phase I and final reports to the IDA analysis or findings are based solely on the 1997 IDA report by Crane, Rivolo, and Comfort. All references to the RAND analysis or findings are based solely on the 1994 RAND report by Rydell and Everingham.

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us policy came to be. A constructive way to do so is to look historically at the evolution of drug policy and the language that has been used to discuss it. Law Enforcement and Medical Approaches Current drug policy has its roots in the adoption of the Harrison Narcotics Act in 1914.2 Although framed as a tax measure, the goal of the statute was to suppress the nonmedical use of what are called narcotic drugs (a classification that encompassed morphine, heroin, and other opiates, as well as cocaine). The effect was to criminalize the manufacture, sale, and possession of these drugs outside medical channels. An aggressive campaign of enforcement by federal authorities was deployed in the 1920s to terminate the practice of opiate maintenance by physicians and clinics. Eventually, the prohibitory approach was extended by Congress to marijuana in 1937, and during the 1930s and 1940s all state legislatures enacted a parallel set of laws. Penalties for narcotics offenses were increased in the 1950s, and new psychoactive pharmaceutical products were brought under federal control in the 1960s in an effort to suppress nonmedical use of these drugs. This accumulation of federal and state antidrug statutes was replaced in 1970 by the federal Controlled Substances Act and by parallel acts at the state level. Until the 1970s, enforcement of this comprehensive array of drug prohibitions was the predominant instrument of the nation’s antidrug policy. What was called the law enforcement approach was generally understood as a relatively complete policy: drugs are dangerous to the social order. Therefore, it is both just and useful to prosecute those who supply drugs and those who use them. By setting out laws against these activities and enforcing them, individuals would be dissuaded and deterred from supplying and using drugs. If some persisted despite the prohibition, it would be both just and effective to incapacitate them as threats to society. In the late 1950s and 1960s, however, the dominance of this law enforcement model was challenged by some influential lawyers and physicians who wanted to respond to drug addiction with medical methods (including civil commitment) rather than prosecution and punishment. In their view, chronic drug use was not a wholly voluntary choice but rather a disease to which some helplessly succumbed. The disease may have had its roots in biology, in the social conditions in which people lived, or in the dependence-producing power of the drugs themselves. But whatever 2   For a historical summary of drug policy predating the Harrison Act, see Institute of Medicine (1990: Volume 1, Chapter 2).

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us the sources, once these factors are present, an individual’s ability to act independently is undermined. Given this fact, it seemed both unjust and ineffective to respond to drug use among individuals as a crime. It seemed unjust because addicts were unable to decide to stop using drugs; ineffective because deterrence would fail, and incapacitation would work only as long as the restraint continued. What they proposed as an alternative was the medical treatment of drug users. The most radical version of the approach called for drugs now banned to be legally available to addicts, their use to be regulated by physicians who could prescribe the drugs to patients under their care. For much of the 1960s, drug policy was locked in a debate between “cops and docs.” Should society continue its commitment to law enforcement, or should it shift to the medical approach? Steps were taken in the 1970s to combine the law enforcement and medical approaches into a single framework. In 1972, Congress enacted legislation embracing one of the core positions of the proponents of the medical approach—that people with drug problems should be given incentives and assurances of confidentiality to encourage them to enter treatment. In addition, the federal government supported programs to use criminal prosecution as a lever for treatment participation. Congress also appropriated funds to support drug treatment programs. The debate between cops and docs receded in a policy environment in which both approaches were used simultaneously. Supply-Reduction and Demand-Reduction Policies In the late 1960s and early 1970s, drug policy analysts began talking in somewhat different terms. Influenced by economic theory, they now referred to supply-reduction and demand-reduction policies. These terms became particularly prominent in the 1980s when the ONDCP was created, with its deputy directors for demand and supply reduction. Supply-reduction strategies focused on limiting the supply of drugs that might flow to illegal markets, while demand-reduction strategies focused on reducing the demand for drugs. To some, the new idea of supply and demand policies was almost indistinguishable from the old idea of cops and docs. Supply-reduction strategies looked like law enforcement, and demand-reduction strategies looked like drug treatment. However, there were important differences in thinking about drug policy in terms of supply and demand rather than in terms of enforcement and treatment. First, in the new conception that distinguished supply and demand approaches, law enforcement was divided into two parts. Enforcement efforts directed at drug producers and distributors were considered sup-

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us ply-reduction strategies, and enforcement efforts directed at drug users were considered demand-reduction strategies. Second, new supply-reduction instruments emerged that were not enforcement activities. The idea took hold that those now engaged in the production of heroin and cocaine in Asia, South America, and elsewhere might be persuaded to stop not by the threat of crop eradication and arrest, but through subsidies supporting efforts to shift production to other, less profitable crops. Similarly, programs to improve the labor market conditions of disadvantaged youth might induce street-level drug dealers to move into legitimate employment. In addition, it was an explicit strategy of major multimodality treatment programs in the early 1970s to reduce local heroin supplies by recruiting user-dealers into treatment. Thus, crop substitution programs, youth employment programs, and programs treating user-dealers became part of the nation’s portfolio of drug control instruments. Third, a new demand-reduction strategy, drug abuse prevention, assumed a more important place in thinking about drug policy. Of course, law enforcement already aimed to prevent drug use. Drug laws put society on notice that use of certain drugs is deviant, and enforcement of these laws sought to deter potential drug users by threatening arrest and incarceration. The new notion of drug abuse prevention brought into play efforts by schools, neighborhood groups, and parents to persuade youth and other populations at risk that drug use is bad and dangerous. It also brought into play efforts by the military, civilian employers, and schools to deter drug use by initiating drug-testing programs and by levying noncriminal sanctions (e.g., fines, suspensions, dismissal) on soldiers, employees, and students found to use drugs. Box 1.1 displays these different policy instruments in the form of a matrix that shows how the original ideas of the law enforcement and BOX 1.1 Matrix of Drug Control Instruments   Supply Reduction Demand Reduction Law enforcement Crop eradication Disruption of transport Domestic enforcement Criminal sanctions for possession/use Coerced treatment Medical Regulation of pharmaceuticals Drug treatment Socioeconomic Crop substitution Youth employment programs Drug education and persuasion Noncriminal sanctions

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us medical approaches are related to the newer ideas of supply-reduction and demand-reduction policies. There is also a third dimension to this matrix: it is useful to distinguish federal efforts from state, local, and community efforts to deal with drug use, and think of national drug control policy as being the sum of efforts that are undertaken at these different levels of government. Complementarities Perhaps the most important advance in thinking about drug policy has been the idea that instruments drawn from the different categories may complement one another in a constructive manner. Thinking in terms of complementarities leaves behind the simple dichotomies of past conceptualizations of drug policy, opening new possibilities for combining instruments in innovative ways. Complementarities can also appreciably complicate the already difficult problem of assessing the effectiveness of alternative drug-control strategies. One aspect of thinking about complementarities combines law enforcement directed at drug users with treatment of those users. For many years it was thought that law enforcement approaches conflicted with treatment approaches. At a philosophical, ideological, or political level, this may still be true. That is, the politics of drugs tends to align those who favor law enforcement approaches as the just and effective response to drug abuse, against those who favor treatment and prevention approaches to drug abuse. Operationally, however, it is increasingly recognized that different instruments may complement one another, in the sense that each one allows the other to perform better than it could alone. For example, law enforcement may help treatment by putting pressure on drug users to seek and remain in treatment, or by providing a direct referral source for drug users who have not yet decided to volunteer for treatment. Drug treatment may help law enforcement succeed by providing a lower cost, more effective response to drug-using offenders than jail or prison, and by softening the harsh consequences of drug law enforcement that would otherwise apply. These positive complementarities between enforcement and treatment, however, must be balanced against the possibility that efforts to coerce drug users into treatment may widen the reach and deepen the intensity of punishment. Complementarities may also exist among drug control instruments operating at different levels of government. It may be that international and federal enforcement efforts create conditions under which local efforts to control street-level drug markets can plausibly succeed in reducing the local availability of drugs. Conversely, effective local law enforce-

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us ment may provide some of the leads that are necessary to allow federal law enforcement efforts to become effective. In a different vein, federal financing of research on treatment may allow for more effective treatment efforts than localities could mount on their own. Moreover, as society has learned to see drug use in epidemic as well as endemic terms, people have begun to realize that the value of a particular policy instrument in a broader portfolio of drug control instruments may vary with time. At the early stage of an epidemic, it may be wise to combine drug abuse prevention activities with law enforcement so as to minimize its spread. At later stages, when rates of initiation of drug use have slowed, it may be that the emphasis should shift to treatment. Thus, thinking about complementaries among drug control instruments should recognize the dynamics of drug problems. SCOPE AND THEMES OF THE REPORT The charge to the committee requested a study of data and research to inform drug control policy. In one very important sense, this charge set a clear limit on the scope of the committee’s work. Our mandate was the positive task of informing drug policy, not the normative task of recommending policy. Thus the reader of this report will not find policy prescriptions herein. In particular, the report neither endorses nor condemns current drug control policy. Yet the charge as stated is very broad. It was clear at the outset that achievement of a useful, well-grounded consensus report would require that the committee limit the scope of its work. As does every NRC committee, we had to confront the reality that, however pressing and important the problem of public policy may be, a time-limited committee of volunteers assisted by a small staff needs to choose its themes carefully if it is to contribute at all. Considering how best to use our time and resources, we were mindful that earlier committees of the National Academies had previously investigated some aspects of the nation’s drug problems, although not the broad question of how data and research might inform policy. Box 1.2 lists these recent reports on drug problems. We have aimed to build on and complement this work, not duplicate it. We also were aware that our own efforts to inform drug control policy would undoubtedly be followed by those of others, who may in turn build on our work. With these thoughts in mind, the committee reached several strategic decisions on scope and themes that ultimately shaped this report. We call attention to these decisions here, so that readers will better anticipate what to expect and not expect in the chapters that follow.

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us BOX 1.2 Recent Reports of the National Academies on Drug Problems Institute of Medicine 1990 Treating Drug Problems, Volume 1. Committee for the Substance Abuse Coverage Study. Dean Gerstein and Henrick J.Harwood, editors. Washington, DC: National Academy Press. 1992 Treating Drug Problems, Volume 2. Committee for the Substance Abuse Coverage Study. Dean R.Gerstein and Henrick J.Harwood, editors. Washington, DC: National Academy Press. 1995 The Development of Medications for the Treatment of Opiate and Cocaine Addictions: Issues for the Government and Private Sector. Committee to Study Medication Development and Research at the National Institute on Drug Abuse. Carolyn E.Fulco, Catharyn T.Liverman, and Laurence E.Earley, editors. Committee to Study Medication Development and Research at the National Institute on Drug Abuse. Washington, DC: National Academy Press. 1996 Pathways of Addiction: Opportunities in Drug Abuse Research. Committee on Opportunities in Drug Abuse Research. Washington, DC: National Academy Press. 1997 Dispelling the Myths About Addiction: Strategies to Increase Understanding and Strengthen Research. Committee to Identify Strategies to Raise the Profile of Substance Abuse and Alcoholism Research. Washington, DC: National Academy Press. 1999 Marijuana and Medicine: Assessing the Science Base. Janet E.Joy, Stanley J.Watson, Jr., and John A.Benson, Jr., editors. Washington, DC: National Academy Press. National Research Council 1993 Preventing Drug Abuse: What Do We Know? Committee on Substance Abuse Prevention Research. Dean R.Gerstein and Lawrence W.Green, editors. Washington, DC: National Academy Press. 1993 Under The Influence? Drugs and the American Work Force. Jacques Normand, Richard O.Lempert, and Charles P.O’Brien, editors. Committee on Drug Use in the Workplace. Washington, DC: National Academy Press.

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us Illegal Drugs The first major decision that the committee made was to focus on substances whose sale or use is illegal in America today, taking the legal status of drugs as given. A more expansive scope for our work could easily have been justified. From a public health perspective, addiction to such legal substances as tobacco and alcohol may constitute problems more severe in their adverse consequences than addiction to such illegal drugs as cocaine, heroin, or marijuana. From a behavioral perspective, complementaries in the use of legal and illegal drugs have been conjectured in the “gateway hypothesis,” which posits that the early use of tobacco and marijuana is usually a precursor to the use of hard drugs, while the substitutability of legal and illegal psychoactive drugs has been emphasized by economic models that focus on the role of prices in determining drug use. From a legal perspective, it is useful to keep in mind that the legal status of addictive substances is not immutable; drug laws are made by and can be changed by society. All of these considerations notwithstanding, the committee made a pragmatic decision to focus its attention on the illegal drugs that are the targets of present-day drug control policy. We decided that any attempt to confront the public health problems posed by alcohol and tobacco would make the task entirely unmanageable. We do, however, cite data and research on alcohol and tobacco when they may offer lessons for analysis of illegal drugs, for example, when studying the drug use of minors. We decided that changes in the legal status of addictive substances, such as the prohibition of alcohol and the legalization of marijuana, are not sufficiently under active consideration by policy makers for this committee to contemplate what data and research may have to say about these policy options. Indeed, the committee has for the most part focused on a subset of illegal drugs. This report dwells on cocaine, with lesser attention to heroin, and still less to other drugs. Giving primacy to cocaine may be natural in light of the “crack” cocaine crisis that gripped American society in the 1980s and the continuing position of cocaine as a focus of research and a flash point in the public debate about drugs. Yet the committee is aware that patterns of drug use may change with time. Twenty years ago it would have been natural to give primacy to heroin, and this may again be the case in the near future. Or one of numerous synthetic addictive substances may pose the overriding drug threat of tomorrow. Be this as it may, the broad substantive concerns and methodological issues addressed in this report will remain germane to drug policy.

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us The Nation’s Investments in Data and Research: Focus on Enforcement As the committee went about its work, it discovered that the research available to evaluate different instruments of drug control policy varies as dramatically in magnitude as in mode. We found the central problem to be a serious lack of investment in programs of data collection and empirical research that would enable evaluation of the nation’s investment in drug law enforcement. Existing programs of data and research on drug treatment and prevention receive more resources and are therefore further developed. The committee does make recommendations whose implementation should further strengthen the nation’s understanding of treatment and prevention, but these recommendations are mainly meant to improve programs of data and research that are already in place. It is the committee’s view that to inform enforcement policy will require initiation of entirely new programs, as well as development of appropriate organizational infrastructure to support them. Between 1981 and 1999 the nation’s 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 committee has reluctantly concluded that the nation is in no better position to evaluate the effectiveness of enforcement now than it was 20 years ago, when the recent intensification of enforcement began. Collection of the data and performance of the research needed to inform enforcement policy will require new resources. The committee has not attempted to determine the specific costs of the initiatives recommended in this report. To explain the absence of cost estimates, it may suffice to observe that the task of producing them lay beyond the charge to the committee. However, the more basic reason why the committee does not provide cost estimates is that any such estimates would be too speculative to be useful. Our recommendations for new data and research to inform enforcement policy call for the nation to begin the process of developing a coherent body of knowledge. The proper time to produce specific cost estimates will be when that process is under way. What the committee can say is that we view the recommended enhancements of data and research as neither impossible to accomplish nor

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us prohibitive in cost. It is the committee’s view that Congress should provide new funds for this effort. Consider 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 caseloads in the federal courts), technology development, and drug testing, rather than data collection and social science research.3 Implementation of Recommendations As the committee formulated each of its many recommendations, it deliberated about how they might best be implemented (Table 1.1 lists all of the recommendations at the end of this chapter). 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 us to do so. The committee deliberated especially fully on how the nation might best implement its recommendations on data collection for monitoring 3   In 1991, the federal investment in enforcement research was $111.6 million, or 2.5 percent of federal domestic enforcement expenditures and 0.5 percent of the total expenditure on drug control. By 1999, federal funds alone for enforcement had increased to $12.3 billion, reflecting a near doubling in spending on domestic enforcement over 1991 levels, yet enforcement research funding remained essentially stable at $113.2 million (Office of National Drug Control Policy, 2000).

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us drug problems. A full chapter of this report (Chapter 4) examines this question. Present-Oriented and Forward-Looking Analysis of Drug Policy Early in its deliberations, the committee found it essential to distinguish between two senses, one present-oriented and the other forward-looking, in which data and research can inform drug policy. We recognize that an analysis may be of value to decision makers today if it makes the best use it can of whatever data are currently available in order to furnish advice or reach conclusions about actions that must be taken now, before better data can be gathered and interpreted. The premises of such an analysis should be explicit, and the logic that links its steps should be transparent. Its conclusions should appropriately convey the uncertainty that is inevitable given the limitations of the existing data. But more than this should not be asked of it. Our report looks mainly to the future. The committee has been asked to explore how new data might enable research that yields much more definitive assessments of drug policy than are possible at present. It may take several years, a decade, or more to gather and interpret crucial data that are now unavailable—during which policy makers must continue to make do as they have in the past. But in the longer run, a sustained and systematic effort to develop firm empirical foundations for drug policy is necessary if the nation is to have any hope of improving the quality of its decision making. It makes no sense to continue to argue about drug policy for additional decades, as we have so often in the past, in terms of plausible but unverified assumptions about the nature of drug production, distribution, and use. If society is to make wiser decisions in the years ahead, we must now decide on a strategy to identify the critical empirical questions for drug policy and take the steps needed to answer these questions. Initiating this process is the important task addressed in this report. REFERENCES Institute of Medicine 1990 Treating Drug Problems, Volume 1. Committee for the Substance Abuse Coverage Study. Dean Gerstein and Henrick J.Harwood, editors. Washington, DC: National Academy Press. Office of National Drug Control Policy 2000 National Drug Control Strategy: Budget Summary February 2000. Washington, DC: U.S. Government Printing Office.

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us TABLE 1.1 Committee Recommendations Listed By Chapter Recommendation Page Number Agency or Agencies Research Data Procedure or Infrastructure Data Needs for Monitoring Drug Problems: Chapter 3 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. 83 ONCDP NIDA     X The committee recommends that the granting agency require that the contractors who gather data for Monitoring the Future move immediately to provide appropriate access to the longitudinal data. The committee recommends that if access is not provided in accordance with the guidelines of the oversight committee, the Office of National Drug Control Policy and the granting agency consider whether the public interest requires relocating the grant in another organization that will provide the level of access necessary for the data to be most useful for purposes of informing public policy on illegal drugs. 84 ONCDP NIDA   X   The committee recommends that work be started to develop methods for acquiring consumption data. 86 NIJ NSF BJS   X  

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us Recommendation Page Number Agency or Agencies Research Data Procedure or Infrastructure The committee recommends that methods be developed 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. 88 SAMHSA ONDCP NIDA BJS   X   The committee recommends a systematic and rigorous research program (1) to understand and monitor nonresponse and (2) to develop methods to reduce nonresponse to the extent possible. 95 NIDA SAMSHA X     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. 100 NIDA SAMSHA X     The committee recommends that the Office for National Drug Control Policy and the Centers for Disease Control and Prevention undertake to develop principles and procedures for information and surveillance systems on illegal drug-taking and its associated hazards. 105 ONCDP CDC X     The committee recommends that work be started to develop methods for improving existing data and acquiring more reliable drug price data. 111 NIJ BJS NSF   X   The committee recommends that a major effort be devoted to “importing” standard procedures on constructing price indices into the development of price indices for illegal drugs. This effort should take place in collaboration with federal statistical agencies that specialize in this area, particularly the Bureau of Labor Statistics. 116 NIJ BJS NSF BLS X    

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us The committee recommends that consideration be given to constructing a set of satellite accounts that track the flows in sectors comprising legal and illegal drugs. This set of accounts would be called the National Drug Accounts. These satellite accounts would not enter into the current core national income and product accounts. 117 BJS NIJ NSF   X   Drug Data Organization: Chapter 4 The committee recommends that public-use files of all major statistical series should be deposited in a data library. On a broader level, every agency sponsoring the collection of population-based data related to illegal drugs should require in their contracts and grants the timely deposit of public-use files in an appropriate data library or its dissemination in other ways. 129 ONDCP NIDA BJS SAMSHA CDC     X The committee recommends the formation of an executive branch board to review proposed data collection protocols that might be used as a part of a research effort to design, collect, report, and validate statistical series on economic data, such as prices, expenditures, and consumption. It may be necessary to have rules or legislation enabling the board to exercise its functions in a manner that clearly separates law enforcement from this research enterprise. 130 ONDCP     X 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. 135 ONCDP     X

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us Recommendation Page Number Agency or Agencies Research Data Procedure or Infrastructure Supply-Reduction Policy: Chapter 5 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. 157 ONDCP NSF BJS NIJ X X   The committee recommends research on how illegal drug prices are determined. Much law enforcement activity is aimed, at least in part, at increasing the price of drugs. Without reliable knowledge of how retail prices are determined, one can only speculate about the effectiveness of such programs. 166 BJS NSF NIJ X     The committee recommends survey research on the labor supply of illegal drug dealers. 169 BJS NIJ NSF X     The committee recommends that state and local governments be encouraged to explore and assess alternative approaches to law enforcement, including decreases as well as increases in the intensity of enforcement. Organizational arrangements should be made to ensure that the resulting changes in law enforcement measures and policy are well designed and that the data needed to evaluate their consequences are acquired and analyzed. 178 BJS NIJ NSF     X

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us Sanctions Against Users of Illegal Drugs: Chapter 6 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. 195 NIJ NIDA X     The committee recommends that the National Institute of Justice and the National Institute on Drug Abuse collaborate in stimulating research on the effects of supplemental sanctions, including loss of welfare benefits, driver’s licenses, and public housing, on the use of illegal drugs. 197 NIJ NIDA X     The committee recommends that the Bureau of Labor Statistics monitor the measures taken by employers to discourage use of illegal drugs by their employees, including drug testing, and that the National Institute on Drug Abuse support rigorous research on the preventive effects and cost-effectiveness of workplace drug testing. 201 BLS NIDA X     The committee recommends that the National Institute on Drug Abuse and the Office of Educational Research and Improvement support rigorous research on the preventive effects, costs, and cost-effectiveness of drug testing in high schools, with a particular emphasis on the relationship between drug testing and other formal and informal mechanisms of social control. 203 NIDA OERI X    

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us Recommendation Page Number Agency or Agencies Research Data Procedure or Infrastructure Preventing Drug Use: Chapter 7 The committee recommends additional research to assess the effectiveness of social competency skill development and normative education approaches, which emphasize conveying correct information about the prevalence of drug use and its harmful effects. 227   X     The committee recommends additional research on prevention practices implemented under conditions of normal practice so that variability in effects from study to study may be better understood. The committee recommends further research on alternative methods and targeting mechanisms for teaching social competency skills. 227   X     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. 234 X      

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us Treatment of Drug Users: Chapter 8 The committee recommends that priorities for the funding of treatment evaluation research should be changed; large-scale, national treatment inventory studies should not be conducted at the expense of greater funding for randomized controlled clinical trials. 249 NIDA X     The committee recommends greater scientific attention to now-missed opportunities to conduct randomized trials of drug treatments with no-treatment control conditions. 258 NIDA X     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. 263 NIDA X     The committee strongly recommends that treatments intended to benefit people be evaluated in carefully conducted randomized controlled experiments. 263 NIDA X     The committee recommends broader use of meta-analytic techniques for cumulating and comparing findings across treatment outcome studies. 265 NIDA X    

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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us Recommendation Page Number Agency or Agencies Research Data Procedure or Infrastructure Final Thoughts: Chapter 9 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. 277 NIJ NSF BJS     X NOTE: BJS=Bureau of Justice Statistics BLS=Bureau of Labor Statistics CDC=Centers for Disease Control and Prevention NIDA=National Institute on Drug Abuse NIJ=National Institute of Justice NSF=National Science Foundation OERI=Office of Educational Research and Improvement ONDCP=Office of National Drug Control Policy SAMHSA=Substance Abuse and Mental Health Services Administration