Misuse of General Population Surveys; The Underestimation of Heroin Use in the USA

• In Event: Improving Our Understanding of Illicit Drug Markets

Abstract

The rise in the number of opioid caused deaths has generated a great interest in the number of those using heroin frequently. Estimates based on the National Survey on Drug Use and Health, the dominant general population surveys in the United States, are routinely published in prominent research journals and cited in policy. General population surveys (GPS) are the mainstay of epidemiologic research and policy statements on the use of addicting substances, but are poorly suited to describing the illicit market for heroin. However, GPS estimates are implausibly low when compared to other indicators, such as treatment admissions and arrestees reporting frequent heroin use. A substantial literature shows that (1) the sample framework is importantly incomplete since omitting the incarcerated population drops a large number of frequent users of heroin; (2) selective non-response is substantial and (3) under-reporting is comparably problematic. Alternative estimates that incorporate a less statistically strong sample of arrestees (Arrestee Drug Abuse Monitoring) are about 5 times as large as those from NSDUH and have been published in leading journals, but are often overlooked by the policy community. We explore the sources of the differences in the estimates, and describe the implications for public health and safety.

Authors

• Peter Reuter, University of Maryland

• Jonathan Caulkins, Carnegie Mellon University

• Greg Midgette, University of Maryland