Most major researchers believe that source, the National Survey on Drug Use and Health, vastly understates the increase in heroin use. But many rely on the survey anyway for a simple reason: It’s the best data they have. Several other sources that researchers once relied on are no longer being updated or have become more difficult to access. The lack of data means researchers, policymakers and public health workers are facing the worst U.S. drug epidemic in a generation without essential information about the nature of the problem or its scale. [...]
Among the key questions that researchers are struggling to answer: Is the recent spike in deaths primarily the result of increased heroin use, or is it also due to the increased potency of the drug, perhaps because of the addition of fentanyl, a synthetic opioid that can kill in small doses? [...]
The National Survey on Drug Use and Health, which is an annual household survey, is sponsored by the Substance Abuse and Mental Health Services Administration, a division of the federal Department of Health and Human Services. Through roughly 70,000 interviews, the survey collects information nationwide on the use of tobacco, alcohol and illegal drugs, as well as Americans’ mental health. Experts who study illicit drugs say the survey is an important source for estimating the number of those who use alcohol, tobacco and, increasingly, cannabis (because of the normalization of marijuana use). But many consider it inadequate for calculating the number of users of harder drugs such as heroin, cocaine and methamphetamine, which carry a greater stigma. Moreover, the survey excludes people without a fixed address, meaning people who are homeless or transient — a category that includes many of the heaviest drug users. These factors lead experts to believe the survey significantly underreports the number of users of hard drugs in the U.S. (A spokesman for SAMHSA said the survey doesn’t capture certain populations, including the homeless, and acknowledged that it faces other “limitations inherent in surveys.”) [...]
The lack of reliable national data is hindering efforts to tackle the spread of heroin, experts say. Some big cities such as New York have embarked on their own data-collection efforts, something the many smaller cities and towns ravaged by heroin overdoses likely can’t afford to do. Researchers say they need the federal government to help fund and coordinate efforts to collect data from local coroner’s offices, emergency rooms and crime labs so that local officials know where and how to direct their efforts. And, more broadly, they say they need a wide range of groups — researchers, public health workers, law enforcement officers, as well as federal, state and local governments — to work together to understand the heroin epidemic and to figure out how to stop it.
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