A Review of Drug Abuse Data Bases: Treatment-Oriented Data Systems

2015

Six treatment-oriented data systems were studied:

1. Drug Abuse Warning Network (DAWN)

Purpose. Project DAWN is a Federal program jointly funded by the Drug Enforcement Administration (DEA) and the National Institute on Drug Abuse (NIDA). DAWN has been in existence since 1972 and was established to monitor the consequences of drug abuse using two indicators, emergency room visits and deaths.

Respondents and Sampling. DAWN collects its information through episode reports provided by selected hospital emergency rooms, crisis centers, and medical examiners. In order to be eligible, emergency rooms must:

  • Be open 24 hours per day;
  • Be located in non-Federal short-term general hospitals (specialty hospitals, hospital units of institutions, and pediatric hospitals are excluded); and
  • Have at least 1,000 patient visits to the emergency room per year.

At the end of 1978, over 900 facilities were supplying data to the program.

Reporting facilities are concentrated in 24 Standard Metropolitan Statistical Areas (SMSA’S) which are not randomly selected but are chosen to account for approximately 30 percent of the population of the U.S. in geographically diverse locations.

Drugs Investigated. DAWN distinguishes between drug “episodes” and drug “mentions.” An episode is a contact with a facility or a medical examiner for a drug-related emergency. A “mention” represents a drug involved in an episode; there may be one or more drugs mentioned for each episode.

DAWN has a vocabulary of approximately 3,000 substances which have been mentioned in relation to incidents of drug abuse. These substances are grouped into 99 therapeutic classes based on the National Drug and Therapeutic Index.

Information Collected. DAWN focuses on the drug users and the drugs used by having a reporter in each participating facility complete a report for each drug abuse contact.

Data / Results. DAWN results are presented system-wide as well as by SMSA. Highlights from the October-December 1978 quarterly report include:

  • In the quarter October – December 1978, the frequency of mentions by therapeutic class was tranquilizers (22 percent), alcohol in combination (13 percent), nonnarcotic analgesics (10 percent), nonbarbiturate sedatives (8 percent), and narcotic analgesics (8 percent). This order has remained the same since the quarter January – March 1978.
  • The trend of marijuana mentions peaked in April 1978 and steadily declined in the remainder of 1978 to reach the 1977 level.
  • Of the 745 deaths reported, 83 percent were drug-caused. The five drugs most often associated with drug deaths were, in order, alcohol in combination, d-propoxyphene, heroin / morphine, diazepam, and secobarbital.
  • Together the hallucinogen PCP and PCP combinations eclipsed LSD as the major hallucinogen of mention in the total DAWN system, accounting for 73 percent of the mentions in its drug class.
  • Between 1976 and 1978, death reports of abusers in the 20 to 29 age range fell by 5 percent, while reports of abuser deaths in the 50 and over range increased by 4 percent.

Limitations of Data Base. Some limitations of the DAWN data collection methodology include:

  • SMSA’s are not randomly selected;
  • All facilities in participating SMSA’s are not able or willing to participate;
  • Only people who seek treatment for drug-related problems (or who die as a result of drug-related causes) are included in DAWN; and
  • The DAWN reporting base (number of days per month, number of reporting facilities, degree of saturation) changes constantly.

2. Drug Watch

Description. Drug Watch is a DAWN-related system for monitoring recent trends in drug-related medical emergencies and deaths. Drug Watch utilizes these incidents as indicators of the changing extent and nature of drug abuse.

Respondents and Sampling. Drug Watch focuses on reports by a select group of approximately 600 emergency rooms and 100 medical examiners that have participated in DAWN since January 1974 and have reported for at least 90 percent of reportable days. The panel is not selected to be geographically representative, but it does have reasonable geographic coverage. Because Drug Watch uses a select panel, it is clear that changes in the trends observed are not attributable to changes in the reporting base.

Drugs Investigated. Because interest is usually in charting trends in the activity of major drug classifications, Drug Watch monitors a limited number of broad drug categories, such as barbiturates or tranquilizers. If there is an interest in a particular drug, more detailed information on that drug will be prepared through Drug Watch.

Information Collected. The Drug Watch computer program reviews reports for each drug group during a 26-month period. The reports are then distributed by month, and monthly totals are converted to 3-month moving averages. The results are then graphed by a high speed line printer. These graphs comprise the bulk of Drug Watch reports.

Data / Results. As previously mentioned, most Drug Watch data are presented graphically. However, some examples of results presented in Drug Watch, July 1977, include the following:

  • Based on reports from emergency rooms from November 1974 to October 1976, tranquilizers were the most frequently mentioned drug, with 73,340 mentions or 24.3 percent of total mentions.
  • Inhalants were the least mentioned drug in emergency room reports, with only 1,486 mentions, or 0.49 percent of total mentions.
  • Medical examiner reports mentioned heroin / morphine most frequently, with 4,093 mentions or 19.4 percent of the total.
  • Cannabis was least mentioned by medical examiners, with only 14 mentions, or 0.07 percent of total mentions.

Limitations of Drug Watch Data Base.

  • Only people who seek treatment for drug-related problems or who die as a result of drug-related causes are included;
  • The use of a select panel limits the reporting base so that it may not be sufficiently broad to accurately reflect trends in drug use; and
  • The panel is not selected to ensure geographical representativeness.

3. Client Oriented Data Acquisition Process (CODAP)

Description. CODAP is a required reporting process for all drug abuse units receiving Federal funds for the provision of treatment and rehabilitation services. CODAP is funded by the National Institute on Drug Abuse and is designed to collect data on clients admitted to and discharged from treatment for drug abuse.

Respondents and Sampling. CODAP admission and discharge forms are completed for each client admitted to and discharged from these clinics, regardless of the source of funding support for any particular client. CODAP Client Flow Summary forms are submitted each month by every clinic that reports through CODAP.

Drugs Investigated / Information Collected. CODAP reports include:

  • General notes and an overview of trends in client drug problems;
  • Trends in client demographics and treatment data for all clients; and
  • Data on clients reporting use of opiates, marijuana, barbiturates, and amphetamines as the primary drug, presented in relation to such client characteristics as geographic region, age at admission, age at first use of primary drug, race / ethnicity, and sex.

Data / Results. Highlights from the Trend Report of January 1975 through September 1978 include:

  • Marijuana abusers represented 16.8 percent of all clients in the first quarter of 1975, declined to 7.9 percent in the third quarter of 1976, and then rose gradually to 12.9 percent in 1978.
  • There were great differences in the relative proportion of opiate abusers among the various regions. For example, in the third quarter of 1978, opiate abusers represented 60.7 percent of all clients in the Middle Atlantic region, while they represented only 19.4 percent of all clients in the East South Central region. It is important to note, however, that regional differences may be due to differences in the types of clients from region to region.
  • At least 50 percent of all admissions were between 21 and 30 years of age.
  • CODAP clients were predominantly male. The relative proportion of males decreased slightly, from 74.3 percent of all admissions in the first quarter of 1975 to 71.9 percent in the third quarter of 1978.

Limitations of Data Base. Limitations inherent in CODAP’s data collection methodology include:

  • Only persons who seek treatment for drug-related problems at a federally funded treatment facility are included.
  • Developing patterns shown in data are generally of small magnitude.
  • Changes observed during a single quarter may be misleading and may not be sustained by subsequent data.
  • Each admission reported does not necessarily represent a different client; to minimize the problem of multiple counts, reports representing the transfers of a client from one clinic to another are not included in the data.

4. Drug Enforcement Statistical Report

Description. The Drug Enforcement Administration of the U. S. Department of Justice publishes the Drug Enforcement Statistical Report. This publication is designed to be a reporting vehicle; no attempt is made to predict future trends. Data are presented by both calendar and fiscal year. Calendar years 1975 through the third quarter of 1979 are included, as are fiscal years 1976 through 1979.

Information Collected. This document is divided into three sections: Enforcement Activity, Drug Abuse Indicators, and Organization and Training Data. The first section, Enforcement Activity, presents data on such subjects as domestic drug removals, port and border drug removals, drug-related arrests and defendant dispositions, and arrests of aliens in the U. S. for drug offenses. The Drug Abuse Indicators section includes data on, for example, national illicit drug retail prices, drug-related deaths and injuries, and federally funded drug treatment admissions. Much of the data in this section is collected through the DAWN and CODAP systems. The last section, Organization and Training Data, presents statistics on the number of DEA personnel and field offices, the number of DEA agents and investigators, and the number of DEA training facilities and activities.

Data / Results. The data highlighted in the Drug Enforcement Statistical Report which covers the period from January 1975 through September 1979 includes the following:

  • Total DEA domestic drug removals for calendar years 1975 through the third quarter of 1979 were highest for stimulants. However, for CY 1978, removals of hallucinogens (4,349,917 dosage units) exceeded stimulants removals.

Limitations of the Data Base. The data in this report have a limited use for projecting nationwide drug use, first, because only cases of drug use identified as the result of a drug-related legal or medical problem are included. In addition, the majority of the data presented here are categorized according to the type of drug involved, rather than according to user characteristics. Finally, those data presented here which are taken from DAWN or CODAP data are subject to the limitations already described for those two systems.

5. Regional Drug Situation Analysis

Description. The Drug Enforcement Administration of the U. S. Department of Justice compiles the Regional Drug Situation Analysis on the following regions: the Northeast, North Central, Southeast, South Central, and Western regions.

Drugs Investigated / Information Collected. Each regional analysis document-contains a summary of nationwide data followed by data specific to the SMSA’s in that particular region. Each document includes the following data:

  • Some significant nationwide and SMSA-specific data (e.g., number of deaths, number of injuries, number of treatment admissions) for the following drugs heroin, cocaine, hallucinogens, stimulants, and depressants;
  • National and regional drug thefts, by number and volume;
  • Retail heroin price and purity index, both national and by region;
  • Drug-related injuries and deaths, nationally, by region, and by drug;
  • Lab seizures by drug and by region; and

Drug mentions by drug type and SMSA.

Data / Results. Examples of data presented in the Regional Drug Situation Analysis are exhibited in tables “Age at Time of Admission to Federally Funded Drug Treatment Programs, 1978 (Regional Drug Situation Analysis)” and “Average Number of Drug-Related Deaths per Quarter by Drug and Region, 1978 (Regional Drug Situation Analysis)” which follow.

Limitations of the Data Base. Many of the data presented in these regional analyses are taken from the DAWN and CODAP systems and thus are subject to the limitations already described. In addition, there is very little breakdown of data by user characteristic in these documents.

6. National Drug Abuse Treatment Utilization Survey (NDATUS)

Description. This data base is composed of statistics similar to those collected by CODAP and suffers from many of the limitations inherent in the CODAP data base.

Unlike CODAP, NDATUS collects data from all known treatment units in the U. S., Puerto Rico, and the Virgin Islands, regardless of their funding source. The data are collected annually for a point prevalence period (i.e., for a given point in time). The most recent published data are for April 1979. Before 1979, data were collected only for drug treatment facilities; however, in 1979, the data base was expanded to include alcoholism treatment units as well as drug treatment units.

Data / Results. In 1979, 3,590 drug abuse treatment units participated in the survey, which represented 94.7 percent of all known drug treatment facilities. The data related to the number of drug abusers are summarized

  • There were 202,689 clients in treatment as of April 30, 1979. This represented a utilization rate of 85.4 percent of the budgeted treatment slots.
  • Between 1977 and 1978, clients in treatment decreased by 9 percent and the utilization rate dropped 2.0 percentage points. Between 1978 and 1979, the utilization rate dropped 3.6 percentage points.

Limitations of the Data Base. Although these data can provide some general trends, they are limited in their usefulness for estimating the number of drug users nationally.

As with all treatment data, the numbers reflect a unique subpopulation of drug abusers–those who seek treatment. From these data, there is no way to estimate the number of users who have neither elected to nor been forced to participate in a treatment program. Also, the NDATUS data are not presented by type of drug problem, a factor which is critical to making estimates of the number of youthful users and the services they might need. Thirdly, the data are not organized according to any demographic features of the clients. Therefore, projections for specific subpopulations become impossible.

 

Selections from the book: “Demographic Trends and Drug Abuse, 1980-1995”. Louise G. Richards, Ph.D. , ed. Estimates of probable extent and nature of nonmedical drug use, 1980-1995, based on age structure and other characteristics of U.S. population. National Institute on Drug Abuse Research Monograph 35, May 1981.