T
The420Guy
Guest
Lies, Damn Lies and the Drug Abuse Warning Network Statistics
The University of Maryland's Center for Substance Abuse Research
(CESAR, www.https://cesar.umd.edu) devoted its latest weekly
CESAR FAX (6/19), which goes out to some 4500 subscribers, to
some dramatic but misleading numbers from the Drug Abuse Warning
Network (DAWN). DAWN reports on emergency room visits for "drug-
related" episodes, which it defines as emergency room visits
"induced by or related to the use of an illegal drug(s) or the
non-medical use of a legal drug for patients 6 years or older."
The fax's headline tells the story: "Marijuana-Related Emergency
Department Visits Now as Common as Heroin-Related." The brief
accompanying text describes a steady increase in marijuana-
related ER visits, from 16,251 in 1991 to a projected 79,088 this
year. Heroin-related visits are estimated to hit 77,009 this
year. Cocaine, meanwhile, will account for a projected 154,956
ER visits, the highest number for any illicit drug.
The inference to be drawn from the headline is that marijuana and
heroin are somehow having a roughly equal impact on users, at
least in hospital emergency rooms. The headline, however,
ignores the huge difference in the universe of heroin users and
that of marijuana users. The ratio of marijuana users to heroin
users is roughly 20:1. A more apt headline could have read,
"Heroin 20 Times More Likely than Marijuana to Be Mentioned in ER
Visits."
In the fax's text, CESAR descends even further into distortion.
The text describes ER incidents where marijuana has been
mentioned as occurring "because of marijuana use."
"CESAR should know better," said Doctor of Public Health David
Duncan of Westat, a research organization doing work under
contract with the federal government. One of Westat's ongoing
contracts involves evaluating the utility and efficacy of the
DAWN program.
"Merely because marijuana was mentioned," Duncan told DRCNet,
"doesn't mean the visit should be attributed to the drug." One
of the problems with the DAWN numbers, Duncan said, is the
confusion between mention and causation. "If you are struck by
lightning and the autopsy finds cocaine in your system, for
example, "that would be listed as a cocaine-related ER incident."
Similarly, DAWN methodology allows for the mention of up to four
drugs for each incident, so someone who comes in with a heroin
overdose but mentions having smoked marijuana will go into the
statistics as a marijuana mention as well as a heroin mention.
According to Chuck Thomas of the Marijuana Policy Project,
another problem with DAWN is that it does not distinguish the
qualitative differences among different ER incidents. Unlike
life-threatening hard drug overdoses, Thomas told DRCNet, most
marijuana-related ER incidents are presumably "anxiety attacks."
"Someone gets too high and his friends aren't smart enough to put
on some mellow music and tell him to calm down," said Thomas, "so
they go to the hospital and the staff there tells him to calm
down."
DAWN's limitations are familiar to professionals in the field.
Problems arise, however, when the data are misinterpreted or
misunderstood, either willfully or because of lack of
understanding of methodological issues. Likewise, the selective
cherry-picking of isolated statistics, as CESAR appears to have
done, distorts the overall findings of the DAWN reports. Among
the findings CESAR did not see fit to mention:
* All drug-related ER episodes declined 7% from the first half
of 1998 to the first half of 1999.
* There was no sign of increases in any of the illicit drugs
tracked.
* ER mentions of marijuana were "statistically unchanged" during
the period in question.
* Heroin-related ER incidents for 26-34 year-olds declined by
20%. (Adios to Gen-X heroin chic?)
* The most commonly cited reasons for heroin- and cocaine-
related ER visits was "seeking detox," in other words, access to
treatment.
CESAR merits criticism for its misleading reporting, but it is
not alone. CESAR Research Assistant Uyen Pham told DRCNet that
the organization sends its weekly faxes to the Substance Abuse
and Mental Health Services Administration (SAMHSA) for
prepublication review. "We do fax for SAMHSA approval, even for
the title," said Pham, "and they suggested no changes."
According to Dr. Duncan, the paramount point for people to
remember when discussing the DAWN numbers is "that they represent
only people who mentioned the drug in some way, not that it had
any role in causing the visit."
And, he cautions, "These numbers track only ER visits for the
substances listed; they do not track drug use levels. Neither do
they track alcohol, the most widely abused drug in America,
because the DEA wasn't interested in that."
The University of Maryland's Center for Substance Abuse Research
(CESAR, www.https://cesar.umd.edu) devoted its latest weekly
CESAR FAX (6/19), which goes out to some 4500 subscribers, to
some dramatic but misleading numbers from the Drug Abuse Warning
Network (DAWN). DAWN reports on emergency room visits for "drug-
related" episodes, which it defines as emergency room visits
"induced by or related to the use of an illegal drug(s) or the
non-medical use of a legal drug for patients 6 years or older."
The fax's headline tells the story: "Marijuana-Related Emergency
Department Visits Now as Common as Heroin-Related." The brief
accompanying text describes a steady increase in marijuana-
related ER visits, from 16,251 in 1991 to a projected 79,088 this
year. Heroin-related visits are estimated to hit 77,009 this
year. Cocaine, meanwhile, will account for a projected 154,956
ER visits, the highest number for any illicit drug.
The inference to be drawn from the headline is that marijuana and
heroin are somehow having a roughly equal impact on users, at
least in hospital emergency rooms. The headline, however,
ignores the huge difference in the universe of heroin users and
that of marijuana users. The ratio of marijuana users to heroin
users is roughly 20:1. A more apt headline could have read,
"Heroin 20 Times More Likely than Marijuana to Be Mentioned in ER
Visits."
In the fax's text, CESAR descends even further into distortion.
The text describes ER incidents where marijuana has been
mentioned as occurring "because of marijuana use."
"CESAR should know better," said Doctor of Public Health David
Duncan of Westat, a research organization doing work under
contract with the federal government. One of Westat's ongoing
contracts involves evaluating the utility and efficacy of the
DAWN program.
"Merely because marijuana was mentioned," Duncan told DRCNet,
"doesn't mean the visit should be attributed to the drug." One
of the problems with the DAWN numbers, Duncan said, is the
confusion between mention and causation. "If you are struck by
lightning and the autopsy finds cocaine in your system, for
example, "that would be listed as a cocaine-related ER incident."
Similarly, DAWN methodology allows for the mention of up to four
drugs for each incident, so someone who comes in with a heroin
overdose but mentions having smoked marijuana will go into the
statistics as a marijuana mention as well as a heroin mention.
According to Chuck Thomas of the Marijuana Policy Project,
another problem with DAWN is that it does not distinguish the
qualitative differences among different ER incidents. Unlike
life-threatening hard drug overdoses, Thomas told DRCNet, most
marijuana-related ER incidents are presumably "anxiety attacks."
"Someone gets too high and his friends aren't smart enough to put
on some mellow music and tell him to calm down," said Thomas, "so
they go to the hospital and the staff there tells him to calm
down."
DAWN's limitations are familiar to professionals in the field.
Problems arise, however, when the data are misinterpreted or
misunderstood, either willfully or because of lack of
understanding of methodological issues. Likewise, the selective
cherry-picking of isolated statistics, as CESAR appears to have
done, distorts the overall findings of the DAWN reports. Among
the findings CESAR did not see fit to mention:
* All drug-related ER episodes declined 7% from the first half
of 1998 to the first half of 1999.
* There was no sign of increases in any of the illicit drugs
tracked.
* ER mentions of marijuana were "statistically unchanged" during
the period in question.
* Heroin-related ER incidents for 26-34 year-olds declined by
20%. (Adios to Gen-X heroin chic?)
* The most commonly cited reasons for heroin- and cocaine-
related ER visits was "seeking detox," in other words, access to
treatment.
CESAR merits criticism for its misleading reporting, but it is
not alone. CESAR Research Assistant Uyen Pham told DRCNet that
the organization sends its weekly faxes to the Substance Abuse
and Mental Health Services Administration (SAMHSA) for
prepublication review. "We do fax for SAMHSA approval, even for
the title," said Pham, "and they suggested no changes."
According to Dr. Duncan, the paramount point for people to
remember when discussing the DAWN numbers is "that they represent
only people who mentioned the drug in some way, not that it had
any role in causing the visit."
And, he cautions, "These numbers track only ER visits for the
substances listed; they do not track drug use levels. Neither do
they track alcohol, the most widely abused drug in America,
because the DEA wasn't interested in that."
