Becoming a Statistic

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Were it not for the gray streak in his mustache, one might never guess that Eddie Olmo is 50 years old. But judging from the scars on his arms and legs, he has lived several lifetimes over, and by all accounts, including his own, he should be dead.

Olmo's scars — the result of needle pricks, cigarette burns and scrapes — mark more than three decades of getting high on heroin. He says he first tried the drug at 13 and "was practically married to it" by the age of 22: "It became my total love. It was everything to me. I became not just an addict, but a stone-cold junkie." But last year he found a new love — a woman named Gladys, who inspired him to enter rehab. In 2006, Olmo was one of an estimated 22 million Americans with a substance abuse or dependency problem; today, he's one of just 2.5 million of those addicts to enter a hospital or clinic for treatment, according to the latest National Survey on Drug Use and Health (NSDUH) from the Substance Abuse and Mental Health Services Administration (SAMHSA).

At least, that's what the numbers say. Though it's been more than 30 years since Richard Nixon famously announced America's "War on Drugs," it's hard to know exactly how far we are from victory, partly because the facts are so elusive: Who uses illegal drugs? Which drugs? How often? The answers come mainly from SAMHSA's national survey, a complex and carefully worded questionnaire administered continually throughout the year. It is one of the government's primary sources of statistical information on the use of illegal drugs by the U.S. population, but its data are far from perfect.

"The bottom line is, we learn about drug use by asking people about their behaviors," says Dr. Wilson Compton, director of the Division of Epidemiology Services and Prevention Research at the National Institute on Drug Abuse. "But because it's survey research, there are multiple ways it can be improved."

One inherent drawback of self-reporting is the tendency for respondents to simply lie about their illicit drug use, for obvious reasons. To address this problem, SAMHSA introduced hand-held computer modules in 1999, eliminating the need for a government mediator to administer the survey face-to-face. To encourage better response rates, the agency began offering a $30 cash incentive. More recently, a new challenge has arisen: as the number of Spanish-speaking Americans continues to grow, officials face problems in translation. Certain Spanish words mean different things to Puerto Ricans than they do to Cubans or Mexicans, according to Joe Gfroerer, director of SAMHSA's population surveys division.

Officials supplement and cross-check the survey's results with other, quantifiable, verifiable data like the number of drug-related arrests and drug seizures in a particular area. Another research tool, known as the Drug Abuse Warning Network, or DAWN, tracks the number of emergency-room visits and drug overdoses throughout the country. Using figures like these, officials determine where and how funding will be allocated throughout the country, Compton says. But these numbers fail to account for those drug dealers and users who have managed to avoid doctors and police.

Another window into the world of drug abuse is through the workplace. Drug tests are often mandated at trucking companies and pharmacies, where on-the-job drug abuse is particularly dangerous to the public. In August, the Office of National Drug Policy released a report showing a 15.9% decline in the number of positive drug tests for cocaine among the U.S. workforce during the first six months of 2007 compared with 2006. But how accurate are these numbers? Workplace drug tests can't catch all drug abuse. The tests have a fleeting detection period — drugs must be consumed within the last few days or even hours for positive results, according to Dr. Barry Sample, Director of Science and Technology for the Employer Solutions Division at Quest Diagnostics, a workplace drug-testing company.

Now researchers at Oregon State University are taking a new approach to assessing drug use that could potentially transform the government's understanding of America's drug problem. In small samples taken from untreated community sewage plants in six major cities, lead researcher Jennifer Field has been identifying and analyzing chemicals the body produces after breaking down substances like marijuana, cocaine, ecstasy and heroin. This method, first used by Italian scientists to gauge regional cocaine use, allows researchers to analyze data within hours, tracking drug use, not over a year's time using aggregated national data, but over a few days' time within a small, defined region. The window of detection is short here too, but if samples are taken frequently enough, you get a long-exposure image of a community's drug habits. Though the science is still relatively new, Field says she hopes to begin working with local police to test the method's accuracy.

But even if such testing proves reliable, drug officials must still grapple with society's changing perception of what constitutes a drug and what constitutes abuse. The Department of Justice and the Department of Health and Human Services work together to rank drugs like ecstasy, aspirin and cocaine on a scale of five schedules, or classifications. Cocaine, for instance, is categorized as a "Schedule II" drug because of its medical use as a local anesthetic. (Other Schedule II drugs include morphine, which also poses a high risk for abuse but is recognized as medically useful. Schedule I drugs, like heroin, are considered the most dangerous of all substances.)

Robert Yancey, a program director at a New York City drug clinic called Turning Point, blames the dangerously lax attitude toward cocaine in the 1970s for fueling the drug's popularity — and fostering the crack epidemic of the 1980s. One law enforcement official in Philadelphia says a contemporary analogy is the growing abuse of prescription painkillers, which now ranks second — behind marijuana use — as the nation's most prevalent illegal drug problem, according to the Office of National Drug Control Policy. But in tracking drugs like OxyContin, also known as "hillbilly heroin," officials must first distinguish drug abuse from mere "medical misuse," Compton says. Officials actually had to modify the NSDUH survey after realizing that some methamphetamine users failed to report using the drug because they were taking it with a prescription.

Next year, the federal government will spend more than $12 billion to battle the use and availability of illicit drugs. The fight involves the work of 11 federal agencies, including the State Department, the Justice Department, the Department of Health and Human Services and the Department of Homeland Security. But for all the complexities that come with fighting such a stubborn plague as substance abuse, recovering drug users like Olmo say surveys and statistics can't capture the all-consuming despair of addiction. The war on drugs, he says, "is all about the numbers and money." We're at least now trying to do something about the numbers.