University of Maryland, Department of Criminology and Criminal Justice, College Park, MD, USA.
University of Maryland, School of Public Policy, College Park, MD, USA.
Addiction. 2021 Oct;116(10):2600-2609. doi: 10.1111/add.15458. Epub 2021 Mar 27.
Globally, heroin and other opioids account for more than half of deaths and years-of-life-lost due to drug use and comprise one of the four major markets for illegal drugs. Having sound estimates of the number of problematic heroin users is fundamental to formulating sound health and criminal justice policies. Researchers and policymakers rely heavily upon general population surveys (GPS), such as the US National Survey on Drug Use and Health (NSDUH), to estimate heroin use, without confronting their limitations. GPS-based estimates are also ubiquitous for cocaine and methamphetamine, so insights pertaining to GPS for estimating heroin use are also relevant for those drug markets.
Four sources of potential errors in NSDUH are assessed: selective non-response, small sample size, sampling frame omissions and under-reporting. An alternative estimate drawing on a variety of sources including a survey of adult male arrestees is presented and explained. Other approaches to prevalence estimation are discussed.
Under-reporting and selective non-response in NSDUH are likely to lead to substantial underestimation. Small sample size leads to imprecise estimates and erratic year-to-year fluctuations. The alternative estimate provides credible evidence that NSDUH underestimates the number of frequent heroin users by at least three-quarters and perhaps much more.
GPS, even those as strong as NSDUH, are doomed by their nature to estimate poorly a rare and stigmatized behavior concentrated in a hard-to-track population. Although many European nations avoid reliance upon these surveys, many others follow the US model. Better estimation requires models that draw upon a variety of data sources, including GPS, to provide credible estimates. Recent methodological developments in selected countries can provide guidance. Journals should require researchers to critically assess the soundness of GPS estimates for any stigmatized drug-related behaviors with low prevalence rates.
在全球范围内，海洛因和其他阿片类药物导致的药物使用相关死亡人数和生命损失年数超过一半，是非法药物的四大市场之一。准确估计有问题的海洛因使用者人数是制定健全的卫生和刑事司法政策的基础。研究人员和政策制定者严重依赖于一般人群调查（GPS），如美国国家药物使用和健康调查（NSDUH），来估计海洛因使用情况，而没有正视其局限性。基于 GPS 的可卡因和甲基苯丙胺估计也无处不在，因此，与 GPS 用于估计海洛因使用情况相关的见解也与这些药物市场相关。
评估了 NSDUH 中可能存在的四个潜在错误来源：选择性无应答、样本量小、抽样框架遗漏和漏报。提出并解释了一种利用各种来源（包括对成年男性被捕者的调查）的替代估计方法。还讨论了其他流行率估计方法。
NSDUH 中的漏报和选择性无应答可能导致严重低估。样本量小导致估计不精确且逐年波动不定。替代估计提供了可靠的证据，表明 NSDUH 至少低估了频繁使用海洛因者的数量的四分之三，甚至可能更多。
GPS，即使像 NSDUH 那样强大，也注定因其性质而难以准确估计罕见且带有污名的行为，这些行为集中在难以追踪的人群中。尽管许多欧洲国家避免依赖这些调查，但许多其他国家都效仿美国模式。更好的估计需要利用各种数据源（包括 GPS）的模型，以提供可靠的估计。选定国家最近的方法学发展可以提供指导。期刊应要求研究人员批判性地评估 GPS 对任何流行率低的带有污名的与药物相关行为的估计的可靠性。
