NATIONAL INSTITUTE NIDA ON DRUG ABUSE

AssessingDrugAbuse

WithinandAcross

Communities

CommunityEpidemiologySurveillance

NetworksonDrugAbuse

SecondEdition
 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

NATIONAL INSTITUTES OF HEALTH 

National Institute on Drug Abuse 

Division of Epidemiology, Services and Prevention Research 

6001 Executive Boulevard 

Bethesda, Maryland 20892 
Acknowledgments 

Acknowledgments 

This publication was prepared under the scientific direction of Moira P. O’Brien, M. Phil., and 

Douglas Rugh, Ph.D., Epidemiology Research Branch, Division of Epidemiology, Services and 

Prevention Research, National Institute on Drug Abuse. The publication was prepared by MasiMax 

Resources, Inc., under contract number NO1-DA-15514 from NIDA. 

NIDA wishes to thank the following individuals for their guidance, comments, and contributions 

during the development and review of this publication: 

Erin Artigiani Daniel Dooley 

Center for Substance Boston Public Health Commission 

Abuse Research (CESAR) 

University of Maryland James N. Hall 

Up Front Information Center 

Judy K. Ball, Ph.D., M.P.A. Nova Southeastern University 

OAS, SAMHSA 

Jane C. Maxwell, Ph.D. 

Caleb Banta-Green, M.P.H., M.S.W. Center for Social Work Research 

Alcohol and Drug Abuse Institute University of Texas at Austin 

University of Washington 

Bruce D. Mendelson 

Elizabeth Crane, Ph.D., M.P.H. U.S. Department of Health and Human Services 

OAS, SAMHSA 

William A. Watson, Pharm. D. 

James K. Cunningham, Ph.D. American Association of Poison 

Drug Problem Analysis Center Control Centers 

University of Arizona 

Eric Wish, Ph.D. 

Samuel Cutler CESAR 

City of Philadelphia Behavioral University of Maryland 

Health System 

NIDA also wishes to acknowledge contributions by other representatives of the Community 

Epidemiology Work Group whose work is represented in this publication. 

All materials in this volume are in the public domain and may be used or reproduced without 

permission from NIDA or the authors. Citation of the source is appreciated. 

The U.S. Government does not endorse or favor any specific commercial product or company. 

Trade, proprietary, or company names appearing in the publication are used only because they are 

considered essential in the context of the material described here. 

NIH Publication No. 06-3614 

Printed September 2006 

Second Edition 

ii Assessing Drug Abuse Within and Across Communities: Second Edition 
 

Preface 

Preface 

Drug abuse has devastating consequences on individual abusers, their 

families, their communities, and our Nation. The phenomenon is dynamic, 

constantly changing, and complex. Like other diseases, it is important to 

identify and assess the nature and extent of drug abuse and emerging drug 

abuse problems as soon as possible. It is also important to closely monitor 

drug problems within and across communities. Epidemiology is one of the 

first lines of defense. It enables researchers to... 

 Assess the causes, determinants, and distribution of drug problems 

 Discover, identify, and track drug problems 

 Identify questions, issues, and research hypotheses 

 Plan appropriate intervention strategies 

 Launch public information campaigns 

 Alert communities 

The National Institute on Drug Abuse (NIDA) supports research on all aspects 

of drug abuse and addiction, ranging from studies of the brain to the nature 

and extent of drug abuse in different populations. A considerable body of 

knowledge has been produced through the research supported by NIDA over 

the years. The research has led to... 

 A greater understanding of the nature of drug addiction as a chronic 

disease 

 Knowledge on how to prevent and treat drug abuse and drug addiction 

NIDA has also supported the Community Epidemiology Work Group 

(CEWG) since 1976. The CEWG monitors and assesses drug abuse patterns, 

trends, and emerging problems across 21 sentinel areas in the United States 

using multiple sources of data. 

One of NIDA’s goals is to develop science-based tools and assist communities 

in using them to identify and assess drug problems, so communities, in turn, 

can provide the information to planners, policymakers, and interventionists 

who are involved in the prevention and treatment of drug abuse. 

In an effort to foster this goal, we are pleased to offer our newest edition of 

Assessing Drug Abuse Within and Across Communities, Second Edition. The 

publication provides updated guidelines on how to effectively establish and 

maintain drug abuse epidemiology surveillance networks. We also invite you 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse iii 
Preface 

to visit our Web site at <www.drugabuse.gov> where this publication and 

other materials related to the consequences, prevention, treatment, and 

monitoring of drug abuse patterns and trends are offered. We hope that 

communities and States will find this guide useful and helpful in their work. 

The strategies suggested in this guide are based on methods that have been 

applied in communities throughout our Nation and in other countries. Many 

of the examples provided on uses of different drug abuse indicators are from 

the CEWG and other epidemiology work groups. 

Nora D. Volkow, M.D. 

Director 

National Institute on Drug Abuse 

iv Assessing Drug Abuse Within and Across Communities: Second Edition 
 

 

Table of Contents 

Table of Contents 

Acknowledgments......................................................................................................ii 

Preface ................................................................................................................... iii 

Introduction..............................................................................................................1 

Part I. Community Epidemiology Surveillance Networks 

on Drug Abuse 

What Are Community Epidemiology Surveillance Networks? ..................................3 

Where and How Did Surveillance Networks Get Started? .......................................4 

Why are Networks Established? .........................................................................4 

What Are the Advantages of a Network? .............................................................6 

What Sources of Information Do Networks Access and Use? ..................................7 

How Are Local Networks Organized?...................................................................7 

How Should the First Network Meeting Be Organized? ..........................................9 

What Types of Problems Are Encountered by Networks? .....................................10 

Who Should Be Invited to the First Network Meeting? .........................................11 

Some Basic Steps in Accessing Drug Abuse Indicator Data ..................................14 

“Tips” on Establishing and Maintaining An Epidemiology 

 Surveillance Network .....................................................................................16 

Part II. Accessing and Analyzing Data from Different Sources 

1. Survey Data ................................................................................................18 

Accessing and Analyzing Survey Data...............................................................19 

2. Drug Abuse Treatment Data.................................................... ....................24 

Where to Start: How to Locate/Identify Treatment Programs in 

Specific Geographic Areas...............................................................................26 

What to Request............................................................................................26 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse v 
Table of Contents 

Uses of the Data: Examples of How Treatment Data are Analyzed 

and Reported ................................................................................................32 

3. Drug Abuse-Related Hospital Data ..............................................................35 

 Emergency Department Data ..........................................................................37 

– The Drug Abuse Warning Network (DAWN)................................................37 

– Local ED Data........................................................................................40 

– Where to Start: Accessing ED Data..........................................................40 

– What to Request ....................................................................................41 

– Uses of ED Data: Some Examples ...........................................................42 

Drug-Related Hospital Admissions and Discharge Data........................................43 

– Hospital Admissions Data: Access and Uses in Drug Analysis.......................44 

– Using Drug-Related Hospital Discharge Data in Colorado .............................52 

 Psychiatric Hospital Data ................................................................................57 

ADDENDUM A: Guidelines on Using Diagnostic Codes ........................................59 

4. Drug-Related Mortality Data .......................................................................62 

 Drug Abuse Warning Network..........................................................................64 

– Where to Start: Accessing DAWN ME/C Data ...........................................67 

– What to Access from DAWN ME/C ...........................................................67 

– Uses of DAWN ME/C Data ......................................................................67 

 Local Mortality Data .......................................................................................69 

– Accessing Local Mortality Data................................................................71 

– Uses of Local Mortality Data: King County, Washington, Example...............72 

Heroin and Prescription Opiates—Categorization Issues ......................................73 

ADDENDUM A: Classification of Mortality Cases in Philadelphia............................75 

5. Other Drug-Related Health Data..................................................................77 

Poison Control Center Data .............................................................................77 

– Where to Start: Accessing PCC Data.......................................................78 

– What to Request...................................................................................78 

– Uses of PCC Data: Texas Highlights........................................................79 

 Telephone Helpline Data .................................................................................83 

– Where to Start: Accessing Helpline Data .................................................84 

– What to Request...................................................................................84 

vi Assessing Drug Abuse Within and Across Communities: Second Edition 
 

Table of Contents 

– Uses of Helpline Data: Boston Example...................................................85 

HIV/AIDS and Hepatitis B and C Data.............................................................. .86 

– Where to Start: Accessing HIV, HBV, and HCV Data .................................86 

- What to Request ..................................................................................87 

– Uses of Data on AIDS and Hepatitis B and C.............................................87 

6. Law Enforcement/Criminal Justice System Data .........................................90 

Drug-Related Arrest Data ...............................................................................91 

– Police Department and Sheriff’s Office Data .............................................91 

– Uniform Crime Report Data....................................................................95 

– Other Sources of Arrest Data .................................................................96 

 Crime Laboratory Drug Data ......................................................................... 100 

– NFLIS Data ........................................................................................ 100 

– ARCOS Data ...................................................................................... 103 

Drug Trafficking and Related Data.................................................................. 104 

– Price and Purity Data—Illicit Drugs........................................................ 104 

– Drug Seizure Data .............................................................................. 108 

7. Qualitative Research Studies.....................................................................111 

 Key Informants ........................................................................................... 111 

 Ethnographic Research ................................................................................. 114 

ADDENDUM A. Ohio Substance Abuse Monitoring (OSAM) Network..................... 118 

ADDENDUM B. The Center for Substance Abuse Research (CESAR) .................... 119 

8. Other Useful Data Sources ........................................................................120 

 Census Data ............................................................................................... 120 

 University Researchers ................................................................................. 121 

 Community-Level Sources ............................................................................ 122 

Part III. Networking and Reporting 

9. Establishing and Developing Relationships with Information Sources ......123 

Public Versus Private Information Sources....................................................... 123 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse vii 
 

Table of Contents 

 Preparation/Making Contact .......................................................................... 123 

 Developing Relationships .............................................................................. 124 

10. Reporting ..................................................................................................125 

References ........................................................................................................... 126 

APPENDIX A. CEWG Primary Members by Location.................................................. 130 

APPENDIX B. Web Sites Containing Data and Information 

Discussed in this Publication ............................................................. 133
 

viii Assessing Drug Abuse Within and Across Communities: Second Edition 
Introduction 

Introduction 

In 1998, the National Institute on Drug Abuse (NIDA) published the first 

edition of Assessing Drug Abuse Within and Across Communities: Community 

Epidemiology Surveillance Networks on Drug Abuse to share information on 

establishing drug abuse epidemiology networks at community and State 

levels. The first edition was widely distributed and well received, with 

ongoing requests for a reprint of the publication. However, it was clear that an 

update and not a reprint would be of most value to the fields of drug abuse 

epidemiology, research, and intervention. Since 1998, the expansion of the 

Internet has greatly enhanced access to relevant drug abuse information. 

Also, since 1998, there have been substantial changes in drug abuse data 

sources used by epidemiology networks. This second edition addresses these 

changes, but the purpose of this edition remains the same: to provide 

guidelines for establishing epidemiology networks to monitor and assess drug 

abuse patterns and trends and emerging drug problems at community and 

State levels to provide a foundation of information for public health response. 

NIDA’s Division of Epidemiology, Services and Prevention Research has 

continued to support epidemiology networks, including the Community 

Epidemiology Work Group (CEWG) consisting of 21 sentinel metropolitan 

areas, the Border Epidemiology Work Group in coordination with the 

Ministry of Health of Mexico, and State Epidemiology Work Groups. 

International epidemiology networks, modeled after the CEWG, often present 

data at CEWG meetings on drug abuse patterns and trends in other nations. 

Years of experience with these groups are testimony to the contributions of 

epidemiology work groups in advising public health response in our Nation as 

well as other countries. 

This second edition differs from the first in format. For each data source, 

there is a description of the source and database, followed by guidelines on 

how to access the data (including Web sites) and what to request, and 

examples of how the data have been used by epidemiology work groups or 

Federal agencies. NIDA hopes that this revised guide is helpful to agencies, 

organizations, and researchers that are involved in or wish to establish 

epidemiology networks in their communities or States. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 1 

 Community Epidemiology Surveillance Networks on Drug Abuse 

PART I. COMMUNITY EPIDEMIOLOGY 

SURVEILLANCE NETWORKS ON 

DRUG ABUSE 

What Are Community Epidemiology Surveillance Networks? 

...network members 

access existing 

information from 

multiple sources... 

Community Epidemiology Surveillance Networks are multiagency work 

groups with a public health orientation that study the spread, growth, or 

development of drug abuse and related problems. The networks have a 

common aim––the assessment of drug abuse patterns, trends, and emerging 

problems to provide the foundation of information for public health response. 

The ultimate goal is the elimination or reduction of drug abuse and its related 

consequences. 

To achieve this goal, network members access existing information from 

multiple sources, including drug abuse treatment agencies, public health 

offices, law enforcement agencies, hospital emergency departments, medical 

examiner and coroners' offices, and local school and household surveys. Much 

useful data are available in published reports. Furthermore, the Internet has 

greatly facilitated access to many data sources and published reports. 

Members meet periodically to review, compare, and draw inferences from the 

data. The data are reported in a standardized format to facilitate the review 

and comparative analyses. Qualitative studies may be conducted to help 

members understand the quantitative findings from existing data sets. 

The primary objectives of the network members are to... 

 Identify drug abuse patterns in defined geographic areas 

 Identify changes in drug abuse patterns over defined time periods to 

establish trends 

 Detect emerging substances of abuse 

 Communicate and disseminate the information to appropriate community 

agencies and organizations so it can be used in developing policies, 

practices, prevention strategies, and research studies 

Network members are individuals who are in a position to access and assess 

information about drug use in specific geographic areas. They may represent 

agencies and organizations that have some responsibility for addressing drug 

abuse problems or that benefit directly from acquiring information about drug 

abuse. Researchers and other individuals who have special knowledge about a 

particular issue or drug-abusing population also may participate. Regularly 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 3 
 

Part I. Community Epidemiology Surveillance Networks on Drug Abuse 

scheduled network meetings provide a forum for members to share, review, 

and analyze information on the epidemiology of drug abuse. 

This guide focuses on practical ways of accessing and analyzing diverse 

indicator data from a variety of data sources and on effective ways of 

reporting such data. 

Where and How Did Surveillance Networks Get Started? 

...the Community 

Epidemiology Work 

Group (CEWG) has 

been meeting 

semiannually since 

1976... 

The first national level surveillance network was established in 1976 by the 

National Institute on Drug Abuse (NIDA), National Institutes of Health, to 

assess current drug use patterns in major metropolitan areas across the country 

and to identify emerging trends within and across these areas. This network, 

called the Community Epidemiology Work Group (CEWG), has been meeting

semiannually since 1976 to fulfill its role as a drug abuse surveillance system. 

CEWG members represent Atlanta, Baltimore, Boston, Chicago, Denver,

Detroit, Honolulu, Los Angeles, Miami/Ft. Lauderdale, Minneapolis/St. Paul, 

Newark, New Orleans, New York City, Philadelphia, Phoenix, St. Louis, San 

Diego, San Francisco, Seattle, the State of Texas, and Washington, DC. 

Names and contact information for CEWG representatives are presented in 

Appendix A of this publication, in each semiannual CEWG Volume II report, 

and on the NIDA Web site <http://www.nida.nih.gov> (see About 

NIDA/Organization/Community Epidemiology Work Group for both CEWG 

contact information and meeting reports). CEWG representatives are useful 

contacts for information specific to their cities and for additional advice on the 

organization of a local community surveillance network. 

Based on the NIDA CEWG model, State Epidemiology Work Groups 

(SEWGs) have been organized in many States. Other countries also have 

adopted the model. Similar work groups have been organized or are under 

development in Asia, Australia, Canada, Central America, Europe, Mexico, 

and South Africa. 

National CEWG information is disseminated by the Division of Epidemiology, 

Services and Prevention Research, NIDA, through its biannual report series 

entitled Epidemiologic Trends in Drug Abuse. Information on the national 

CEWG, its reports, and other important data sources can be accessed from the 

NIDA Web site (specified above). By clicking on “organization,” you will find 

it listed under Division of Epidemiology, Services and Prevention Research. 

Why Are Networks Established? 

Drug abuse and dependence strain resources at local, State, and national levels 

and threaten the well-being of drug abusers and their significant others. The 

4 Assessing Drug Abuse Within and Across Communities: Second Edition 
 Community Epidemiology Surveillance Networks on Drug Abuse 

...drug abusers 

continue to be an 

elusive population... 

The primary 

purpose...is to share 

timely and reliable 

information... 

types of drugs used and the populations using a particular drug or drugs at a 

particular period in time change, and drug abusers continue to be an elusive 

population that is not fully captured in prevalence studies. Drug abusers often 

remain “hidden” until they seek medical care, are arrested, or come into 

contact with social and criminal justice agencies. 

To best understand the problem, planners, policymakers, and practitioners 

need timely information on a regular basis so human, financial, and medical 

resources can be allocated appropriately. The research community also needs 

such information so studies can be planned and implemented to provide more 

indepth and definitive data to help guide policy and prevention and treatment 

interventions. 

In Chapters 1–8 of this publication, descriptions are provided of major types 

of data sources used by a network, with examples of how these data have been 

used. Many of the examples are provided by representatives of the CEWG. In 

the description of different data sources, the reader is referred to relevant Web 

sites. Information about relevant Web sites is also provided in Appendix B. 

Note, however, that Web site addresses sometimes change, and it may be 

necessary to search by the name of an agency or organization. 

The primary purpose of a local surveillance network is to share timely and 

reliable information about drug abuse. Surveillance networks help define and 

determine the magnitude of drug problems and provide an early warning for 

emerging problems. What types of drugs are being used in particular 

communities? Who is using them? How are they being used? What are the 

consequences of use? How are the patterns of use changing? 

Information of this type is essential to many agencies and organizations, 

especially those with responsibility for planning and allocating resources to 

address drug abuse and related problems. Too often, agencies plan strategies 

and commit resources without having up-to-date information about the nature 

and extent of drug abuse problems. These efforts can be wasteful and 

counterproductive. 

Patterns of drug use are determined not only by the availability and cost of 

different substances, but also by the dynamics and differences within groups, 

cultures, and communities. Drug abuse patterns are complex, dynamic 

phenomena that can quickly spread through and across communities. Drug 

abuse has been associated with increasing rates of crime and violence, as well 

as health problems such as human immunodeficiency virus (HIV) infection, 

which causes the acquired immunodeficiency syndrome (AIDS); other 

sexually transmitted diseases (STDs); and other infectious diseases such as 

hepatitis B and C. If a pattern is identified early, appropriate action can be 

taken to control its spread. 

By monitoring drug abuse over time, it also is possible to evaluate whether 

programs are having any impact on particular aspects of drug abuse problems. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 5 
Part I. Community Epidemiology Surveillance Networks on Drug Abuse 

It is important for 

members to 

understand the 

specific purposes... 

It is important for members to understand the specific purposes, advantages, 

organization, and limitations of the network. Through this understanding,

local networks are more likely to be successful and contribute to needs 

assessments. 

What Are the Advantages of a Network? 

Often, people who 

are sought as 

members of a 

network already are 

engaged by 

agencies or 

organizations 

involved in the drug 

abuse field... 

The surveillance network model has many advantages for planning purposes... 

 It uses a practical formula. 

 It is not costly. 

 It makes use of existing resources. 

 It provides immediate feedback. 

 It works on many different levels (e.g., local, State, national, 

international). 

 The information is useful to many agencies and organizations. 

 It provides input from different perspectives. 

 It establishes a network of people who share information and work 

together on common problems. 

 It builds an infrastructure for further research. 

Often, people who are sought as members of a network already are engaged 

by agencies or organizations involved in the drug abuse field and may be 

currently collecting data from or about drug-using populations. In addition, 

their agencies would probably recognize the short- and long-term benefits to 

be derived from participation in a surveillance network. 

Optimally, meetings should be regularly scheduled about twice each year. 

This time frame provides a sufficient time gap (6 months) to assess changes in 

drug use patterns and keep the groups active without placing a heavy burden 

on participants. At least 1 full day should be set aside for each meeting. 

6 Assessing Drug Abuse Within and Across Communities: Second Edition 
 

 Community Epidemiology Surveillance Networks on Drug Abuse 

What Sources of Information Do Networks Access and Use? 

Each source has the 

potential to provide 

data/information 

about different drugusing populations... 

...indicators help 

identify different 

types of drug 

abusers... 

One source can 

complement and 

support another and 

help to validate 

information on drug 

use patterns. 

Epidemiology networks make use of multiple sources of information, such as 

those described above and elaborated upon in the chapters that follow. Each 

source has the potential to provide data/information about particular drugusing populations and/or different facets of the behaviors and outcomes of the 

same or similar populations. The data/information obtained from each source 

is considered a drug abuse indicator. The direction of changes in indicators 

across time is a measure of relative change in drug-abuse behaviors and 

related problems rather than a measure of absolute change. Indicators do not 

provide estimates of the number (prevalence) of drug abusers at any given 

time. Rates (e.g., per 100,000 population) at which drug-abusing populations 

may be increasing or decreasing in size are sometimes reported and help 

standardize data. However, indicators do help identify different types of drug 

abusers, such as those who have been arrested, treated in hospital emergency 

departments, discharged from hospitals, admitted to drug abuse treatment 

programs, involved in accidents, diagnosed with HIV/AIDS, or died with 

drugs found in their bodies. 

Survey data can be used to complement indicator data. Most surveys can 

provide estimates of the prevalence of drug use in particular populations (e.g., 

general household and school populations), including the prevalence of use of 

specific substances. However, the populations covered in surveys may not 

provide information on many groups at high risk for drug abuse (e.g., 

homeless persons, school dropouts). Methodologically sound surveys provide 

valuable prevalence estimates of the population groups that are sampled. 

By comparing information from different sources concurrently, network 

members can identify and learn more about different drug-using populations, 

the similarities and differences across groups, and perhaps emerging patterns 

and trends. One source can complement and support another and help to 

validate information on drug use patterns. Networks, at all levels, use many 

data sources. 

How Are Local Networks Organized? 

Sponsoring a 

network can be of 

great benefit to an 

agency... 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 7 

Generally, the impetus for organizing a surveillance network comes from an 

agency that recognizes the need for up-to-date information about drug abuse 

patterns and trends. The agency may be one that coordinates drug abuse data 

sources or a health planning organization. Sponsoring a network can be of 

great benefit to an agency, as it provides that agency with important information about drug trends, knowledge about street use, and a network of 

sources to answer questions. Any agency that deals with the general public, 
Part I. Community Epidemiology Surveillance Networks on Drug Abuse 

...it is important to 

have someone 

assume the role of 

Network 

Coordinator... 

It is best to plan and 

maintain small work 

groups... 

...arrange a small 

planning meeting of 

staff from key 

agencies. 

answers questions about drugs, or provides public information will find the 

investment in sponsoring a local network worthwhile. In addition, it will be 

possible to provide education and information materials and press releases to 

inform the public of current trends. 

For practical reasons, it is important to have someone assume the role of 

Network Coordinator, a member who will serve as the key point person to 

ensure that all members are informed of the time and place of each meeting, 

that a meeting agenda is finalized and disseminated to all participants, and that 

each member is fully aware of the roles that he or she should assume at each 

meeting. In some networks, members have shared this role, since it is 

demanding and requires ongoing coordination and communication. The 

Network Coordinator may be someone who works for a lead agency (e.g., a 

drug abuse treatment agency) and is given the time and resources to carry out 

this role. The Coordinator also assumes the lead role at network meetings, 

briefly reviewing findings and issues raised at the prior meeting, the 

objectives for the current meeting, and the plans for the next meeting. 

It is best to plan and maintain small work groups so that all participants have 

an opportunity to contribute to the process. Try to get members from different 

organizations and with different perspectives. Include the medical examiner, 

treatment program personnel, HIV street outreach workers, health planners, 

university researchers, and local police officers. If the network is comprised of 

representatives of different towns, cities, or counties, the reporting process 

should be standardized so that comparisons can be more easily made across 

different jurisdictions. 

Initially, one or two staff members can be assigned to review and report on 

potential benefits, other potentially valuable participants, and accessible 

sources of information. Representatives of other agencies can be contacted to 

determine how the information might be useful to them, their level of interest, 

and who from their agencies might meet the qualifications to participate in the 

network. This type of review should be completed within a 1–2 month period. 

If, on the basis of the information, it is decided to begin efforts to organize a 

surveillance network, arrange a small planning meeting of staff from key 

agencies. This meeting should include researchers and agency representatives 

who are familiar with drug abuse issues and sources of data and who are 

interested in the possibility of establishing a network. The meeting should be 

structured to... 

 Establish the rationale for and the purpose of a network 

 Identify potential sources of data/information 

 Identify agencies and individuals with access to information 

 Identify individuals who could contribute in other ways to the network 

 Develop an agenda for the first meeting 

8 Assessing Drug Abuse Within and Across Communities: Second Edition 
 Community Epidemiology Surveillance Networks on Drug Abuse 

...enlisting the 

official’s support 

may increase 

the agency’s 

participation and 

contribution... 

 Determine who should be invited to participate in the first meeting and 

what they should be asked to contribute 

 Establish a time and place for the first meeting 

 Develop a plan for the second meeting, including the date, place, and 

general themes to be covered 

A preliminary step that has proven useful is to hold a preplanning meeting 

with officials of selected organizations or agencies to discuss the purpose and 

goals of the network; how the agency or organization can contribute; the staff 

capabilities, knowledge, skills, and experience required to contribute; and the 

benefits to the agency of belonging to the network. 

While it is unlikely that an agency official will be a working member of the 

local network, enlisting the official's support may increase the agency's 

participation in and contribution to the network. Unless the official 

understands the value of the network, he or she may not be willing to support 

the initiative and the investment of time by the agency. In addition, the official 

may help identify the most qualified person(s) from the agency to serve on the 

network. In some instances, it is beneficial to invite both the official and his or 

her data person to the meeting so the official can become informed of the 

benefits of the group and the data person can be involved from the beginning 

in identifying needed information. 

How Should the First Network Meeting Be Organized? 

The first meeting is very important because it sets the stage for what the 

surveillance network will be, how it will function, and how it will be 

perceived by participants and others. Two interrelated objectives should 

always be kept in mind... 

 Obtaining knowledge about drug abuse 

 Developing and strengthening the work group 

Care should be taken to avoid common pitfalls that others have encountered in 

planning initial network meetings. Four principles should be observed... 

1.	 Start small. Be selective in inviting individuals to attend. It is easy to add 

individuals once the needs and sources have been identified and to change 

individuals based on the strengths and interests of the members. 

Have clear, attainable 

objectives for the 

meeting. 

2. Have clear, attainable objectives for the meeting. Avoid trying to

overachieve at the beginning.

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 9 
Part I. Community Epidemiology Surveillance Networks on Drug Abuse 

...determine what 

steps should be 

taken to identify 

agencies and 

individuals who can 

provide access to 

each of these 

sources. 

Surveillance networks need to 

remain focused 

on questions... 

3.	 Establish the agenda in coordination with other participants so they feel 

invested from the beginning. 

4.	 Give each participant a role to play and a contribution to make. 

The first meeting should be organized to accomplish several objectives... 

 Identify known and potential sources of data and information. Selected 

participants can be asked to describe particular data sets and to prepare 

and briefly present data from sources to which they have access. 

 Review the types of data sources (indicators) accessed by other 

epidemiologic networks to determine if they might be available in your 

area. If they are, determine what steps should be taken to identify agencies 

and individuals who can provide access to each of these sources. 

 Assign participants to follow up (after meetings), and, if appropriate, make 

contacts to find out what types of data are available, how the data can be 

made available, and who is most knowledgeable about the data and the 

data sources. 

 Determine how the information from the meetings should be recorded, 

reported, and disseminated, including to whom it should be sent. A full 

report with all the information will prove useful for agency planners, grant 

writers, and staff associated with the network member agencies. An 

executive summary that brings all the information together in a quickreference format will prove very popular with the press and the general 

public. 

 Identify current and potential sources of support for organizing and 

conducting the meeting and producing and disseminating meeting reports. 

The full report should be based largely on the papers prepared and 

presented by participants, along with data tables. 

Surveillance networks need to remain focused on questions such as: What 

drugs are currently being used? Who is using them? Are drug use patterns 

changing from year to year? If so, how? 

What Types of Problems Are Encountered by Networks? 

As in any network, individuals who participate in the meetings are likely to 

have different backgrounds and different frames of reference. It may not 

always be clear to them what is expected. If each member is sent the specific 

format for the presentation in advance, it will be easier to keep the meetings 

on track and to get the information in a form that is comparable with that 

submitted by other members. 

10 Assessing Drug Abuse Within and Across Communities: Second Edition 
 Community Epidemiology Surveillance Networks on Drug Abuse 

...define carefully 

what information 

the participants 

need to present and 

keep the meetings 

focused. 

It must be kept in mind that there is limited time to address the key questions 

and achieve the network's objectives. It is therefore important for the persons 

coordinating or chairing network meetings to define carefully what 

information participants need to present and to keep the meetings focused. 

Tell each member in advance the time limit for the oral presentation. 

Another problem is the turnover in members and finding members who are 

interested in the network and willing to commit to the process and collect and 

report on the information on a continuing basis. The Network Coordinator will 

occasionally confront the need to search for new members and persons who 

have the time to participate. It is good policy to routinely call the agency 

directors to thank them for the past participation of their staff, inform them 

that another meeting is planned, and explain the importance of their agency's 

participation and the benefit to the agency. At times, unless informed, the 

director will not know that a meeting has been scheduled, and the local 

network member may be unable to attend the meeting or not have time to 

gather the needed data. 

Who Should Be Invited to the First Network Meeting? 

One of the primary 

objectives of the first 

meeting is to identify 

individuals who are in 

the best position to 

contribute 

information... 

The first meeting should be considered a planning session. The organizers 

should emphasize that the individuals who attend this meeting will not 

necessarily be permanent members and they are not obligated to attend future 

meetings. One of the primary objectives of the first meeting is to identify 

individuals who are in the best position to contribute information to the 

network planning process. If a national CEWG representative is located in 

your State, or if there is a planner at the State Substance Abuse Agency 

(SSAA) who is knowledgeable about sources of data, invite them to the first 

meeting. 

The first meeting should include individuals who are capable of providing 

information about different sources of data, including the following: 

Survey Data 

If not yet known, find out if any relevant local surveys have been or are 

currently being conducted or planned. These would include household, school, 

and special population surveys that provide information about substance use. 

In addition, some States have contracts from Federal agencies to perform 

surveys. In some instances, the State agency has conducted the surveys, while 

in other States, surveys are done by a university or survey research firm. If a 

relevant survey has been or is being conducted, invite the Principal 

Investigator or another person who can describe the data collected. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 11 
Part I. Community Epidemiology Surveillance Networks on Drug Abuse 

...find out who 

would be the most 

appropriate person to 

participate in the first 

network meeting. 

...drug use data on 

local arrestees... 

...contact the State, 

county, and city health 

departments to 

identify individuals 

who can provide 

information... 

HIV/AIDS is a 

reportable condition 

in all States and 

territories in the 

United States. 

Drug Abuse Treatment Data 

If not yet known, find out which agencies collect information about drug 

abusers entering, undergoing, and/or leaving treatment. Every treatment 

program that receives funds from the SSA is required to report data to the 

State. Which local drug abuse treatment programs participate in the State 

system, and which are required to report client data to county and city 

coordinating agencies? Find out who in the different agencies is responsible 

for coordinating these efforts. Contact these individuals to find out who would 

be the most appropriate person to participate in the first network meeting. 

Treatment facilities can be found at <http://findtreatment.samhsa.gov>. 

Law Enforcement Data 

If not yet known, find out which agencies, departments, or offices collect drug 

use data on local arrestees charged with criminal offenses, including drug 

violations. Drug violations, including arrests for possession and/or trafficking, 

are reported by counties and States. Several different State offices can be 

contacted to determine sources of arrest data. These include the Uniform 

Crime Report Office, the Statistical Analysis Center, the Law Enforcement 

Planning Office, and the Attorney General's Office. In some instances, the 

same arrest will be reported by the local police, the State police, and Federal 

agents, so inquire about possible duplicate reporting and overlap. Other law 

enforcement data that can be very useful include information on price and 

purity of drugs confiscated. Try to find out which levels of law enforcement 

agencies are included in a report. State Statistical Analysis Centers (SACs) 

assemble statewide criminal justice statistics, act as a clearinghouse for 

statewide crime information and statistics, and issue periodic reports. Contact 

names, addresses, and telephone numbers for the SAC office in each State can 

be found at <http://www.jrsa.org/sac>. 

Hospital Data Pertaining to Drug Use 

If not yet known, contact the State, county, and city health departments to 

identify individuals who can provide information about relevant hospital data 

sources. If the geographic area covered by the network is relatively small, it 

may be appropriate to contact administrators of each hospital to find out what 

types of data related to drug use are collected and who coordinates such 

efforts within or outside the hospital. 

AIDS Cases and HIV Seroprevalence Data 

HIV/AIDS is a reportable condition in all States and territories in the United 

States. The HIV/AIDS Surveillance System, established by the Centers for 

Disease Control and Prevention (CDC), monitors the incidence and 

demographic profile of AIDS cases and describes the modes of HIV 

transmission among infected persons. Information can be found at 

<http://www.cdc.gov/hiv/surveillance.htm>. State and local health 

12 Assessing Drug Abuse Within and Across Communities: Second Edition 
 Community Epidemiology Surveillance Networks on Drug Abuse 

...identify changing 

patterns in the 

modes of HIV 

transmission. 

Local and State school 

systems may fund 

surveys of drug use 

among students. 

...data/information 

sources can be 

obtained from smaller 

entities. 

departments conduct active surveillance. Standardized case report forms and 

software (HIV/AIDS Reporting System) are used to produce local tabulations 

and to report cases monthly to the CDC. All 50 States, U.S. territories and 

possessions, and some major cities report to the CDC surveillance system. 

One of the objectives of surveillance is to identify changing patterns in the 

modes of HIV transmission. The local health department office responsible 

for HIV/AIDS surveillance should be contacted to find out who is the best 

person to report relevant information at the first network meeting, such as 

information on the percentage of injection drug users who have contracted the 

virus. 

Other Health Data 

Since substance abuse is also related to numerous health consequences, such 

as tuberculosis and sexually transmitted diseases, the State, county, or city 

health departments will have information on the number of individuals who 

have these diseases and the prevalence rates for these diseases in your local 

area. Contact the health department to get the statistics and to obtain 

information from the street outreach workers who seek out persons with these 

diseases. In some instances, certain outreach workers concentrate on drugusing populations, while others will concentrate on prostitutes and commercial 

sex trade workers. 

School Data 

Local and State school systems may fund surveys of drug use among students. 

If a relevant survey has been or is being conducted in your area, invite the 

Principal Investigator or another person who could describe the data collected. 

School survey data may be available in a network’s area from the Youth Risk 

Behavior Survey (YRBS), supported by CDC and conducted in coordination 

with State and local educational entities (see Chapter 1). 

Community-Level Data Sources 

At the community or neighborhood level, data/information sources can be 

obtained from smaller entities. Be careful to check that this information is not 

already included in reports from the various State agencies. The following are 

some suggested local sources of data: 

 Drug abuse treatment and intervention programs (both public and private) 

 Local hospitals and hospital associations 

 State, county, and local health departments and agencies/clinics 

 Medical examiners and coroners offices 

 Poison control centers 

 Drug helplines 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 13 
Part I. Community Epidemiology Surveillance Networks on Drug Abuse 

 Community mental health centers 

 HIV and STD outreach programs 

 Pharmaceutical associations 

 State and county forensic laboratories 

 Criminal justice and correctional agencies that report arrest data (e.g., 

police, sheriff) 

 Agencies that collect and report data on drug seizures and the price and 

purity of different drugs 

 Drug courts 

 Education offices and departments and schools 

 Recreation facilities 

 University researchers who conduct surveys or studies on drug abuse 

There may be many other potential sources of information, depending on the 

community. 

Network members may also review the Computer Retrieval of Information on 

Science Projects (CRISP) to determine if any studies are relevant to their area. 

CRISP is a searchable database of federally funded biomedical research 

projects being conducted at universities, hospitals, and other research 

institutions. CRISP, maintained by the National Institutes of Health (NIH), 

includes NIDA grantees who are conducting drug abuse research. The 

information may be accessed through related links on NIDA’s Web site 

(<www.nida.nih.gov>; see Appendix B). 

Over time, the network can identify individuals most likely to have data on 

drug abusers and make efforts to engage them as regular members. 

CRISP is a searchable 

database of federally 

funded biomedical 

research projects... 

Some Basic Steps in Accessing Drug Abuse Indicator Data 

...it may be necessary 

to contact agencies 

and organizations to 

obtain needed 

information... 

Many data sets can be accessed on the Internet (see Appendix B). Other 

relevant data may not be available online, and it will be necessary to access

information through records, publications, or some other type of 

documentation. In either case, it may be necessary to contact agencies and

organizations to obtain needed information. However the data are accessed, 

taking the steps outlined below will prove useful. 

14 Assessing Drug Abuse Within and Across Communities: Second Edition 
 Community Epidemiology Surveillance Networks on Drug Abuse 

Access all numeric 

data of interest and 

any available 

information needed to 

further manipulate 

the data. 

1.	 Identify the data set and its characteristics by addressing such 

questions as the following: 

3⁄4 What are the data categories relevant to illicit drugs and to nonmedical 

use of prescribed drugs? How is each category defined? 

3⁄4 What populations are covered in the data set? Are data on 

demographic and other social or behavioral characteristics of each 

drug-abusing group available? How is each of these categories 

defined? 

3⁄4 What geographic area(s) is covered (e.g., State, region, county)? Can 

the data be aggregated into subareas of interest (e.g., metropolitan 

area, Zip Code)? 

3⁄4 What time period(s) is covered? Does each period represent a 

calendar year or a fiscal year? For which years are comparable data 

available so that trend analyses can be conducted? 

3⁄4 Are the raw data (numbers) available? Are the data reported as 

percentages, averages, or in some other descriptive statistic form? Are 

the data in a format or system that can be manipulated for further 

analysis? Access all numeric data of interest and any available 

information needed to further manipulate the data. 

2.	 Obtain documentation on the system (e.g., data collection instruments, 

sampling methods, analytic methods) to assist in understanding the data. 

3.	 Identify any privacy or confidentiality procedures that must be 

followed in analyzing and reporting the data. 

4.	 Identify a person(s) in the agency/organization who can answer questions 

that may arise. Inquire if the person/agency would like to participate in 

analyses or receive a copy of your report. Establish ongoing rapport with 

the data provider. 

Documenting information on the questions and issues summarized above will 

be important. For example, information on the questions listed in Step 1 will 

assist not only in understanding the data from a specific data source but also in 

comparing indicators across data sources. Agencies and organizations collect 

information relevant to their own specific mission and objectives, and there 

may be many differences across data systems in the populations covered, how 

information is categorized and defined, in the time periods represented in the 

data, and in the way the information is analyzed. Maintaining rapport with the 

data sources is also important, especially if researchers plan multiyear studies 

of drug abuse patterns and trends. Providing the agencies with network 

reports and findings also will further future cooperation. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 15 
 

Part I. Community Epidemiology Surveillance Networks on Drug Abuse 

“Tips” on Establishing and Maintaining An Epidemiology 

Surveillance Network 

An epidemiology network can function as a drug abuse surveillance system at 

any jurisdictional level––national, regional, State, county, city, or community. 

The descriptions in this guide focus primarily on the local community level. 

Activities of an epidemiology surveillance network include those summarized 

in the box below. 

Planning for regularly scheduled meetings, as well as agenda items for future 

meetings, collection of data from multiple sources, data analysis and reporting, 

timely dissemination of findings, and continuity of the network 

Developing and expanding the network and updating data sources and 

contacts 

Creating a key informant network of individuals who can be contacted quickly 

for information if a drug abuse problem emerges or increases 

Networking through an ongoing group process in which members gain knowledge 

and current information about drugs of abuse, drug abuse patterns and trends, 

and emerging drug problems 

Connecting, communicating, and coordinating with one another on an 

ongoing basis, and with “data sources,” that is, agencies, organizations, and 

systems that have relevant information/data on drugs, drug-abusing populations, 

and the knowledge and skills to contribute to the network 

Accessing and compiling data at regularly scheduled times, in coordination with 

data sources 

Analyzing and reporting data systematically, based on a standardized format 

Identifying the target audiences (e.g., practitioners, administrators, 

policymakers, legislators) that can benefit from the data/information and findings 

produced by the network 

Disseminating the information to target audiences 

Providing feedback to participating agencies and organizations, including copies 

of the network’s reports 

Assessing progress and goal attainment periodically so that changes can be 

made, if necessary, to ensure continuity and expansion of the network 

Developing knowledge and skills over time. Because drug abuse is a complex 

and changing phenomenon, network members build collective knowledge and skills 

as they work together over time. By accessing and sharing information and 

knowledge, members impart and gain an understanding of the following: 

(Continued) 

16 Assessing Drug Abuse Within and Across Communities: Second Edition 
 Community Epidemiology Surveillance Networks on Drug Abuse 

•	 Knowledge of licit and illicit drugs and ways in which different drugs are 

abused 

•	 Knowledge of relevant sources of drug abuse information/data and skills in 

retrieving the information/data 

•	 Knowledge of their community/area and the “street savvy” and cultural 

awareness needed to ensure that relevant data are collected and that the data 

are interpreted accurately and in meaningful ways 

•	 Skills in analyzing and interpreting data/information gathered collectively by 

the group 

•	 Skills in preparing reports appropriate for different target audiences 

•	 The capability to disseminate reports to different target audiences 

•	 The skills needed to ensure continuity and effectiveness of network activities 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 17 
Part II. Accessing and Analyzing Data from Different Sources 

PART II. ACCESSING AND ANALYZING 

DATA FROM DIFFERENT 

SOURCES 

1. SURVEY DATA 

...surveys of a 

specific population 

can provide 

estimates of the 

incidence and 

prevalence of drug 

use in that 

population, overall 

and by drug type... 

Surveys are among the primary sources of epidemiologic data on drug abuse. 

When based on probability sampling, well-tested questionnaires, and wellcontrolled field procedures, surveys of a specific population can provide 

estimates of the incidence and prevalence of drug use in that population, 

overall and by drug type, as well as by demographic subgroup (e.g., gender,

age, race/ethnic group). Many surveys also yield information on drug-using

behaviors (e.g., age of first use, route of drug administration, frequency of

use), attitudes toward drug use, and health consequences associated with drug

use. Surveys conducted regularly over specific time periods (e.g., annually) 

provide data for trend analyses, and, thus, can show changes in overall drug 

use and the use of specific drugs by specific population groups across time 

periods. 

Three periodic national surveys that provide important drug abuse data are... 

 The National Survey on Drug Use and Health (NSDUH) 

 Monitoring the Future (MTF) 

 Youth Risk Behavior Survey (YRBS) 

Occasionally, national-level data, such as NSDUH and MTF data, can be 

compared with data from local and State surveys to determine how a 

community deviates from the drug abuse patterns in larger geographic areas. 

NSDUH estimates are available by State, although special data requests may 

be needed to obtain State-level data on a specific drug of interest. When 

comparisons between local and national surveys are of interest, the 

questionnaires must be compared to determine differences in wording of 

questions, since they may be so different as to be noncomparable. YRBS data 

are available for several cities across the Nation, while the MTF represents 

secondary school students across the coterminous United States. 

A comparison of local versus national data could, theoretically, yield a 

number of different but useful findings. For example, a comparison of local 

versus national data in a given year may show little difference between the 

local and national prevalence rates and patterns of drug use. Conversely, a 

comparison of local and national data may show divergent drug use patterns 

18 Assessing Drug Abuse Within and Across Communities: Second Edition 
1. Survey Data 

...national data may 

show the emergence 

of a new drug of 

abuse that has not 

yet appeared in the 

local data. 

overall or for a particular drug or population group. For example, national data 

may show the emergence of a new drug of abuse that has not yet appeared in 

the local data. Such a divergence could serve as an “alert” to local planners, 

policymakers, and providers, leading them to address such questions as: Has 

the trend been missed in local data gathering, or is it a pattern that may 

emerge in the future? How should local efforts be designed to determine 

whether the specific drug is or will become a substance of abuse in a confined 

geographic area? 

Knowledge of national surveys can also be useful in planning surveys at the 

local and State levels. The national-level methods and questionnaires have 

been tested for utility and for reliability and validity. Sampling strategies 

have been developed by expert statisticians; confidentiality and privacy 

procedures conform to Federal guidelines; and methods for training data 

collectors have been carefully developed and monitored. Many instruments 

and methods are available to the public and can be used without cost. 

Accessing and Analyzing Survey Data 

Network members 

may care to first 

examine the 

national surveys... 

...NSDUH... provides 

information on 

prevalence and 

trends... 

Network members may care to first examine the national surveys described 

below. However, network members should also inquire with State and local 

educational institutions and researchers to determine whether household or 

school surveys have been or are being conducted in their local areas. 

The National Survey on Drug Use and Health 

The NSDUH is conducted annually under the sponsorship of the Office of 

Applied Studies (OAS), Substance Abuse and Mental Health Services 

Administration (SAMHSA). The NSDUH (formerly the National Household 

Survey on Drug Abuse, NHSDA) provides information on the prevalence of 

and trends in the use of illicit drugs, alcohol, tobacco, and the nonmedical use 

of prescription-type drugs among members of the civilian, noninstitutionalized population age 12 and older in the United States and represents nearly 98 

percent of this population. The NSDUH also provides information about 

substance abuse and dependence, based on the Diagnostic and Statistical 

Manual of Mental Disorders, Fourth Edition (American Psychological 

Association 1994), mental health problems, and treatment needed and 

received for substance abuse and mental health problems. 

The survey employs a 50-State sample design with an independent, multistage 

area probability sample for each of the 50 States and the District of Columbia, 

enabling the calculation of State estimates. In the eight States that constitute 

48 percent of the Nation’s population age 12 and older, SAMHSA reports 

substate area estimates. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 19 
 

Part II. Accessing and Analyzing Data from Different Sources 

The NSDUH collects 

data on lifetime 

(“ever used”), pastyear, and past-30-

day use of illicit 

drugs... 

...publications/ 

reports can be 

viewed at... 

<http://www.oas. 

samhsa.gov>. 

...MTF provides data 

on the prevalence of 

drug use and related 

attitudes among 

students in grades 

8, 10, and 12. 

The NSDUH collects data on lifetime (“ever used”), past-year, and past-30-

day use of illicit drugs, such as powder cocaine, crack cocaine, heroin, 

marijuana, methamphetamine, and various hallucinogens; psychotherapeutic 

drugs (nonmedical use, e.g., of narcotic analgesics, sedatives, tranquilizers, 

stimulants); alcohol; and tobacco (cigarettes, smokeless tobacco). As noted 

above, the survey also yields diagnostic data related to abuse or dependence 

on drugs, mental health problems (including co-occurring disorders), and 

treatment. 

Of special note is the fact that trend analyses are limited prior to 2002 because 

of the redesign of the NSDUH. Data from 2002 onward should not be 

compared with 2001 and earlier NHSDA data to assess changes over time 

(SAMHSA 2004a). 

NSDUH publications can be obtained by contacting the National 

Clearinghouse for Alcohol and Drug Information (NCADI),1

 or publications/reports can be viewed at the following Web site: <http://www.oas. 

samhsa.gov>. Public data files for the NHSDA and NSDUH for 1979, 1982, 

1985, 1988, and annually from 1990 to 2003 are currently available through 

the Substance Abuse and Mental Health Data Archive (SAMHDA Online 

Analysis) and the archive’s online data analysis system (DAS), which allows 

analysts to run statistical analyses directly from public use data files and 

obtain results online without the need to download the data file. The Web site 

is <http://www.icpsr.umich.edu/SAMHDA/das.html>. 

Monitoring the Future Study 

The MTF survey has been conducted for nearly three decades by the Institute 

for Social Research, University of Michigan, under grant support from NIDA. 

The MTF provides data on the prevalence of drug use and related attitudes 

among students in grades 8, 10, and 12. Data have been collected since 1975 

on high school seniors and since 1991 on students in grades 8 and 10. The 

data represent public and private secondary schools in the coterminous United 

States. A followup panel survey is structured to collect data from a random 

sample of high school seniors biannually after high school, covering college 

students and young adults. 

Information on lifetime, past-year, and past-30-day use is collected on many 

drugs, including illicit and licit drugs. Illicit drugs data include “any illicit 

drug,” marijuana, powder cocaine, crack cocaine, heroin, methamphetamine, 

hallucinogens, and methylenedioxymethamphetamine (MDMA or “ecstasy”). 

Nonmedical use of licit drugs covers such prescription-type drugs as narcotic 

painkillers (e.g., Vicodin, oxycodone, Ritalin), sedatives (barbiturates), 

stimulants, and tranquilizers. Alcohol and tobacco use are also covered. 

Students are also asked about the perceived risk of using specific drugs, their 

disapproval of people using each of the drugs, and their perception of the 

availability of each drug. 

1

P.O. Box 2345, Rockville, MD 20852-2345; Phone: 800-729-6686; Fax: 301-468-6433. 

20 Assessing Drug Abuse Within and Across Communities: Second Edition 
1. Survey Data 

YRBSS...monitors 

six categories of 

health-risk 

behaviors among 

youth and young 

adults... 

The YRBS covers 

lifetime use of many 

illicit drugs...as well 

as “current” (past30-day) use of some 

drugs... 

Publications may be ordered from NCADI or through the NIDA Web site 

<http://www.NIDA.NIH.gov>. Those interested in obtaining the results and 

key findings from the MTF survey (1975–2004) can go directly to 

<http://monitoringthefuture.org> where tables and figures from the most 

recent MTF survey’s published findings can be found. 

Youth Risk Behavior Survey 

The Youth Risk Behavior Surveillance System (YRBSS), developed by the 

Centers for Disease Control and Prevention, monitors six categories of healthrisk behaviors among youth and young adults (tobacco use, unhealthy dietary 

behaviors, inadequate physical exercise, alcohol and other drug use, risky 

sexual behaviors, and behaviors that contribute to unintentional injuries and 

violence). The system includes a national school-based Youth Risk Behavior 

Survey (YRBS), as well as State, territorial, and local school-based YRBSs 

conducted by education and health agencies. 

The YRBS covers lifetime use of many illicit drugs, including cocaine 

(powder, crack, freebase), heroin, marijuana, methamphetamine, inhalants, 

and ecstasy, as well as “current” (past-30-day) use of some drugs (e.g., 

cocaine, inhalants, marijuana), and injection of any illicit drugs. YRBS also 

covers alcohol and tobacco use and nonmedical use of steroids. Other 

behaviors included in the survey are, as noted above, unhealthy dietary 

behaviors, inadequate physical exercise, risky sexual behaviors, and behaviors 

that contribute to unintentional injuries and violence. 

Since 1991, the national YRBS has been conducted every other year. State 

and local school-based YRBS efforts are based on a two-stage cluster sample 

design to produce representative samples of students in grades 9–12 within 

their jurisdictions. In 2003, 32 States were included in the YRBS, as were 18 

local jurisdictions. Data are weighted, and confidence intervals are reported. 

The YRBS city data can be obtained by contacting school districts. Findings 

are also summarized in CDC’s Morbidity and Mortality Weekly Report 

(MMWR). The YRBSS Web site is available at <http://www.cdc.gov/Healthy 

Youth/YRBS/about_YRBS.htm>. This Web site includes the most recent 

YRBS questionnaire for surveys of 9th–12th grade students, published 

reports, data files and documentation, and Youth Online, which provides 

interactive access to survey results. 

National-level estimates of drug use may mask substantial variations in local 

areas. Recent YRBS data reveal such variations in the abuse of drugs, such as 

the three stimulant drugs shown in exhibit 1 for 13 CEWG areas where the 

survey was conducted. The exhibit is based on weighted 2003 data for 

students in grades 9–12 and presents confidence intervals (CIs) by drug and 

area. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 21 
City Cocaine Methamphetamine Ecstasy 

Percent CI2

 (±) Percent CI (±) Percent CI (±) 

Boston PS 3.3 1.1 3.6 1.4 6.2 1.7

Broward Co., FL PS 5.9 1.4 4.5 1.1 7.8 1.6

Chicago PS 5.6 1.6 3.7 1.7 5.3 1.9

Dallas ISD 11.9 1.8 5.2 1.2 NA3 –

DeKalb Co., GA PS 3.4 1.2 2.9 0.8 4.7 1.3

Detroit PS 2.3 0.8 2.6 1.0 NA –

Los Angeles USD 9.9 2.2 8.0 1.7 4.7 2.0

Miami-Dade Co., FL PS 6.3 1.1 3.8 1.0 8.2 1.6

New Orleans PS 3.4 1.3 5.8 1.8 7.2 1.9

New York City PS 3.5 0.6 2.4 0.5 5.0 0.8

Philadelphia SD 2.9 0.9 2.0 0.9 4.9 1.5

San Diego USD 7.7 1.7 7.6 1.5 9.0 1.6

Wash., DC PS 6.2 1.5 5.7 1.5 8.8 2.0

Part II. Accessing and Analyzing Data from Different Sources 

Exhibit 1. Lifetime Use of Cocaine, Methamphetamine, and Ecstasy Among Students in Grades 9–12 in 13 

 CEWG Areas,1 by Percent: 2003 

22 Assessing Drug Abuse Within and Across Communities: Second Edition 

1

PS=Public school; SD=school district; ISD=independent school district; USD=unified school district. 2

At the 95 percent confidence level.

3

NA=Not available. 

SOURCE: Centers for Disease Control and Prevention, Youth Risk Behavior Survey 

As shown in exhibit 1, estimates of lifetime use of cocaine among high school 

students ranged from a low of 2.3 percent in Detroit to 11.9 percent in Dallas. 

Lifetime use of methamphetamine varied from 2 percent in Philadelphia to 8 

percent in Los Angeles. Ecstasy use, reported from 11 CEWG areas, also 

shows variation, with a low of 4.7 percent in the Atlanta area (DeKalb 

County) and a high of 9.0 percent in San Diego. 

Other Surveys 

Network members should check with education departments, public health 

...check with 

education 

departments, 

public health 

departments, and 

universities... 

departments, and universities in their area to determine whether other surveys

on drug use have been or will be conducted in their local area or State. For

example, in Texas, a school survey is conducted every other year, and data 

can be accessed from school districts in different parts of the State. Exhibit 2

shows data from four different survey years on students in grades 7–12 in two 

Independent School Districts in Webb County, Texas, as reported by Jane 

Maxwell, Ph.D. (2003), at the September 2003 Border Epidemiology Work 

Group meeting. 
 

1. Survey Data 

Exhibit 2. Substance Use Among 7th–12th Grade Students in Webb County (Laredo), Texas, ISDs,1 by Year2 

and Percent: 1993–2002 

ISD Lifetime Substance Use (Percent) Past-Month Substance Use (Percent) 

United ISD 1993 1998 2000 2002 1993 1998 2000 2002 

Tobacco 61 56 54 47 28 28 27 21 

Alcohol 75 74 76 73 43 44 45 41 

Inhalants 21 17 19 18 3 8 8 8 

Any Illicit Drug 19 28 29 31 7 14 15 15 

Marijuana 17 25 25 27 6 11 12 12 

Cocaine/Crack 7 11 13 13 2 6 6 5 

Laredo ISD 1993 1994 1998 2002 1993 1994 1998 2002 

Tobacco 56 56 55 44 25 25 25 21 

Alcohol 75 76 75 71 40 42 42 40 

Inhalants 13 13 18 16 4 4 7 8 

Any Illicit Drug 18 20 30 26 8 8 14 12 

Marijuana 16 17 26 22 7 7 10 9 

Cocaine/Crack 7 8 13 12 3 3 6 4 

1

ISD=Independent School District.

2

Laredo ISD did not participate in the 2000 survey. 

SOURCE: Texas Commission on Alcohol and Drug Abuse and Public Policy Research Institute of Texas A&M University
 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 23 
Part II. Accessing and Analyzing Data from Different Sources 

2. DRUG ABUSE TREATMENT DATA 

Data collected by 

programs that treat 

substance abusers 

can be another 

important indicator 

of substance abuse 

patterns and 

trends... 

...network members 

can quickly make 

comparisons 

between the 

different types of 

drug abusers and 

draw some 

important 

inferences. 

Data collected by programs that treat substance abusers can be another 

important indicator of substance abuse patterns and trends in particular 

geographic areas. These data, generally collected uniformly at admission and 

reported to State and Federal agencies, include the numbers and types of 

substances used by drug abusers entering treatment. They also include the 

characteristics (e.g., gender, age, ethnicity/race) of the treatment admissions 

by specific drug. For example, it is possible to determine how many 

admissions report cocaine as their primary drug at treatment entry during a 

specific time period and the characteristics of the cocaine abusers. What 

percent were male and female? African-American, White, Hispanic, or of an 

other racial/ethnic group? What were the specific age categories for these 

admissions? Based on these variables alone, many comparisons can be made. 

The characteristics of primary cocaine abusers, for example, can be compared 

with the characteristics of those who reported other types of primary drugs 

during the same admission period. Consequently, network members can 

quickly make comparisons between the different types of drug abusers and 

draw some important inferences. Many other reported data elements collected 

at admission could be analyzed to learn more about the drug-abusing 

population. These elements will be presented later in this chapter of the 

guide. The chapter includes information on... 

 Advantages of treatment data 

 Major limitations of treatment data 

 How to locate/identify treatment programs in specific geographic areas 

 Obtaining information about treatment programs and their facilities, 

including data from local programs, State agencies, and the Federal 

Government 

 Examples of how treatment data can be analyzed and reported 

Advantages of Treatment Data 

Some of the advantages of using treatment data are as follows: 

 Treatment data are generally a good indicator of the types of drugs being 

used in geographic areas; these data also show changes in patterns of drug 

use over time. 

 Treatment admissions data are collected and reported by all publicly 

funded and some privately funded substance abuse treatment programs, 

based on standardized questions. 

 Data on the specific drugs (primary, secondary, and tertiary) used and the 

characteristics of the users are collected systematically at intake by trained 

staff. 

24 Assessing Drug Abuse Within and Across Communities: Second Edition 
2. Drug Abuse Treatment Data 

These data only 

represent drug 

abusers who enter 

particular types of 

treatment 

programs... 

 These data are relatively easy to access and analyze. 

 These data can be analyzed over time (e.g., years) to assess changes over 

time and trends. 

 These data may show emerging drugs or drug problems that require 

treatment. 

 Comparisons can be made with treatment data from other areas within a 

State or across States. 

Major Limitations of Treatment Data 

The limitations of treatment data include... 

 Treatment data cannot be used to make drug abuse prevalence estimates 

for or by geographic area. These data only represent drug abusers who 

enter particular types of treatment programs and exclude the majority of 

drug abusers who are unable to access treatment or who do not seek the 

treatment services that are available. An unknown number of drug abusers 

obtain treatment from private programs that are not required to report data. 

 There is a gap between the time when a person starts using a drug or drugs 

and the time when that individual seeks or is referred to treatment. By the 

time an individual enters treatment, it is likely that s/he had been using 

drugs for some time. The data are unlikely to reflect the newest drug 

patterns on the street. 

 A drug abuser can enter treatment more than one time in a calendar year 

and is most likely to be counted each time s/he was readmitted. However, 

some programs can provide unduplicated counts, and network members 

should request unduplicated data. Multiple admissions by the same person 

are more likely in short-term outpatient programs. 

 The substances reported at treatment admission are the substances that led 

individuals to seek or be referred to treatment at that particular time. 

Therefore, treatment data often do not provide a complete history of all 

substances used. 

 In seeking treatment, drug abusers may not be totally honest in reporting 

their primary drug problem. For example, some may be afraid of 

reporting an illicit drug problem that has more serious legal implications. 

Interviews with active methamphetamine abusers in Ohio suggest that 

some may conceal their use of the drug from treatment providers or avoid 

treatment altogether because of heightened media attention and increased 

law enforcement efforts focused on methamphetamine (Wright State 

University 2005). 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 25 
Part II. Accessing and Analyzing Data from Different Sources 

Where to Start: How to Locate/Identify Treatment Programs 

in Specific Geographic Areas 

...SAMHSA’s 

National Survey of 

Substance Abuse 

Treatment Services 

(N-SSATS). 

The first step is to identify treatment programs in your area. The yellow pages 

of the telephone directory may be useful in identifying substance abuse 

treatment programs in your area or areas for which the network is attempting 

to assess drug abuse patterns and trends. Network members may also contact 

the local Chamber of Commerce for this information. 

A useful online source is the Substance Abuse and Mental Health Services 

Administration’s Treatment Facility Locator, which is based on facility 

responses to SAMHSA’s National Survey of Substance Abuse Treatment 

Services (N-SSATS) and periodically updated. New facilities are added 

monthly, if facilities inform SAMHSA of changes. 

For a listing of programs on the Treatment Facility Locator go to: 

<findtreatment.samhsa.gov>. 

1.	 Click to enter the drug abuse and alcoholism Treatment Facility Locator. 

2.	 A Quick Search with Map It page will appear. Click on the State or 

Territory of interest to the network. 

3.	 On the next page, to search for programs in your area, type in the City 

name and the Search Radius (e.g., 30 miles), that is, the geographic area of 

network interest. Optional choices are available for Zip Code areas and 

Street Address. 

4.	 Continue, and a map of the area (e.g., 30 miles around your city) will 

appear that identifies the geographic areas where programs are situated. 

Scroll down, and the following information will be provided on each 

program: facility number (corresponding to the map number), name of the 

facility, address, and phone number. Other information summarizes the 

program’s focus (e.g., mix of mental health and substance abuse services), 

services provided, type of care (e.g., residential, outpatient), special 

programs (e.g., women, adolescents), and forms of payment accepted. 

Some programs also list their Web sites. 

What to Request 

Network members need to carefully consider the types of information that will 

be most useful. If State or local data are not easily accessible, network 

members may wish to use data from SAMHSA’s Treatment Episode Data Set 

(TEDS), which is described later in this chapter. Some useful types of 

information for a specified geographic area or areas, which should be 

accessible from your State or TEDS, include the following: 

26 Assessing Drug Abuse Within and Across Communities: Second Edition 
2. Drug Abuse Treatment Data 

 The primary drug of abuse (the drug the client feels caused him/her to 

enter treatment) as well as the secondary and tertiary drugs of abuse 

 Sociodemographic characteristics of different primary drug-abusing 

groups (e.g., gender, age, race/ethnicity, educational level, employment 

status, criminal justice system involvement) 

 Frequency of drug use (e.g., daily, several times a week or month) 

 Route of drug administration (e.g., injection, smoking, inhalation) 

 The demand for treatment generated by referral source (e.g., the criminal 

justice system) 

Other data that may be important for analysis, especially if discharge data are 

used, include date of admission and type of service provided at admission. If 

discharge data are requested and available, the following types of information 

can be accessed for the 20 or more States that provide such data to TEDS: 

 Type of service at discharge 

 Date of last contact 

 Date of discharge 

 Reason for discharge, transfer, or discontinuance of service 

If network members contact drug abuse treatment programs directly to access 

client data, the following things should be kept in mind: 

 Do not request information that would potentially make it possible to 

identify an individual client; such information cannot be divulged under 

penalty of Federal law. Programs can only provide data at aggregate or 

summary levels. 

 The primary responsibility of treatment programs is treating clients. As 

appropriate, staff see treatment as their primary obligation, and are likely 

to be less interested in the potential benefits of research. Some may feel 

that any attempt to obtain client data is another demand on their limited 

time. 

Obtaining Information about Treatment Programs and Facilities 

Substance abuse treatment programs differ in many ways, e.g., by area, 

modality, services provided, length of treatment, and treatment philosophy. In 

the National Directory of Drug and Alcohol Abuse Treatment Programs, 

SAMHSA uses the codes shown in the box below to distinguish between 

types of providers, services, and care and specialized programs by agency. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 27 
Codes for Providers, Services, Care, and Special Programs 

Primary Focus of Provider 

Substance abuse treatment services 

Mental health services 

Mix of mental health and substance abuse services 

General health services 

3⁄4 3⁄4

3⁄4 3⁄4

3⁄4 3⁄4

3⁄4 3⁄4

3⁄4

Type of Care 3⁄4

3⁄4 Outpatient 

Partial hospitalization 

Hospital inpatient 

3⁄4

3⁄4 3⁄4

3⁄4 3⁄4

3⁄4

Services Provided 

3⁄4 Substance abuse treatment 

Detoxification 

Methadone/LAAM 

Halfway house 

3⁄4

3⁄4

3⁄4

Part II. Accessing and Analyzing Data from Different Sources 

Special Programs/Groups Offered 

Adolescents 

Dually diagnosed 

Persons with HIV/AIDS 

Gay and lesbian 

Seniors/older adults 

Pregnant/postpartum women 

Other women’s groups 

Groups of men only 

DUI/DWI offenders 

Other criminal justice groups

It may be possible 

to obtain treatment 

data directly from 

substance abuse 

treatment agencies. 

The most recent National Directory of Drug and Alcohol Treatment Programs 

can be accessed through the Internet at <http://findtreatment.samhsa.gov>. 

Hard copies of the directory can be obtained from the NCADI by calling 1-

800-729-6686. 

Obtaining Treatment Data from Local Programs 

It may be possible to obtain treatment data directly from substance abuse 

treatment agencies. To release data, the Executive Director would have to be 

informed about the reasons for requesting the data, how the data would be 

used, and the goals and makeup of the network. The Executive Director 

would have to be convinced that the data would be used appropriately and for 

a good purpose. It may be that the Executive Director is already familiar with 

the network and knows some of the members. Following an introductory 

telephone call to the Executive Director, the network should follow up with a 

formal letter, making the request in writing. It might be helpful to invite the 

Executive Director, or his/her representative, to the next network meeting to 

discuss the possibility of obtaining the data, how the data can be obtained, and 

how the information produced by the network can be of use to the agency. 

If the network covers a large geographic area where many substance abuse 

treatment agencies are located, the process involved in acquiring the data 

directly from agencies would obviously be more difficult. However, there are 

many advantages in getting data directly from each treatment agency rather 

than from the State or Federal agencies. First, it is possible to obtain insight 

and understanding from program staff about the different types of clients 

admitted to treatment and the patterns of drug use. Second, local programs 

can identify more specifically the geographic areas where clients reside. They 

cannot identify specific addresses of clients, but by using "mapping" software 

they can show the general locations where client addresses are clustered. 

When done by type of drug used by clients, mapping can identify even more 

28 Assessing Drug Abuse Within and Across Communities: Second Edition 
2. Drug Abuse Treatment Data 

Treatment staff 

often serve as “key 

informants”... 

...a link on 

Treatment Facility 

Locator lists SSAAs 

in each State and 

U.S. Territory. 

TEDS is an 

exceptionally 

large treatment 

data set... 

TEDS does not 

include all 

substance abuse 

treatment 

admissions in 

States. 

information about the geographic areas where specific types of drug abuse 

problems are clustered. Third, treatment program staff (e.g., counselors) are 

often able to help surveillance networks answer questions that emerge from 

the quantitative admissions data. Treatment staff often serve as "key 

informants" for CEWG representatives, providing insight on issues that 

emerge from the data. 

Obtaining Treatment Data from State Agencies 

Those who wish to obtain data for their area from their State Substance Abuse 

Agency will find a link on Treatment Facility Locator that lists SSAAs in each 

State and U.S. Territory. This listing provides the name, address, and telephone 

number for each SSAA. Network members are likely to find SSAAs useful in 

providing the most recent treatment data. 

Obtaining Treatment Data from the Federal Government 

Characteristics of clients entering publicly funded programs (and some private 

programs) are collected at admission and reported to the State Substance 

Abuse Agency, which in turn, forwards the data in a standardized “Minimum 

Data Set” to SAMHSA for inclusion in TEDS. Some States also submit a 

more detailed Supplemental Data Set on admissions, and all States will be 

submitting discharge outcome data in the future. The TEDS Minimum Data 

Set is collected in a standardized way within each State, which permits 

comparisons across geographic areas (e.g., counties, cities, States) and also 

provides information on the types of clients served in publicly funded 

programs. 

The Treatment Episode Data Set was established through the 1988 

Comprehensive Alcohol Abuse, Drug Abuse and Mental Health Amendments 

(Public Law 100-690), which mandates that data be collected and reported on 

clients receiving treatment from publicly supported programs for either 

alcohol or drug abuse. Some States also voluntarily collect and report data 

from private programs. TEDS is an exceptionally large treatment data set, so 

caution must be taken in interpreting the data. 

Accessing TEDS Data. The quickest way to access the most recent TEDS 

data is through the SAMHSA Web site <http://www.drugabusestatistics. 

samhsa.gov>. 

Hard copies of the most recent TEDS annual report can be obtained by calling 

NCADI at 1-800-729-6686. 

Limitations of TEDS. TEDS does not include all substance abuse treatment 

admissions in States. The scope of the treatment facilities included in TEDS 

is affected by differences in State licensure, certification, accreditation, and 

disbursement of Federal funds. Crisis intervention facilities and hospital 

emergency departments are not included in TEDS. Hospital-based substance 

abuse treatment facilities are not licensed through the State substance abuse 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 29 
Part II. Accessing and Analyzing Data from Different Sources 

agencies. Some State agencies include data from correctional facilities, while 

others do not. 

TEDS, an admission-based information system, does not represent 

individuals. An individual admitted to a treatment program twice within a 

calendar year would be counted as two admissions. 

Another disadvantage to using TEDS is the fact that data from a particular 

year may not be available until 1 or 2 years later. 

Standardizing Treatment Data 

Exhibit 1 on the following page illustrates how network members can record 

treatment data in a standardized way, using their own data form to collect 

information the network considers most important. It is vital to obtain the total 

number of admissions for a given time period, since the total serves as a 

denominator (e.g., to calculate the percentage of, say, primary cocaine 

admissions in a specific time period and geographic site). Network members 

may wish to add drugs to their recording form (e.g., opiates other than heroin) 

or to add other client characteristics (e.g., age of first use for each drug). 

30 Assessing Drug Abuse Within and Across Communities: Second Edition 
 

 

 

2. Drug Abuse Treatment Data 

Exhibit 1. Standard Treatment Data Request Form 

Site: 

Characteristics of Clients Admitted to Treatment 

From To , (Months/Year) 

Total Number of Treatment Admissions: N= 

Characteristics 

Alcohol 

(Only 

or in 

Combo) 

Cocaine Heroin Other 

Opiates Marijuana Methamphetamine 

(Other) 

Stimulants1 

All 

Other 

Total n: 

Gender 

Male % % % % % % % % 

Female % % % % % % % % 

Race/Ethnicity 

White % % % % % % % % 

Afican-American % % % % % % % % 

Hispanic % % % % % % % % 

Other 

1. % % % % % % % % 

Other 

2. % % % % % % % % 

Age at Admission 

17 and younger % % % % % % % % 

18 to 25 % % % % % % % % 

26 to 34 % % % % % % % % 

35 and older % % % % % % % % 

Route of Administration 

Smoking % % % % % % % % 

Sniffing % % % % % % % % 

Intravenous % % % % % % % % 

Other/multiple % % % % % % % % 

Secondary Drug 

Type of Drug % % % % % % % % 

Tertiary Drug 

Type of Drug % % % % % % % % 

1

Use this column if you cannot provide separate data on methamphetamine (MA) OR to document other stimulant admissions if you can 

provide data on MA admissions. 

SOURCE: Adapted from the National Institute on Drug Abuse, 1998, page 14. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 31 
Part II. Accessing and Analyzing Data from Different Sources 

Uses of the Data: Examples of How Treatment Data are 

Analyzed and Reported 

Treatment data can be analyzed in many ways, as illustrated in the examples 

below. When trend data are used and there are substantial changes in the 

numbers and types of clients over time, network members may need to check 

with treatment providers and the State funding agency. The changes may reflect 

new services to specific populations (e.g., drug courts, pregnant women) or the 

closing of one or more programs. 

Detecting Emerging Drugs in Ohio 

As noted earlier, treatment data can be an indicator of emerging drug problems. 

Wright State University researchers, who manage the Ohio Substance Abuse 

Monitoring (OSAM) surveillance network for the Ohio Department of Alcohol 

and Drug Addiction Services, reported the following example in their January 

2005 OSAM-O-GRAM: In the year 2000, information about methamphetamine 

abuse in the State was beginning to filter down from law enforcement officials 

and drug abusers. In 2002, treatment programs in Akron reported increases in 

methamphetamine treatment admissions. Dayton treatment providers reported 

increases in methamphetamine treatment admissions in 2004. Although methamphetamine abusers still only represented a small proportion of the 2004 

treatment admissions in the State, treatment and other indicator data were being 

closely monitored by area and State officials. 

A Metropolitan Area: Baltimore 

Leigh Henderson, Ph.D., the CEWG representative for Baltimore, accesses 

substance abuse treatment admissions data from the Maryland Drug Abuse 

Administration (State authority). She accesses data for the Baltimore Primary 

Metropolitan Statistical Area (PMSA) and two different segments of the 

PMSA: Baltimore City and the PMSA areas excluding Baltimore City. 

Recently, Dr. Henderson requested multiyear data (2000 to 2004), by drug 

category, and the characteristics (gender, age and race/ethnicity) of first time 

treatment admissions. Exhibit 2 displays data for the drug category Narcotic 

Painkillers, by year and geographic area (PMSA, city, and non-city). Similar 

tables were constructed for the following drug categories: powder cocaine, 

smoked cocaine, intranasal heroin, injected heroin, and marijuana (see 

Henderson and Walker 2006). From each table, one can determine the 

demographic characteristics by area and year, and these variables can be 

compared with the similar variables in tables displaying the same type of data 

for other drugs. Several different variables are shown in exhibit 2 (e.g., daily 

use, first treatment episode, median duration of use, and criminal justice 

referral), and these can be compared by type of area and drug. As findings in 

exhibit 2 illustrate, the numbers of primary Narcotic Painkiller admissions to 

treatment increased each year (2000 to 2004) in all three Baltimore areas. 

32 Assessing Drug Abuse Within and Across Communities: Second Edition 
A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 33 Exhibit 2. Characteristics of Narcotic Painkiller (Primary, Secondary, or Tertiary) Admissions in Baltimore, by Percent: 200

Characteristic Total PMSA 2000 2001 2002 2003 Baltimore City 2004 2000 2001 2002 2003 PMSA exclud

2004 2000 2001 

(Number of Admissions) (960) (1,413) (1,907) (2,201) (2,293) (192) (282) (509) (531) (728) (768) (1,131) 

Gender Male 55.0 56.5 54.6 56.5 56.6 45.8 50.7 46.4 49.7 54.5 57.3 58.0 

Female 45.0 43.5 45.4 43.5 43.4 54.2 49.3 53.6 50.3 45.5 42.7 42.0 

Race/Ethnicity While 87.3 88.9 86.6 87.4 87.7 63.0 73.4 67.6 66.4 75.4 93.4 92.8 

African-American 10.6 8.6 10.9 10.0 9.7 33.9 24.8 30.6 30.0 21.2 4.8 4.6 

Hispanic 0.6 1.3 1.5 1.5 1.6 -' 1.4 - 2.5 2.1 0.8 1.3 

Other 1.5 1.1 1.0 1.0 1.0 3.1 0.4 1.8 1.1 1.4 1.0 1.2 

Age al Admission Younger than 18 5.3 6.3 6.1 6.4 7.5 13.2 14.2 7.1 8.5 8.2 3.3 4.4 

18-25 16.0 20.4 23.7 27.6 26.1 17.4 18.1 21.7 20.9 25.4 15.6 20.9 

26-34 25.3 24.1 23.4 21.7 22.7 22.6 21.4 26.8 21.1 21.3 26.0 24.7 

35 and older 53.4 49.3 46.8 44.3 43.7 46.8 46.3 44.4 49.5 45.1 55.1 50.0 

Median Age at Admission (Years) (35) (34) (33) (32) (32) (33) (33) (33) (34) (32) (36) (35) 

Daily Use 51.4 71.1 65.0 66.6 66.7 59.0 73.6 70.9 74.9 81.8 64.4 70.5 

First Treatment Episode 42.1 42.8 40.6 40.2 44.3 47.4 48.9 32.6 37.5 39.3 40.8 41.3 

Median Duration of Use2 (Years) (5) (3) (3) (4) (4) (5) (3) (3) (3) (3) (5) (3) 

Criminal Justice Referral 14.6 16.0 13.0 13.9 13.0 18.2 18.4 9.0 12.1 7.1 13.7 15.4 

'Quantity is zero 2 For first-time treatment admissions. SOURCE: Based on data from Alcohol and Drug Abuse Administration, Maryland Department of Health and Mental Hygiene 
Part II. Accessing and Analyzing Data from Different Sources 

A Network of Areas Within a State: Louisiana 

A drug abuse surveillance network has been operational in Louisiana since 

1997. Established by the Louisiana State Office for Addictive Disorders, the 

State drug abuse authority, the network has been using treatment data as one 

of its primary sources for assessing drug abuse patterns and trends in parishes 

located throughout the State. Representatives of the parishes assume 

responsibility for analyzing the treatment data along with other local data 

sources and reporting findings at annual meetings. Exhibit 3 is an example of 

treatment admissions data reported by parish, making it possible to assess 

similarities and differences in the types of 2004 treatment admissions (in 

Thorton-Collins 2006). Crack cocaine (smoked cocaine) has been one of the 

most serious drug problems throughout the State for many years. Almost onehalf (45.5 percent) of the 2004 admissions in Baton Rouge reported smoked 

cocaine as their primary drug of abuse. The percentages of heroin admissions 

were low in all parishes, with the exception of Orleans Parish, where 11 

percent of the 2004 admissions reported heroin as the primary drug. The 

percentages of methamphetamine admissions were also relatively low, but two 

parishes (Rapides and Bossier) reported higher percentages of primary 

methamphetamine admissions in 2004 than in prior years. 

Exhibit 3. Treatment Admissions for Selected Drugs in Nine Parishes of Louisiana, by Primary Drug and 

Percent: 2004 

Drug 

Parish 

Orleans Bossier Calcasieu 

East 

Baton 

Rouge 

Lafayette Ouachita Rapides St. 

Tammany 

Terrebonne 

Cocaine 31.6 26.7 15.8 45.5 32.3 24.8 26.5 28.4 17.3 

Heroin 11.1 0.0 0.3 0.8 0.9 0.3 0.7 3.3 0.3 

Other Opiates 3.6 8.9 11.4 5.0 11.5 4.7 11.4 21.1 7.5 

Marijuana 32.1 15.4 30.0 13.2 13.3 26.6 17.5 17.3 37.3 

Methamphetamine 0.2 6.2 4.2 2.1 1.0 3.8 6.7 1.6 1.0 

Alcohol 18.7 40.8 30.7 32.6 37.8 36.1 32.9 24.7 34.2 

Other Drugs 2.5 2.0 7.6 0.8 3.2 3.7 4.3 3.6 2.4 

Total (N=)1 (2,306) (292) (983) (3,432) (885) (914) (1,295) (1,026) (986) 

1

Excludes admissions for whom a primary drug was not reported. 

SOURCE: Louisiana State Office of Alcohol and Drug Abuse 

34 Assessing Drug Abuse Within and Across Communities: Second Edition 
3. Drug Abuse-Related Hospital Data 

3. DRUG ABUSE-RELATED HOSPITAL DATA 

Hospitals treat a 

broad range of 

substance abuserelated conditions 

and populations... 

Local ED data 

can... provide 

critical insights into 

the health impacts 

of drug use. 

...ties may need to 

be established with 

State and local 

health agencies to 

obtain the data. 

Hospital data on the effects of drug abuse can be a valuable indicator in 

assessing drug abuse patterns and trends within a community or State. Hospitals treat a broad range of substance abuse-related conditions and populations presenting with those problems. Hospitals are the only type of care 

available 24 hours a day, 365 days a year, to provide emergency care and rehabilitative inpatient treatment. Hospitals are in a position to test patients for 

alcohol and drug use and to provide treatment or refer patients to appropriate 

treatment. Detoxification and medical rehabilitation are among the primary 

services provided to substance abusers in a hospital setting. 

Often serious complications from abuse of drugs and alcohol occur at times 

when the hospital is the provider. Cases involving accidents and illnesses 

may be complicated by drug or alcohol abuse. Some individuals are admitted 

to the hospital for a medical or psychiatric condition that is a consequence of 

drug-using behavior. Or, there may be a “co-morbid” condition, such as affective disorder coexisting with drug or alcohol dependence. 

Many drug abusers, especially those who do not have medical insurance, use 

the hospital emergency department (ED) as their primary source of care. 

Some chronic drug abusers relapse from time to time and seek care at various 

hospitals. 

Generally, alcohol and drug abuse patients receive care in three basic types of 

hospitals: acute general, private psychiatric, and State psychiatric hospitals. 

Accessing Hospital Data 

Hospital data may be difficult to access for a new network. SAMHSA’s Drug 

Abuse Warning Network (DAWN) ED data, described below, are the easiest 

to review and access, if a network’s area is included in DAWN. Automated 

hospital discharge data that have already been analyzed are also useful and 

can provide some insight into the effects of drugs in an area. Local ED data 

are more difficult to obtain and analyze, but they can provide critical insights 

into the health impacts of drug use. Local hospital data will generally provide 

smaller numbers than comparable DAWN ED data, and they may provide less 

insight into serious acute consequences of drug use. 

For network members interested in accessing data directly from local hospitals, ties may need to be established with State and local health agencies to 

obtain the data. For hospitals that do not have public online data, permission 

must be obtained to collect the data directly from medical records. Hospital 

confidentiality procedures are stringent. Strategies will need to be devised to 

convince those with data to share it with the network in ways that will be 

useful to the work group. Assurances must be explicitly stated regarding 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 35 
 

 

Part II. Accessing and Analyzing Data from Different Sources 

...the purposes for 

collecting the data 

should be explained 

to the hospital 

staff... 

maintaining confidentiality of records. The purpose of collecting the data 

needs to be made clear to hospital staff. It should also be made clear that the 

network will provide the hospitals with a report of its findings. 

To facilitate accessing information, contact should be made with the hospital’s 

Executive Director, the official in charge of planning or marketing, or the 

hospital’s epidemiology department. If the hospital is relatively small, it 

should be fairly easy to identify the appropriate hospital representative. 

 Whether the data are accessed electronically or manually by searching 

medical or toxicology records, the purposes for collecting the data should 

be explained to the hospital staff and it should be stated that the findings 

will be shared with the hospital. 

 Collecting and sharing the data will allow community-based providers to 

work more closely together to provide better case management and aftercare services. 

In cases where network members must collect the data directly from medical 

records, the data may be categorized by codes. The diagnostic codes may be 

the Diagnostic Related Groups (DRGs), which are used to set limits on Medicare reimbursement, as established by the enactment of the Tax Equity and 

Fiscal Responsibility Act of 1982. Or the data may be classified according to 

the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).1 Addendum A: Guidelines on Using Diagnostic Codes, 

presented at the conclusion of this chapter, lists the addiction-related codes, 

with a section on matching DRGs and ICD-9-CM codes. 

Admittedly, hospital-based drug use data are difficult to collect, aggregate, 

and analyze. While most hospitals collect and record drug-related data, there 

is a lack of uniformity among public, private, and not-for-profit hospital databases that makes it challenging to report the extent of substance abuse in any 

jurisdiction, region, or on a statewide basis. Some of these challenges are encountered in the DAWN national coverage of emergency departments. Ways 

in which “Reporters” are trained to systematically record drug-related data 

from patient records are described in Drug Abuse Warning Network: 

Development of a New Design (Methodology Report) (SAMHSA 2002), and 

may be useful to network members who need to explore different ways 

hospitals patient record data and the systematic way in which DAWN 

retrieves data. 

1

While ICD-9 has been the medical coding system in the United States for more than a quarter century, there is an effort underway to adopt the World Health Organization’s ICD-10, which is better suited for new electronic health systems and is used in all 

other developed countries. The American Health Information Management Association (AHIMA) calls for the adoption of ICD10-CM for diagnostic coding and ICD-10-PSC for hospital inpatient services no later than 2008, and for support in the form of 

legislative authority and financial allocation. The decision rests with the Secretary of Health and Human Services. Additional 

information on ICD-10, including testing of the system, is available at <http://www.ahima.org/coding/index.asp> and 

<http//:www.cdc.gov/nchs/about/major/dvs/icd10des.htm>. 

36 Assessing Drug Abuse Within and Across Communities: Second Edition 
3. Drug Abuse-Related Hospital Data 

...identify someone 

at the local level 

who has knowledge, 

skills, and time to do 

the necessary work. 

Given the difficulties in accessing hospital data directly from medical records,

and the limited time and resources of a network, it is advisable to identify

someone at the local level who has knowledge, skills, and time to do the necessary work. Unless there is a network member who has knowledge of and 

expertise in accessing and analyzing hospital data sets, via record search or 

electronically, a second step might be to identify a researcher who can assist 

the network in collecting and analyzing the data. This person may well be interested in becoming a member of the network. Ideally, this person would 

access, prepare, and report the data at the network meeting in a simple format 

so the data can be used with other indicator data to assess drug abuse patterns 

and trends. There should be a periodic independent investigation on a sampling basis of the quality and accuracy of different hospital data systems. 

The remainder of this section focuses on accessing and using the following 

types of hospital data––emergency department drug-abuse data and drugrelated hospital admissions and discharge data. 

Emergency Department Data 

The American Hospital Association (1991) defines an emergency department 

as “an organized hospital facility for the provision of unscheduled outpatient 

services to patients whose conditions are considered to require immediate 

care. An ED must be staffed 24 hours a day.” 

The Drug Abuse Warning Network (DAWN) 

Judy K. Ball, Ph.D., M.P.A. 

DAWN is administered by the Office of Applied Studies (OAS) at the 

Substance Abuse and Mental Health Services Administration (SAMHSA). 

DAWN has two components: the emergency department (ED) component 

and the mortality component (which is described in Chapter 4). 

DAWN’s ED component 

provides information 

about drug-related ED 

visits for the Nation 

and for a selection of 

metropolitan areas. 

DAWN’s ED component provides information about drug-related ED visits

for the Nation and for a selection of metropolitan areas. ED estimates are

published annually. DAWN cannot be used to measure the prevalence of 

drug abuse (i.e., how many people abuse or misuse drugs); instead, it provides

valuable information about the more severe health consequences of drug use, 

misuse, and abuse. 

DAWN was redesigned in 2003. The current ED component is based on a 

statistical model that is more precise and a sample of hospitals that permits 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 37 
 

Part II. Accessing and Analyzing Data from Different Sources 

DAWN relies on a 

stratified probability 

sample of short-term, 

general, non-Federal 

hospitals that operate 

24-hour emergency 

departments. 

Any emergency 

department visit 

related to recent drug 

use is reportable as a 

DAWN case. This 

broad definition covers 

“drug use,” “drug 

misuse,” and “drug 

abuse.” 

To be a DAWN case, a 

drug does not have to 

have been the direct 

cause of the visit; the 

drug only needs to be 

implicated in the ED 

visit. 

...DAWN Reporters 

review medical charts 

for all patients treated 

in participating EDs. 

generalizations for the entire Nation. Other changes to DAWN include new 

case criteria, new case-finding methods, new data items, and improved quality 

assurance. For these reasons, data published prior to 2003 are no longer 

comparable to those collected in the redesigned system (see SAMHSA 2002). 

DAWN relies on a stratified probability sample of short-term, general, nonFederal hospitals that operate 24-hour emergency departments. The sample of 

hospitals was designed to represent such hospitals nationally and also oversamples such hospitals in selected metropolitan statistical areas (MSAs), 

including some of the MSAs that were in DAWN prior to 2003. Network 

members interested in learning whether the DAWN ED component includes 

their MSA in any given year can access the information at the following 

World Wide Web site: <http://DAWNinfo.samhsa.gov>. 

Any emergency department visit related to recent drug use is reportable as a 

DAWN case. This broad definition covers “drug use,” “drug misuse,” and 

“drug abuse.” All types of drugs are included: illicit drugs, prescription and 

over-the-counter medications, dietary supplements, non-pharmaceutical 

inhalants, and alcohol. Excluded are cases in adults when alcohol is the only 

drug involved, but alcohol in combination with other drugs is always 

reportable. Alcohol only cases are included for persons younger than 21. 

Each case is assigned to one of eight case types, according to documentation 

in the medical chart (see exhibit 1 below). Case types include suicide attempt, 

seeking detoxification, “underage drinking” (when alcohol is the only drug in 

a person under age 21), adverse reactions, overmedication, malicious 

poisoning, accidental ingestion, and “other.” The final case type “other” 

includes all drug-related cases not assigned to any of the previous seven case 

types. It is the category designed to capture most cases involving illicit drugs 

of abuse. For analyses focusing on drug misuse and abuse, DAWN cases 

classified as overmedication, malicious poisoning, and case type “other” are 

combined. Accidental ingestion and adverse reactions are never classified as 

“drug abuse.” Multiple drugs plus alcohol may be reported for any case. 

To be a DAWN case, a drug does not have to have been the direct cause of the 

visit; the drug only needs to be implicated in the ED visit. Only recent drug use 

is included. Case criteria are sufficiently broad to encompass all types of drugrelated events, including explicit drug abuse. It is recognized that medical 

records, the source of DAWN data, often lack explicit documentation of substance abuse, and distinctions between drug use, misuse, and abuse are often 

subjective (SAMHSA 2004b). Therefore, explicit documentation of drug 

“abuse” is not used in making DAWN case determinations or in assigning case 

type. 

To find cases, DAWN Reporters review medical charts for all patients treated in 

participating EDs. The Reporters submit data only for the ED visits that meet 

the DAWN case criteria. Data are submitted electronically over a secure 

Internet connection, and the system alerts Reporters of inconsistent or invalid 

data. 

38 Assessing Drug Abuse Within and Across Communities: Second Edition 
3. Drug Abuse-Related Hospital Data 

Exhibit 1. DAWN Decision Tree 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 39 

YES

NO

NO

NO

NO

 

 

 

NO 

NO

 

 

 

 

 

NO

NO

YES

YES

YES

YES

YES

YES

YES

 

 

 

 

 

 

 

 

 

Is this a DAWN Case? Based on documentation in the chart, 

was the ED visit for a condition induced by or related to drug use?

This is a DAWN Case.

Answer the following questions in order. Assign Type of Case to first Yes.

1. Does the chart indicate that the patient attempted suicide with a drug involved?

•“Suicide ideation”

•No documentation of suicide attempt

•Psych evaluation

•Tried to harm self

2. Does the chart indicate that the patient was seeking detox or entry into a drug

treatment program?

•Withdrawal, but not seeking detox

3. Is the patient under age 21 and alcohol is the only drug mentioned in the chart?

•Other drug(s) and alcohol are involved

•Patient is age 21 or over

STOP

Not a DAWN Case

01 SUICIDE ATTEMPT

•“Suicide attempt

•Completed suicide

•Attempted to kill self

02 SEEKING DETOX

•Seeking detoxification

•Medical clearance for drug treatment

admission

•Request for drug rehabilitation

03 ALCOHOL ONLY (AGE < 21)

•Patient under age 21 and alcohol is the

only drug

04 ADVERSE REACTION

•Allergic reactions

•Drug interactions

•“Side effect” of drug

Is this a DAWN Case? Based on documentation in the chart, 

was the ED visit for a condition induced by or related to drug use? 

This is a DAWN Case. 

Answer the following questions in order. Assign Type of Case to first Yes. 

YES 

1. Does the chart indicate that the patient attempted suicide with a drug involved? 

NO 

•“Suicide ideation” 

•No documentation of suicide attempt 

•Psych evaluation 

•Tried to harm self 

2. Does the chart indicate that the patient was seeking detox or entry into a drug 

treatment program? 

NO •Withdrawal, but not seeking detox 

3. Is the patient under age 21 and alcohol is the only drug mentioned in the chart? 

NO •Other drug(s) and alcohol are involved 

•Patient is age 21 or over 

STOP

Not a DAWN Case

STOP 

Not a DAWN Case 

01 SUICIDE ATTEMPT 

•“Suicide attempt 

•Completed suicide 

•Attempted to kill self 

02 SEEKING DETOX 

•Seeking detoxification 

•Medical clearance for drug treatment 

admission 

•Request for drug rehabilitation 

03 ALCOHOL ONLY (AGE < 21) 

•Patient under age 21 and alcohol is the 

only drug 

04 ADVERSE REACTION 

•Allergic reactions 

•Drug interactions 

•“Side effect” of drug 

NO 

YES 

YES 

YES 

•Unexpected reaction to illicit drugs 

•Toxicity without documentation of “adverse reaction” 

•Too little medication; took less than prescribed dose 

•Took someone else’s drug or medication 

5. Did the patient exceed the prescribed dose of a prescription drug or the 

recommended dose of an over-the-counter medication or dietary supplement?

6. Does the chart indicate that the patient was deliberately poisoned or drugged 

by another person?

7. Does the chart indicate that the drug was used accidentally or unknowingly?

05 OVERMEDICATION

•Tried to make up a missed dose

•Forgot they had taken a dose

•Treated symptoms that did not subside 

with recommended dose

06 MALICIOUS POISONING

•Drug-facilitated assault

•Drug-facilitated rape

•Homicide with drug as the weapon

•Product tampering

07 ACCIDENTAL INGESTION

•Accidental child poisoning

•Took wrong drug or medication

5. Did the patient exceed the prescribed dose of a prescription drug or the 

recommended dose of an over-the-counter medication or dietary supplement? 

NO 

6. Does the chart indicate that the patient was deliberately poisoned or drugged 

by another person? 

NO 

7. Does the chart indicate that the drug was used accidentally or unknowingly? 

05 OVERMEDICATION 

•Tried to make up a missed dose 

•Forgot they had taken a dose 

•Treated symptoms that did not subside 

with recommended dose 

06 MALICIOUS POISONING 

•Drug-facilitated assault 

•Drug-facilitated rape 

•Homicide with drug as the weapon 

•Product tampering 

07 ACCIDENTAL INGESTION 

•Accidental child poisoning 

•Took wrong drug or medication 

YES 

YES 

YES 

4. Does the chart indicate that the patient had an “adverse reaction” to a 

prescription drug, over-the-counter medication, or dietary supplement taken as

prescribed or recommended?

4. Does the chart indicate that the patient had an “adverse reaction” to a 

prescription drug, over-the-counter medication, or dietary supplement taken as 

prescribed or recommended? 

NO 

YES 

•Illicit drugs 

•Malicious poisoning 

•Took someone else’s drug or medication 

•Accidentally took the wrong drug or medication 

NO 08 OTHER

•Any DAWN Case not assigned above

•Most illicit drug use

•Toxicity due to drugs

•Withdrawal

•Psych evaluation with drugs detected

•Took someone else’s drug or medication

08 OTHER 

•Any DAWN Case not assigned above 

•Most illicit drug use 

•Toxicity due to drugs 

•Withdrawal 

•Psych evaluation with drugs detected 

•Took someone else’s drug or medication 

SOURCE: Office of Applied Studies, SAMHSA 
Part II. Accessing and Analyzing Data from Different Sources 

Primary users of the DAWN ED data are the participating hospitals, local 

public health officials, Federal agencies (SAMHSA, the Food and Drug 

Administration, the Office of National Drug Control Policy, and the Drug 

Enforcement Administration), and the Community Epidemiology Work 

Group. DAWN data for MSAs can be accessed from SAMHSA publications 

or online. 

For additional information, contact Dr. Judy Ball, Acting Director, Division of 

Operations, OAS, SAMHSA; Phone: 240-276-1256; E-mail: 

<Judy.Ball@samhsa.hhs.gov>. 

Local ED Data 

The availability of local ED data (for hospitals not included in the DAWN 

sample) will vary from hospital to hospital and from community to 

community. Network members will need to obtain information about their 

local hospital emergency department before requesting access to the data. 

Where to Start: Accessing ED Data 

Communities located 

in metropolitan areas 

that are part of the 

DAWN ED system can 

access data on their 

MSAs from DAWN’s 

annual publications... 

or online at 

<http://DAWN 

info.samhsa.gov>. 

Network members 

whose communities 

are not covered in 

DAWN... should check 

with the State hospital

association, local 

health department, or 

other hospitals 

directly... 

...check first as to 

what types of information the hospital 

maintains on drugabusing patients, and 

then determine 

whether the data will 

be useful... 

DAWN Data. Communities located in metropolitan areas that are part of the

DAWN ED system can access data on their MSAs from DAWN’s annual 

publications, available in hard copy from NCADI or online at 

<http://DAWNinfo.samhsa.gov>. These data are released approximately 6 to

12 months after the close of the data year. There is a time lag between the end 

of the data year and the release of the data, because DAWN ED data must 

undergo a series of checks before they are weighted and analyzed. SAMHSA

ED publications now include confidence intervals (i.e., the margin of error) 

and relative standard errors (RSE), which provide information about the 

reliability and precision of the estimates.

Network members whose communities are not covered in DAWN, or who

wish to use data in addition to or other than DAWN, should check with the 

State hospital association, local health department, or other hospitals directly

to determine whether any information on drug abuse-related ED patients can

be accessed electronically. 

If data must be collected directly from hospital records, members need to 

check first as to what types of information the hospital maintains on drugabusing patients, and then determine whether the data will be useful to the

network. If the information appears useful and network members request and 

obtain permission to access information directly from medical records, and

perhaps also toxicology laboratory reports, it will be most useful to prepare a

data form(s) before requesting the data. 

40 Assessing Drug Abuse Within and Across Communities: Second Edition 
 

 

3. Drug Abuse-Related Hospital Data 

Local Data. CEWG representative James Hall, together with colleagues in 

South Florida, gathered data on drug-related emergency department cases 

semiannually from a hospital in Broward County (Fort Lauderdale) before it 

became part of the DAWN sample. These data were derived from medical 

records, reported at the semiannual CEWG meetings, and published in CEWG 

Volume II Proceedings reports. 

In addition to extracting data from medical records, the Florida researchers 

found it useful to generate a daily printout of all toxicology laboratory work 

done by the lab from the previous day and to focus on those cases with a 

positive toxicology report. The lab data helped in identifying specific drugrelated cases that may be missed or difficult to find by chart review alone. 

These researchers also educated ED staff in identifying drug-related cases and 

provided them assistance on how to document the cases. 

What to Request 

For networks that will rely on DAWN published reports, there will be ample 

data from which to select, including the types of information listed below.2 

Similar information may be available from local EDs that are not part of 

DAWN or other databases. 

 The total number of drug-related ED visits in a metropolitan area, and the 

ED visits broken out by case type. 

 The number of drug misuse/abuse ED visits. For analyses using DAWN 

drug misuse/abuse data, cases classified as overmedication, malicious 

poisoning, and the category “other” are combined; accidental ingestion 

and adverse reactions are never classified as “drug abuse.” 

 The total number of ED visits and the number of drug misuse/abuse ED 

visits that involved a particular drug or drug category. 

 Drug concomitance (whether the ED visit involved a single drug or 

multiple drugs). 

 Demographic information about patients in drug-related ED visits (e.g., 

gender, age group, race/ethnicity). 

 The disposition (i.e., outcome) of the drug-related ED visits: treated and 

released, admitted to the hospital, and all other dispositions. 

2

 DAWN will publish metropolitan-level estimates beginning with the 2004 ED estimates; these will be available at 

<http://DAWNinfo.samhsa.gov/>. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 41 
Part II. Accessing and Analyzing Data from Different Sources 

If raw data are 

collected from 

a hospital, it is 

important to 

provide a context 

for the data. 

If raw data are collected from a hospital, it is important to provide a context

for the data. This can be done by documenting the total number of ED visits

in the hospital, and/or the number of ED visits reviewed, as a denominator for 

the data. The denominator can be used to calculate percentages (i.e., X 

percent of ED visits were drug-related, or X percent of drug-related ED visits 

involved Y drug). 

Uses of ED Data: Some Examples 

DAWN Data. Exhibit 2 is an example from the first publication from the 

redesigned DAWN. This simple chart shows the rate of ED visits for four 

major illicit drugs, per 100,000 population, in the second half of 2003. 

Exhibit 2. Rates of Illicit Drugs per 100,000 Population in DAWN ED Visits in the Coterminous United States: 

Third and Fourth Quarter 2003 

ED Visits per 100,000 Population 

60
 

50
 

40
 

30
 

20
 

10
 

0
 

44 

28 

16 15 

Cocaine Marijuana Heroin Stimulants 

SOURCE: Adapted from the Office of Applied Studies, SAMHSA, Drug Abuse Warning Network 2004b, p.37 

Local Data. Exhibit 3 illustrates some findings from the Fort Lauderdale 

hospital; these involved ED mentions of gamma hydroxybutrate (GHB) from 

1996 through 2003. As shown, GHB mentions peaked in 2000 but remained 

higher in 2003 than from 1996 to 1998. 

42 Assessing Drug Abuse Within and Across Communities: Second Edition 
3. Drug Abuse-Related Hospital Data 

Exhibit 3. Emergency Department GHB Mentions in Fort Lauderdale, Florida: 1996–2003 

Number of Mentions
 

100
 

90
 77
 

80
 71 

70 

60 48 

50 

34 40 30 

30 

13 20
 

3 4 10
 

0
 

1996 1997 1998 1999 2000 2001 2002 2003 

SOURCE: Broward General Medical Center 

Other analyses of the Fort Lauderdale ED data accessed from the local ED 

were also reported including, by drug, patient demographic characteristics 

(age, gender, race/ethnicity), reasons for visiting the ED (e.g., depression/suicidal, dependence/seeking detoxification, trauma/accident), and combinations 

of drugs used by patients (see Hall and Camejo 2005). 

Drug-Related Hospital Admissions and Discharge Data 

Hospital drugrelated admissions 

and discharge data 

can be a valuable 

indicator of drug 

abuse and 

associated health 

consequences. 

Hospital drug-related admissions and discharge data can be a valuable 

indicator of drug abuse and associated health consequences. Many drug 

abusers require hospitalization and may be admitted to the hospital for a 

medical or psychiatric illness that is the consequence of a drug-using 

behavior. These data may be among the most difficult for network members to 

access and analyze. The data may be available from a local or State hospital 

association or a State health department. Two examples are presented below. 

The first was prepared by James Cunningham, Ph.D., University of Arizona, 

and illustrates how drug-related hospital admissions data can be accessed and 

analyzed to provide information about the epidemiology of drug problems and 

the impacts of drug policies on hospital admissions. The second, prepared by 

former CEWG representative Bruce Mendelson, illustrates how hospital 

discharge data are used in Colorado. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 43 
Part II. Accessing and Analyzing Data from Different Sources 

Hospital Admissions Data: Access and Uses in Drug Analysis 

James K. Cunningham, Ph.D. 

...hospital admissions data can 

provide important 

information about 

the epidemiology of 

drug problems and 

the impacts of drug 

policies. 

Data for the study of 

hospital admissions 

comes from what is 

known as hospital 

discharge data 

systems. These 

systems consist of 

patient-level 

records that include 

date of admission as 

well as date of 

discharge. 

There are two main 

sources of data from 

hospital discharge 

systems... Statebased agencies and 

the Healthcare Cost 

and Utilization 

Project. 

Most States now 

have agencies... that 

have been entrusted 

with the supervision, storage, 

analysis, and 

dissemination of 

statewide hospital 

discharge data. 

Drug-involved hospital admissions data can provide important information 

about the epidemiology of drug problems and the impacts of drug policies. 

This paper describes procedures and sources for accessing these data and 

examples of their use in epidemiologic and drug policy analysis. 

Where to Start: Accessing the Data 

Data for the study of hospital admissions comes from what is known as 

hospital discharge data systems. These systems consist of patient-level 

records that include date of admission as well as date of discharge. The 

systems, however, are called discharge data systems because hospitals submit 

their data to the systems based on the date of patient discharge. Researchers 

extract records from the systems and conduct analyses as needed. Drug 

researchers typically extract the records for analyses that involve the date of 

admission. Later in this paper, for example, data from a hospital discharge 

data system is used to examine trends in methamphetamine, cocaine, and 

heroin/opioid-related hospital admissions. The term “discharge data” is used 

here in reference to the systems that provide the data. The term “admissions 

data” is used in reference to data that have been extracted from these systems 

and analyzed according to date of admission. 

There are two main sources of data from hospital discharge systems in the 

United States—State-based agencies and the Healthcare Cost and Utilization 

Project. 

Most States now have agencies—governmental, educational, or private—that 

have been entrusted with the supervision, storage, analysis, and dissemination 

of statewide hospital discharge data. Many of these agencies belong to the 

National Association of Health Data Organizations (NAHDO), which lists 

contact information for each of its member organizations (see 

<www.nahdo.org>). To illustrate how discharge data are accessed from Statebased agencies, procedures for obtaining data in Arizona, California, and 

Nevada follow. 

In Arizona, the Department of Health Services, Bureau of Public Health 

Statistics, makes two types of limited (public use) discharge data sets 

available for the purposes of supporting research, public health, and health 

care operations. One set consists of discharge data from acute care hospitals, 

the other includes discharge data from emergency room departments. Each 

data set includes principal and secondary diagnoses (ICD-9-CM), as well as 

demographic (e.g., race/ethnicity, age, and gender), geographic (e.g., county), 

and service (e.g., principal and secondary procedures) variables. Each data set 

requires an approved application form and fee. In addition to providing 

44 Assessing Drug Abuse Within and Across Communities: Second Edition 
3. Drug Abuse-Related Hospital Data 

...the Healthcare 

Cost and Utilization 

Project (H-CUP) is a 

Federal-StateIndustry partnership... H-CUP 

operates the State 

Inpatient Databases 

(SID), which consist 

of records of all 

inpatient discharges 

from each of 36 

different States... 

While there are 

differences across 

States in the availability of variables, 

each State’s SID... 

generally includes... 

principal/secondary 

diagnoses as well as 

basic demographic, 

geographic, and 

service variables. 

discharge data, the Bureau of Public Health Statistics also responds to requests 

for customized data reports. 

In contrast to State-based agencies, the Healthcare Cost and Utilization 

Project (H-CUP) is a Federal-State-Industry partnership sponsored by the 

Agency for Healthcare Research and Quality. H-CUP operates the State 

Inpatient Databases (SID), which consist of records of all inpatient discharges 

from each of 36 different States, representing about 90 percent of all 

community hospital discharges in the Nation. Of the 36 States that participate 

in SID, 20 provide their discharge data for direct access through H-CUP. 

These States are Arizona, California, Colorado, Florida, Iowa, Kentucky, 

Maine, Maryland, Massachusetts, Michigan, Nebraska, New Jersey, New 

York, North Carolina, Oregon, South Carolina, Utah, Washington, West 

Virginia, and Wisconsin. H-CUP provides information on how to obtain SID 

files directly from the remaining 16 states: Connecticut, Georgia, Hawaii, 

Illinois, Kansas, Minnesota, Missouri, Nevada, Ohio, Pennsylvania, Rhode 

Island, South Dakota, Tennessee, Texas, Virginia, and Vermont. 

While there are differences across States in the availability of variables, each 

State’s SID data set generally includes at a minimum principal/secondary 

diagnoses as well as basic demographic, geographic, and service variables. 

Moreover, where possible, standardized formatting and coding are used to 

increase uniformity across the data sets. Approved applications are required 

before a SID data set is released. The fees charged generally differ from one 

State data set to another. SID files are provided on CD in ASCII format for 

use with statistical packages such as SAS or SPSS. 

When interpreting local drug-related hospital discharge trends, it can be 

helpful to contrast them with national trends. To this end, researchers may 

wish to consider H-CUP’s National Inpatient Sample (NIS), which contains 

discharge data from a national sample of approximately 1,000 hospitals. As 

with SID, NIS includes principal/secondary diagnoses as well as 

demographic, geographic, and service variables; requires approval and a fee; 

and provides data on CD in ASCII format. 

Uses of Hospital Data 

Data derived from hospital discharge data sets may be unique in that they can 

provide information on drug problems both statewide and regionally, as well 

as information on the impact of specific drug policies. An example of each is 

presented here using Arizona hospital admissions related to methamphetamine, cocaine, and heroin/opioids. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 45 
Part II. Accessing and Analyzing Data from Different Sources 

[In Arizona, coders] 

assign ICD-9-CM 

codes to describe 

what occasioned the 

admission of a 

patient, what 

contributed to the 

patient’s length of 

stay and financial 

charges, and the 

Diagnostic Related 

Group appropriate 

to the patient. 

Methods Used in Analyzing Arizona Hospital Data 

Data for the Arizona Hospital Discharge Data System (AHDDS) are 

abstracted from hospital patient charts by coders employed by hospitals or 

hospital subcontractors to maintain medical records. The coders review charts 

of all patients and abstract information such as race/ethnicity, sex, age, source 

of admission, and patient disposition. They also assign ICD-9-CM codes to 

describe what occasioned the admission of a patient, what contributed to the 

patient’s length of stay and financial charges, and the Diagnostic Related 

Group appropriate to the patient. The abstracted information and diagnostic 

codes are forwarded to the Arizona Department of Health Services, which 

until 1994, used up to five fields for diagnostic codes. (Note that the ICD-9 E 

codes were entered in the diagnostic fields through 1994.) Starting in 1995, 

the AHDDS began using nine fields for diagnostic codes that are not E codes 

(i.e., not external cause of injury or poisoning codes) and up to two E-code 

fields. Starting in 2004, the system included four E-code fields. All available 

diagnostic code and E-code fields were used in the analyses for this paper. 

The increase in diagnostic fields beginning in 1995 may have lead to more 

accurate reporting, and thus slightly larger drug admission counts for the years 

1995–2004 versus 1990–1994. The changes in E-code fields may have had 

similar effects. (Note, however, that a record that includes a drug-related E 

code usually includes other diagnostic codes related to the same drug.) 

The ICD-9-CM codes used to identify whether a hospital admission was 

amphetamine-related are 304.4 (amphetamine and other psychostimulant 

dependence), 305.7 (amphetamine or related acting sympathomimetic abuse), 

1969.7 (psychostimulant poisoning), and E854.2 (accidental psychostimulant 

poisoning). These diagnostic codes are for the general category of 

amphetamines/psychostimulants; thus, analyses in this paper do not 

distinguish among types of amphetamines. Notwithstanding this, most of the 

chemicals offered on the street as amphetamine or the other terms listed above 

include d-methamphetamine. For this reason, the admissions examined here 

are referred to as methamphetamine admissions. 

The codes used to identify whether an admission was cocaine-related are 

304.2 (cocaine dependence), 305.6 (nondependent abuse of cocaine), 968.5 

(poisoning by surface and infiltration anesthetics including cocaine), and 

E855.2 (unintentional poisoning by local anesthetics including cocaine). A 

case having any one of these codes was considered a cocaine admission. 

The codes used to identify whether an admission was heroin/opioid-related are 

304.0 (opioid type dependence), 304.7 (dependence involving combinations 

of opioid type drug with any other), 305.5 (opioid use), 965.0 (poisoning by 

opiates and related narcotics), E850.0 (accidental poisoning by heroin), 

E850.1 (accidental poisoning by methadone), and E850.2 (accidental 

poisoning by other opiates and related narcotics). A case having any one of 

these diagnoses was considered a heroin/opioid-related admission. (Codes for 

opioids causing adverse effects in therapeutic use—E950, E951, E952—were 

46 Assessing Drug Abuse Within and Across Communities: Second Edition 
Years

Admissions per 100,000 pop. 

3. Drug Abuse-Related Hospital Data 

not used to identify admissions because such use is generally not indicative of 

morbidity caused by heroin/opioid abuse.) Historically, heroin has been the 

single most common opioid associated with hospital admissions. In light of 

this, the term heroin/opioids, rather than opioids, is used here. 

Population data 

from the U.S. 

Census and the 

Arizona Department 

of Health Services 

were used in the 

construction of 

hospital admission 

population rates. 

Population data from the U.S. Census and the Arizona Department of Health

Services were used in the construction of hospital admission population rates.

Statewide Trends in Arizona 

In Arizona, methamphetamine hospital admissions rose and fell sporadically

during the 1990s, then surged 229 percent during 2000–2004, from 1,649 

admissions to 5,424. The increase in the rate of admissions per 100,000 

population during 2000–2004 was 194 percent (exhibit 1). At the end of the 

study period (2004), there were 94 methamphetamine admissions per 100,000 

population, more than twice the highest rate of the 1990s (41 per 100,000 in 

1995). During 1990–2004, the population rate for methamphetamine 

admissions increased 1,075 percent. 

Exhibit 1. Methamphetamine, Cocaine, Heroin/Opioid Hospital Admissions per 100,000 Population in 

Arizona: 1990–2004 

Rate 

120 

100 

80 

60 

40 

20 

0 

Heroin/Opioids 

Methamphetamine 

Cocaine 

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 

SOURCE: The University of Arizona 

Cocaine admissions climbed steadily throughout the 15-year study period and 

increased 47 percent during 2000–2004, from 3,554 to 5,227—a 32-precent 

rise in the rate per 100,000 population. During 1990–2004, the population 

rate for cocaine admissions increased 194 percent. 

Heroin/opioid admissions also climbed steadily throughout the study period 

and increased 52 percent during 2000–2004, from 3,658 to 5,568—a 37­

percent rise in the population rate. During the 15-year study period, the 

population rate increased 194 percent. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 47 
 

Part II. Accessing and Analyzing Data from Different Sources 

Annual methamphetamine, cocaine, 

and heroin/opioid 

admissions for 

Arizona were 

comparable in 

number in 2004, 

related in part to 

the surge of 

methamphetamine 

admissions... 

Annual methamphetamine, cocaine, and heroin/opioid admissions for Arizona 

were comparable in number in 2004, related in part to the surge of 

methamphetamine admissions during the last 5 years of the study period. 

Regional Trends 

Trends in admissions for three Arizona regions are shown in exhibit 2. One 

region is Maricopa County, which includes the city of Phoenix; another is 

Pima County, which includes the city of Tucson; and the third consists of the 

remaining counties in Arizona, which are predominantly rural and referred to 

here as the “Rural Counties.” Rates in all three regions rose substantially 

during the last 5 years of the study period. 

Maricopa County had the highest rates throughout the study period. This 

notwithstanding, and largely because of a particularly sharp rise in 2003– 

2004, the rate in Pima County approached that of Maricopa County in 2004. 

The Rural Counties had the lowest rates. This finding should be interpreted 

with caution, however, because it is possible that people from these counties 

often go to hospitals in Maricopa and Pima Counties (Arizona’s major 

population centers), which would artificially lower rates in rural areas, while 

raising rates in metropolitan areas. 

Exhibit 2. Methamphetamine Hospital Admissions per 100,000 Population in Maricopa, Pima, and Rural 

Counties in Arizona: 1990–2004 

Rate
 

120
 

100
 

80
 

60
 

40
 

20
 

0
 

Maricopa 

Pima 

Rural Counties 

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 

48 Assessing Drug Abuse Within and Across Communities: Second Edition 

SOURCE: The University of Arizona 
 

3. Drug Abuse-Related Hospital Data 

Cocaine admission rates in Maricopa County and the Rural Counties increased 

slightly, while rates in Pima County surged during the last 10 years of the 

study period (exhibit 3). Early in the study period, rates in Maricopa and 

Pima Counties were fairly similar. During the last study year, Pima County’s 

cocaine rate was more than three times that of Maricopa County and also 

substantially higher than that of the Rural Counties. 

Exhibit 3. Cocaine Hospital Admissions per 100,000 Population in Maricopa, Pima, and Rural Counties in 

Arizona: 1990–2004 

Rate 

300 

250 

200 

150 

100 

50 

0 

SOURCE: The University of Arizona 

Maricopa 

Pima 

Rural Counties 

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 49 

As with cocaine, heroin/opioid admission rates in Maricopa County and the 

Rural Counties increased slightly during the study period (exhibit 4). In 

contrast, heroin/opioid rates in Pima County increased sharply during 1996– 

1998, and again during 2003–2004. During the first 5 years of the study period, 

rates in Maricopa and Pima Counties were fairly similar. During the last year 

of the study period, Pima County’s heroin/opioid rate was more than twice that 

of Maricopa County. It was also substantially higher than that of the Rural 

Counties, which consistently had the lowest rates of the three regions. 
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 

Exhibit 4. Heroin/Opioid Hospital Admissions per 100,000 Population in Maricopa, Pima, and Rural Counties in 

Arizona: 1990–2004 

 Rate 

250 

200 

150 

100 

50 

0 

Maricopa 

Pima 

Rural Counties 

Admissions per 100,000 population

Part II. Accessing and Analyzing Data from Different Sources 

SOURCE: The University of Arizona 

In 2004, cocaine and heroin/opioid admission rates in Pima County far 

surpassed the rates for any of the drugs in Maricopa County and the Rural 

Counties (exhibit 5). Maricopa and Pima Counties had similar methamphetamine rates, even though methamphetamine was the top drug associated 

with admissions in Maricopa County and the bottom drug associated with 

admissions in Pima County. Within the Rural Counties, the three types of drug 

admissions ranked in the same order as those in Maricopa County. 

Exhibit 5. Methamphetamine, Cocaine, and Heroin/Opioid Hospital Admissions per 100,000 Population in 

Maricopa, Pima, and Rural Counties in Arizona: 2004 

Rate 

300 

250 

200 

150 

100 

50 

0 

Methamphetamine 

Cocaine 

Heroin/Opioids 

Maricopa Pima Rural Counties 

SOURCE: The University of Arizona 

50 Assessing Drug Abuse Within and Across Communities: Second Edition 
3. Drug Abuse-Related Hospital Data 

...the time-series 

intervention 

design... involves 

assessing baseline 

data (i.e., data 

patterns prior to a 

policy change), and 

then determining 

whether the data 

changed beginning 

with the implementation of the 

policy. 

Relevant Findings: Admissions Data and Drug Policy Impacts 

One of the more useful approaches for evaluating large-scale drug-policy 

impacts is the time-series intervention design (also known as the interrupted 

time-series design). This design involves assessing baseline data (i.e., data 

patterns prior to a policy change) and then determining whether the data 

changed beginning with the implementation of the policy. Critical to the 

design is the availability of data with fine-grained time units. Annual or 

biannual time periods are typically not appropriate for time series intervention 

designs, as the periods are too gross to facilitate a reasonable analysis. 

Fortunately, hospital data can often be analyzed using finer-grained time 

periods such as months or even weeks. As such, they are particularly useful 

for policy analysis. 

To illustrate, monthly methamphetamine admissions data in Arizona and the 

points in time when the Federal Government implemented methamphetamine 

precursor regulations to reduce methamphetamine problems are shown in 

exhibit 6. The first regulation noted in exhibit 6 targeted ephedrine pills in 

single ingredient form (ephedrine is a common chemical precursor used in the 

illicit production of methamphetamine). Methamphetamine admissions fell 

sharply when the regulation was implemented. Products that contained 

ephedrine in combination with other medicinal ingredients were implemented 

in 1996. This regulation appears to have had little effect on admissions. 

Products containing pseudoephedrine (another common precursor chemical) 

were regulated in 1997, and hospital admissions began dropping once again. 

Exhibit 6. Trends in Methamphetamine Hospital Admissions in Arizona Following Different Precursor Chemical 

Regulations: 1991–2000 

1991 1992 1993 1994 1995 1996 1997 

Months 

Product Regulation 

1998 1999 2000 

Product Regulation 

Ephedrine Combination 

Product Regulation 

250 

Ephedrine Single Ingredient 

200 

150 

100 

50 

0 

ARIZONA (1991–2000) 

Pseudoephedrine 

Admissions 

SOURCE: Public Statistics Institute 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 51 
Part II. Accessing and Analyzing Data from Different Sources 

When conducting 

time-series impact 

analyses, impacts 

should be examined 

not only visually, but 

statistically as well 

using procedures such 

as ARIMA analysis. 

Compare the monthly data in exhibit 6 to the annual methamphetamine data in 

exhibit 1. While the associations between the regulations and hospital 

admissions data are easily seen in exhibit 6, the annual data in exhibit 1 

(which are very useful for epidemiologic purposes) would be too gross to 

facilitate a quality policy impact analysis. 

Note: When conducting time-series impact analyses, impacts should be 

examined not only visually, but statistically as well using procedures such as 

ARIMA analysis. More information on hospital discharge data, precursor 

regulations, and ARIMA analysis can be found in Cunningham and Lon-Mu 

(2003). 

Using Drug-Related Hospital Discharge Data in Colorado 

Bruce Mendelson, M.A. 

In this example, the author explains how drug-related hospital discharge data 

are accessed in Colorado and provides examples of how the data are analyzed. 

Findings from this database continue to be reported regularly in CEWG 

reports and to State planners (e.g., Brace 2006). 

In Colorado... 

codes are based 

on... ICD-9-CM 

Where to Start: Accessing Hospital Discharge Data 

In Colorado, all hospital discharge data are initially collected and coded by the 

Colorado Hospital Association (CHA). Codes are based on the International 

Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9­

CM). CHA annually provides a tape of all such discharge data to the Colorado 

Department of Public Health and Environment (CDPHE), which in turn 

provides the Colorado Alcohol and Drug Abuse Division (ADAD) with an 

Excel file of requested hospital discharge information. The file includes the 

drug-related codes listed in exhibit 1. (ADAD also requests alcohol codes.) In 

requesting data, network members need to be familiar with these codes. 

ADAD can request a file from CDPHE with statewide data only (i.e., 

aggregated) by the specific ICD-9-CM codes; a file with a number of 

disaggregated cross tabulations by ICD-9-CM codes including age, gender, 

and county; or any combinations of these (e.g., a three-way cross tab of ICD9-CM code by gender by age). In the data request, ADAD must clearly 

specify whether the needed data set is to be limited to only Colorado residents, 

or to both residents and out-of-state individuals (i.e., an “occurrence” vs. a 

“resident” analysis). 

52 Assessing Drug Abuse Within and Across Communities: Second Edition 
3. Drug Abuse-Related Hospital Data 

Exhibit 1. ICD-9-CM Drug-Related Codes Used in Colorado Department of Public Health and Environment 

Discharge Data 

Drug Dependence (304.0-304.9): 

Drug Dependence – Opioid Type 304.0 

Drug Dependence – Barbiturate Type 304.1 

Drug Dependence – Cocaine 304.2 

Drug Dependence – Cannabis 304.3 

Drug Dependence – Amphetamine Type and Other Psychostimulants 304.4 

Drug Dependence – Hallucinogens 304.5 

Drug Dependence – Other 304.6 

Drug Dependence – Combination of Morphine Type With Other 304.7 

Drug Dependence – Combination Excluding Morphine Type 304.8 

Drug Dependence – Unspecified 304.9 

Drug Abuse, Not Alcohol or Tobacco (305.2-305.9): 

Nondependent Abuse of Drugs – Cannabis 305.2 

Nondependent Abuse of Drugs – Hallucinogens 305.3 

Nondependent Abuse of Drugs – Barbiturates and Tranquilizers 305.4 

Nondependent Abuse of Drugs – Morphine Type 305.5 

Nondependent Abuse of Drugs – Cocaine Type 305.6 

Nondependent Abuse of Drugs – Amphetamine Type 305.7 

Nondependent Abuse of Drugs – Antidepressants 305.8 

Nondependent Abuse of Drugs – Other, Mixed, or Unspecified 305.9 

Drug Poisoning (E850.0-E858.9): 

Accidental Poisoning By Analgesics, Antipyretics, etc. E850 

Accidental Poisoning by Barbiturates E851 

Accidental Poisoning by Other Sedatives and Hypnotics E852 

Accidental Poisoning By Tranquilizers E853 

Accidental Poisoning By Other Psychotropic Agents E854 

Accidental Poisoning By Other Drugs Acting on Nervous System E855 

Accidental Poisoning By Other Drugs E858 

Opiates and Related Narcotics N965.0 

Barbiturates N967.0 

Surface and Infiltration Anesthetics N968.5 

Antidepressants N969.0 

Phenothiazine-Based Tranquilizers N969.1 

Other Antipsychotics, Neuroleptics and Major Tranquilizers N969.3 

Benzodiazepine-Based Tranquilizers N969.4 

Other Tranquilizers N969.5 

Psychodysleptics (Hallucinogens) N969.6 

Psychostimulants N969.7 

SOURCE: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), World Health Organization 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 53 
Part II. Accessing and Analyzing Data from Different Sources 

ADAD uses the 

hospital discharge 

data in a variety of 

analyses... 

...hospital discharge 

and treatment data 

can be used for local 

substance abuse 

services planning. 

Uses of Hospital Discharge Data: Colorado Highlights 

ADAD uses the hospital discharge data in a variety of analyses, including the 

following: 

 Statewide single-year or trend analysis of aggregate alcohol and/or drug 

hospital discharge numbers and/or rates; the analysis may also be done by 

demographic characteristics 

 Statewide single-year or trend analysis of specific alcohol and/or drug 

ICD-9-CM codes. For drugs, this analysis usually focuses on drug types 

(e.g., cocaine or cannabis) 

 Substate planning area (typically counties) single-year or trend analysis of 

aggregate alcohol and/or drug hospital discharge numbers and/or rates 

The types of analyses described above represent only a fraction of those that 

can be done with this versatile data set. However, there may be data issues, 

such as “small cell sizes,” that can present a misleading picture if not dealt 

with appropriately (e.g., when calculating rates for substate planning areas 

with small populations). It may be necessary to suppress data for small 

geographic areas or specific subgroups, report averages for multiple years, or 

aggregate data by several geographic areas to increase case size. 

The examples that follow show how drug-related hospital discharge data have 

been used at the county and State level, with some illustrations of how the 

hospital discharge data have been triangulated with other drug abuse indicator 

data. 

Using Hospital Discharge Data for Local Planning in Colorado 

Exhibit 2, based on data from Adams County, illustrates how hospital 

discharge and treatment data can be used for local substance abuse services 

planning. In this populous county, east of the city and county of Denver, drugrelated hospital discharges increased dramatically (87 percent) during the 8­

year time period shown. The overall rate increase (23 percent) in drug-related 

treatment admissions from 1993 to 1999 indicated the county was attempting 

to respond appropriately with increased treatment services funding. The 

decline in the treatment admission rate between 1999 and 2000 needed to be 

explored indepth by local planners to determine whether the drop reflected 

data system/reporting problems or an actual decline in the treatment effort that 

warranted a review of drug treatment funding policies. 

54 Assessing Drug Abuse Within and Across Communities: Second Edition 
3. Drug Abuse-Related Hospital Data 

Exhibit 2. Adams County Rates per 100,000 Population of Drug-Related Hospital Discharges and Treatment 

 Admissions: 1993–2000 

78 

120 

170 

147 

115 122 121 131 

304 292 

315 

339 

292 

351 

374 

287 

0 

50 

100 

150 

200 

250 

300 

350 

400 

1993 1994 1995 1996 1997 1998 1999 2000 

Drug-related hospital discharges Drug treatment admissions 

SOURCE: Colorado Alcohol and Drug Division (analysis by Bruce Mendelson) 

...it is important to 

put hospital 

discharge data into 

perspective in 

comparison to 

population growth. 

Statewide Trend Analysis of Drug-Related Hospital Discharge Data 

Exhibit 3 shows Colorado statewide aggregate (i.e., all ICD-9-CM codes) 

drug-related hospital discharges by age group from 1995 through 1999. 

Overall, the discharges increased by 15.1 percent during the 5-year period, 

with those for those patients age 20 and younger increasing by nearly 36 

percent. Like any other indicator, it is important to put hospital discharge

data into perspective in comparison to population growth. The last line of 

exhibit 3 does this by showing the annual rate of drug-related hospital 

discharges per 100,000 population. The results clearly demonstrate that

drug-related hospital discharges were increasing at a faster rate than the 

population size. Such rate calculations can also be made by age group. 

Exhibit 3. Colorado Drug-Related Hospital Discharges by Age: 1995–1999 

Age Group 1995 1996 1997 1998 1999 

20 and younger (n) 1,310 1,935 2,210 2,069 1,779 

21 and older (n) 9,556 9,194 10,096 10,531 10,729 

Total 10,866 11,129 12,306 12,600 12,508 

20 and younger (%) 12.1% 17.4% 18.0% 16.4% 14.2% 

21 and older (%) 87.9% 82.6% 82.0% 83.6% 85.8% 

State Population (N) 3,764,585 3,819,789 3,892,996 3,966,198 4,039,402 

Hospital Discharge Rate per 100,000 

Population 288.6 291.4 316.1 317.7 309.6 

SOURCE: Colorado Alcohol and Drug Division (analysis by Bruce Mendelson) 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 55 
Part II. Accessing and Analyzing Data from Different Sources 

Analysts can go 

beyond examining 

aggregate drugrelated hospital 

discharge data and 

document trends in 

specific types of 

drugs... 

Analysts can go beyond examining aggregate drug-related hospital discharge 

data and document trends in specific types of drugs, as illustrated in exhibit 4. 

Statewide Colorado hospital discharge rates for the three drugs in the graph 

showed different trends from 1993 through 2001. Cocaine rates increased 

from 1993 to 1998 but then stabilized; marijuana discharge rates climbed 

rather steadily; and amphetamine hospital rates fluctuated considerably, but 

still more than doubled over the 9-year period. 

Exhibit 4. Colorado Drug-Related Hospital Discharge Rates per 100,000 Population for Selected Drugs: 

1993–2001 

Rate 

80 

70 

60 

50 

40 

30 

20 

10 

0 

45.5 

8.2 

30.4 

60.1 

16.3 

41.9 

55.3 

19.4 

45.6 

59.0 

13.9 

45.6 

57.7 

24.6 

54.4 

62.8 

56.1 

20.5 

62.3 

54.6 

17.7 

21.8 

56.8 

63.2 63.2 

26.3 

62.5 

Cocaine 

Amphetamines 

Marijuana 

1993 1994 1995 1996 1997 1998 1999 2000 2001 

SOURCE: Colorado Alcohol and Drug Division (analysis by Bruce Mendelson) 

Another way to look 

at single drug-type 

hospital discharge 

rates is to compare 

them with trends in 

other indicators for 

the same drug... 

Another way to look at single drug-type hospital discharge rates is to compare 

them with trends in other indicators for the same drug, as in exhibit 5. While 

the indicators shown are not based on comparable samples or data collection 

methods, showing trends for each data source is a parsimonious way of 

looking at the findings. As illustrated in exhibit 5, cocaine-related hospital 

discharge rates increased through 1993–2001, while other indicators showed a 

mixed pattern. ED mentions fluctuated dramatically, peaking in 1999; 

cocaine-related death rates rose fairly steadily up to 1999 and then declined; 

the percentages of primary cocaine treatment admissions declined 

dramatically; and there was a slight decline in the proportion of cocaine 

admissions among new users (i.e., those who entered treatment within the first 

3 years of their cocaine use). 

56 Assessing Drug Abuse Within and Across Communities: Second Edition 
3. Drug Abuse-Related Hospital Data 

Exhibit 5. Colorado Cocaine Trends—Selected Indicators: 1993–2001 

0 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Deaths per million 21 20 23 27 24 28 36 27 30 

ED rates per 100,000 65 86 75 53 69 73 87 83 69 

Hospital discharge rates per 

100,000 population 

46 60 55 59 58 63 62 63 63 

Percent of treatment admisisons 41 39 31 31 27 27 24 21 21 

Percent of new users 18 17 16 15 14 16 16 17 16 

1993 1994 1995 1996 1997 1998 1999 2000 2001 

1 

1

Based on the DAWN system prior to its redesign in 2003. 

SOURCE: Colorado Alcohol and Drug Division (analysis by Bruce Mendelson) 

The mixed picture in this assessment of multiple cocaine indicators suggests 

that a more detailed examination might be useful. For example, one might 

look at age group proportions across indicators. The increasing percentage of 

older users among the various indicator populations represented in exhibit 5 

suggested an aging cocaine-using population that was experiencing 

consequences of long-term drug use, rather than a new cocaine epidemic. 

Psychiatric Hospital Data 

...contact the State 

mental health 

authority and 

become familiar 

with its data system 

and the people who 

maintain it. 

Both State and private psychiatric hospitals sometimes have units dedicated to 

the dually diagnosed patient or units dedicated to the addicted population. For

State psychiatric hospital data, one should contact the State mental health 

authority and become familiar with its data system and the people who

maintain it. If the private psychiatric hospital data are not in a State database,

this information will be harder to access; one will need to visit each private 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 57 
Part II. Accessing and Analyzing Data from Different Sources 

psychiatric hospital to determine the extent to which these hospitals serve 

drug-abusing populations. Network members might want to see if there is a 

separate association of private psychiatric providers in the area who would be 

interested in the network’s data collection and reporting efforts. 

An Internet site that identifies psychiatric hospitals in communities is 

<http://www.hospitallink.com>®. 

58 Assessing Drug Abuse Within and Across Communities: Second Edition 
 

 

3. Drug Abuse-Related Hospital Data 

ADDENDUM A: Guidelines on Using Diagnostic 

Codes 

...ICD-9-CM 

delineates the 

clinical picture of 

each patient... 

Nearly all six DSMIV classifications 

are identical to IDC9-CM codes. 

...DRGs have been 

used to set limits on 

Medicare 

reimbursement. 

As noted earlier, it may be necessary to collect hospital data by diagnostic 

code (as shown in the examples in Arizona and Colorado drug-related hospital 

admissions and discharge data). This addendum provides an overview of 

widely used diagnostic classification systems and focuses primarily on ICD-9­

CM and Diagnostic Related Groups (DRGs). 

The International Classification of Diseases (ICD) led the way for the current 

text in international use today in the United States, the International 

Classification of Diseases, 9th Revision, Clinical Modification, referred to as 

ICD-9-CM. This version precisely delineates the clinical picture of each 

patient, providing exact information beyond that needed for statistical

groupings and analysis of health care trends.3 

Another classification system is the fourth edition of the Diagnostic and 

Statistical Manual of Mental Disorders (DSM-IV) published by the American 

Psychiatric Association (1994). In DSM-IV, psychoactive substance use 

means “the persistence of psychoactive substance use for at least 1 month or 

repeatedly over a long period of continuing use despite the recurrence or 

persistence of one or more known adverse consequences or taking of recurrent

physical risks such as driving while intoxicated.” Nearly all six DSM-IV

classifications are identical to ICD-9-CM codes. 

Another classification system is the DRGs. Since 1982, DRGs have been

used to set limits on Medicare reimbursement. 

Since it requires considerable knowledge and expertise to work with these 

data, networks should identify a researcher who knows how to access and 

analyze the information. This might be someone who is associated with a 

hospital, health department, or university. 

Drug-Related IDC-9-CM Diagnoses and Diagnostic Related Groups 

Computer systems can usually use either the ICD-9-CM or DRG classification 

system. 

ICD-9-CM... provides 

principal, secondary, and tertiary 

diagnostic codes. 

The ICD-9-CM classification system provides principal, secondary, and 

tertiary diagnostic codes. It will be useful to look at secondary (and perhaps

3

ICD-9-CM, Official Guidelines for Coding and Reporting can be obtained from: Superintendent of Documents, P.O. 

Box 37194, Pittsburg, PA 15250-7954; fax (202) 512-2250. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 59 
 

 

 

 

 

 

 

 

Part II. Accessing and Analyzing Data from Different Sources 

tertiary) codes. There may be as many drug cases that fall into the secondary 

diagnostic codes as fall into the principal diagnostic codes. The majority of 

cases where the drug code is not the principal code may have a mental health 

code (e.g., affective disorder, adjustment reaction) as the principal code. 

Other conditions that may have a secondary code related to drug or alcohol 

dependence, psychosis, or nondependent abuse are pregnancy, accidental 

poisoning, and fractures. 

Below are the addiction-related DRG codes matched to ICD-9-CM codes. 

DRG 433: Alcohol/Drug Abuse or Dependence, Left Against Medical Advice 

DRG 434: Alcohol/Drug Abuse Dependence, Detoxification or Other Symptomatic Treatment with 

Complication Condition 

Principal ICD-9-CM Codes: 

291 Psychosis, alcoholic 

292 Psychosis, drug 

303.0 Intoxication, acute alcoholic, or alcoholism 

303.9 Other and unspecified alcohol dependence 

304 Dependence, drug 

304.9 Other and unspecified drug dependence 

305.0 Abuse, alcohol; nondependent 

305.2 Abuse, cannabis; nondependent 

305.3 Abuse, hallucinogen; nondependent 

305.4 Abuse, barbiturate, similarly acting sedative or hypnotic; nondependent 

305.5 Abuse, opioid-mixed; nondependent 

305.6 Abuse, cocaine; nondependent 

305.7 Abuse, amphetamine; nondependent 

305.8 Abuse, antidepressant; nondependent 

305.9 Abuse, unspecified drug; nondependent 

790.3 Excessive levels of blood alcohol 

DRG 435: Alcohol/Drug Abuse or Dependence, Detoxification or Other Symptomatic Treatment Without 

Complicating Condition 

DRG 436: Alcohol/Drug Dependence with Rehabilitation Therapy 

Principal or secondary ICD-9-CM codes: 

291.0 Delirium, alcohol withdrawal 

291.1 Syndrome, amnestic, alcohol 

291.2 Dementia, alcoholic, other 

291.3 Hallucinosis, alcohol withdrawal 

291.8 Psychosis, alcoholic, specified 

291.9 Psychosis, alcohol, unspecified 

292 Drug withdrawal syndrome 

303.0 Intoxication, acute alcoholic, alcoholism 

Secondary IDC-9-CM codes: Non-operating room procedures 

94.61 Rehabilitation, alcohol 

94.64 Rehabilitation, drug 

94.67 Rehabilitation, combination alcohol and drug 

DRG 437: Alcohol/Drug Dependence with Combined Rehabilitation and Detoxification Therapy 

Secondary IDC-9-CM codes: Non-operating room procedures 

94.63 Rehabilitation/detoxification, alcohol 

94.66 Rehabilitation/detoxification, drug 

94.69 Rehabilitation/detoxification, alcohol and drug 

60 Assessing Drug Abuse Within and Across Communities: Second Edition 
3. Drug Abuse-Related Hospital Data 

In addition to these DRG codes and the 29 ICD-9-CM codes corresponding to 

them, there are drug-related ICD-9-CM codes that are not matched to DRG 

codes, including the following: 

265.2 Pellagra (alcoholic) 

357.5 Alcoholic polyneuropathy 

357.6 Polyneuropathy due to other toxic agents (specific illicit drugs can be found in E codes 850-

854) 

425.5 Alcoholic cardiomyopathy 

535.3 Alcoholic gastritis 

571.0 Alcoholic fatty liver 

571.1 Acute alcoholic hepatitis 

571.2 Alcoholic cirrhosis of liver 

571.3 Alcoholic liver damage, unspecified 

572.3 Portal hypertension 

573.3 Hepatitis (unspecified toxic) 

648.3 Complications of pregnancy due to drug dependence 

648.4 Complications of pregnancy due to alcohol and drugs 

655.4 Suspected damage to fetus from alcohol 

655.5 Suspected damage to fetus from drugs 

760.71 Fetus affected by alcohol (fetal alcohol syndrome) 

760.72 Fetus affected by narcotics 

760.73 Fetus affected by hallucinogenic agents 

760.75 Fetus affected by cocaine 

965.00 Poisoning by opium 

965.01 Poisoning by heroin 

965.09 Poisoning by other drugs 

967.0 Poisoning by barbiturates 

967.4 Poisoning by methaqualone compounds 

967.8 Poisoning by other sedatives and hypnotics 

968.5 Poisoning by topical and infiltration anesthetics (e.g., cocaine) 

970.0 Poisoning by central nervous system stimulants analeptics 

970.1 Poisoning by central nervous system-opiate antagonists 

980.0 Toxic effect of alcohol 

Limitations of Using Hospital Data 

Limitations of the ICD-9-CM handicap efforts to assess the true nature and 

magnitude of drug-related health consequences. For example, there is no 

code-specific category for acute alcoholic pancreatitis or drug-related HIV 

transmission. Therefore, it is impossible to separate drugs or alcohol from 

other causes of illness; when presenting the information, one can say the 

utilization data being prepared present a conservative estimate, since the data 

do not include all drug-related conditions (Dufour and Caces 1993). Many 

State health statistics units are working on these issues and should be 

consulted by network members. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 61 
 

 

Part II. Accessing and Analyzing Data from Different Sources 

4. DRUG-RELATED MORTALITY DATA
 

ME/Cs provide vital 

information about 

drug-related 

mortality patterns 

and trends... 

...it may be necessary to contact local 

ME/Cs or the toxicology laboratory... 

Medical examiners and coroners (ME/Cs) provide vital information about 

drug-related mortality patterns and trends in the United States, and they are an 

excellent source of data for epidemiology networks. Often, ME/Cs or 

members of their staff will be interested and active participants in a network 

because they need to know what drugs are on the street, as well as information 

on changes in purity or drug combinations that could be causing a series of 

overdose deaths. 

Causes of death are listed on death certificates, which are completed by local 

doctors, coroners, and justices of the peace, among others. The death 

certificate is submitted by the local official to the section of the State health 

department that is responsible for handling birth and death data. The names, 

addresses, and telephone numbers for State officials in charge of mortality 

data can be accessed through CDC’s Medical Examiner and Coroner 

Information Sharing Project (MECISP) at <http://www.cdc.gov/epo/dphsi/ 

mecisp>. Go to “About MECISP” and to the link on Death Investigation 

System Description for U.S. States; this will lead to a place where one can 

click on a State name to find information. 

Many State databases on drug-involved mortality aggregate all drug-involved 

deaths into a “single” drug category and present the data alongside alcoholinvolved deaths. To obtain information on specific drugs, it may be necessary 

to contact local ME/Cs or the toxicology laboratory to which the local 

jurisdictions send samples for testing. 

Network members whose local jurisdictions participate in SAMHSA’s Drug 

Abuse Warning Network (see below) may find these data the easiest to use if 

they are reported for their area, since these data are already collected and 

analyzed. ME/C annual reports often have drug-specific data and are also 

easy to use. Secondary analyses of ME/C or toxicology data can provide far 

more detail than DAWN or ME/C annual reports; they allow an analyst to 

examine drug-specific combinations and demographic data. However, 

secondary analyses can be quite complicated and time intensive. Other death 

data may be available from State or county health or law enforcement 

agencies, either in preformatted or raw format form. 

There are limitations in drug-related morality data. As noted in MECISP, 

only about 20 percent of the deaths in the United States are investigated by 

ME/Cs, although the percentage varies by State. The guidelines for which 

deaths are to be investigated also vary widely by jurisdiction (whether State, 

county, district, or city). The most notable difference is that some 

jurisdictions use the medical examiner system while others use the coroner 

system. The type of system used may be uniform throughout the State or may 

vary from county to county within a State. Medical examiners may have 

62 Assessing Drug Abuse Within and Across Communities: Second Edition 
4. Drug-Related Mortality Data 

...guidelines for 

which deaths are to 

be investigated vary 

widely by 

jurisdiction... 

Discrepancies and 

nonreporting can 

occur for several 

reasons 

State, district, or county jurisdiction. Usually the MEs are appointed and must 

be licensed physicians; some are expert forensic pathologists. In comparison, 

coroners or justices of the peace may have district or county jurisdiction, are 

usually elected, and need not be physicians. Many are only required to be of a 

minimum age (often 18) and a resident of the county or district. 

Within local jurisdictions, there is also variation in the percentage of deaths 

that are investigated. In addition, the guidelines for which deaths are to be 

investigated vary widely by jurisdiction, but most require the following types 

of deaths to be investigated: 

 Deaths caused by homicide, suicide, or accidental causes such as motor 

vehicle crashes, falls, burns, or the ingestion of drugs or other chemical 

agents 

 Sudden or suspicious deaths or unattended deaths 

 Deaths caused by an agent or disease constituting a public health threat 

 Deaths that occurred while the decedent was at work 

 Deaths of people in custody or confinement and those institutionalized for 

reasons other than organic diseases 

 Deaths of persons to be cremated 

The thoroughness of death investigations (and, consequently, the 

completeness of death investigation records) also varies from case to case. 

Sometimes a postmortem examination may consist of only an external 

examination of the body. A record of a complete examination includes the 

following items: 

 The initial report of the death made to the ME/C office (e.g., by a family 

member, police officer, or attending physician) 

 A determination of the circumstances surrounding the death 

 Findings of a scene investigation 

 Findings of a postmortem examination or autopsy 

 Results of laboratory tests conducted to determine the presence of drugs, 

toxins, or infectious agents 

 Certification of the cause and manner of death 

As noted above, there are variations across States and local jurisdictions in 

who completes the death certificate, e.g., trained personnel such as 

pathologists or medical examiners versus persons with no formal training. 

Discrepancies and nonreporting can occur for several reasons. For example, 

staff of the ME’s office may not be consistent in their reports; one may 

specify the exact drugs involved while another may record only “drug abuse,” 

even when toxicological reports are available. Or, to spare the feelings of the 

family, a coroner may not mention drugs on the certificate. In areas where 

suicide has a negative religious connotation, suicide may not be mentioned as 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 63 
Part II. Accessing and Analyzing Data from Different Sources 

the motive on the certificate. There is no way of determining how widespread 

such underreporting is. 

The death certificate may be submitted to the responsible State health 

department immediately, or there may be a significant time lag with the cause 

of death shown as “pending.” In the latter case, an amended certificate will be 

issued later, following receipt of the toxicology or pathology report. It could 

take 6–10 months to get complete data. 

One standardized system for collecting information on deaths related to drug 

abuse is the Drug Abuse Warning Network’s system described below. 

64 Assessing Drug Abuse Within and Across Communities: Second Edition 

Drug Abuse Warning Network 

Elizabeth Crane, Ph.D., M.P.H. 

The DAWN mortality 

component provides 

information about 

drug-related deaths 

that were investigated by medical 

examiners/ coroners 

in participating 

jurisdictions. 

The new DAWN 

mortality component 

includes all deaths 

related to recent drug 

use, both intentional 

and accidental, for all 

ages. In addition to 

deaths that were the 

result of drug use 

(such as an overdose 

or allergic reaction), 

DAWN includes deaths 

where drugs 

contributed, but did 

not directly cause, 

the death... 

Medical examiner/coroner data on drug abuse cases is one component of the 

OAS, SAMHSA, DAWN surveillance system (the emergency department 

[ED] component was described in Chapter 3). 

The DAWN mortality component provides information about drug-related

deaths that were investigated by medical examiners/coroners in participating

jurisdictions. Data are currently collected from 8 States and 35 metropolitan

areas. Profiles of the States and metropolitan areas are published annually.

DAWN does not produce national estimates of drug-related deaths. 

When DAWN was redesigned in 2003, the case definition and types of 

information collected changed. The metropolitan area boundaries were 

updated to be consistent with the ED component; the new DAWN also seeks 

to cover 100 percent of death investigation jurisdictions in each of the selected 

metropolitan areas. DAWN now collects data on all drug-related deaths, 

which are then categorized by manner of death. Data collected by the 

redesigned system are not comparable to data collected in 2002 or before. 

The new DAWN mortality component includes all deaths related to recent

drug use, both intentional and accidental, for all ages. In addition to deaths

that were the direct result of drug use (such as an overdose or an allergic 

reaction), DAWN includes deaths where drugs contributed, but did not

directly cause, the death (such as motor vehicle crash where the driver was the 

under the influence of drugs). DAWN data are abstracted from death 

certificates and the ME/C’s death investigation records by a trained DAWN

Reporter. After determining that the death was a DAWN case (i.e., drugrelated), the Reporter completes an electronic case report form. Detailed

information about the manner and cause(s) of death is recorded, together with 

information about all drugs that were involved in the death. All types of drugs

are included: illicit drugs, prescription drugs, over-the counter medications, 

dietary supplements, nonpharmaceutical inhalants, and alcohol. 
4. Drug-Related Mortality Data 

From 2003 to 2005, DAWN Reporters assigned each death to one of seven case 

types, as shown in the “Decision Tree” diagram (exhibit 1). For analytic 

purposes, deaths in the following case types—homicide by drugs, overmedication, all other accidental, and could not be determined—were combined to 

create a new analytic category, drug misuse deaths. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 65 

Exhibit 1. DAWN ME/C Decision Tree1 

 

 

 

YES

NO

NO 

NO 

 

 

 

NO

NO

NO

 

 

NO

YES

YES

YES

YES

YES

YES

YES

 

 

 

 

 

 

 

 

 

Manner of Death on 

Death Certificate 

Is this a DAWN Case? Based on available documentation, 

was the death induced by or related to the decedent’s ingestion

or use of a drug?

Relationship of drug use to the death was confirmed or presumed.

Drug use includes appropriate or inappropriate use of legal or illegal drugs or substances.

Alcohol alone (with no other drug) is a DAWN case for decedents under age 21.

This is a DAWN Case.

Answer the following questions in order. Assign DAWN Manner of Death

to first Yes.

1. Does the documentation indicate that the death was ruled a Suicide?

2. Does the documentation indicate that the death was ruled a Homicide and the 

method of homicide was poisoning by a drug?

Homicide not poisoning

Homicide related to drug trafficking

3. Does the documentation indicate the death was ruled Natural or Accidental and

the death resulted from an adverse reaction to a prescription drug, over-thecounter medication, or dietary supplement?

Unexpected reaction to illegal drugs

Took too little medication

Combination of legal and illegal drugs

4. Does the documentation indicate the death was ruled Natural or Accidental and

the death resulted from exceeding the recommended dose of a prescription drug, 

over-the-counter medication, or dietary supplement?

Illegal drugs

Combination of legal and illegal drugs

Accidental ingestion

5. Did the documentation indicate the death was ruled Natural or Accidental and

the death resulted from the decedent accidentally or unknowingly ingesting a 

drug?

6. Does the documentation indicate the death was ruled Natural or Accidental and

the death could not be assigned to another category above?

7. Does the documentation indicate the manner of death was “Could not be

determined” or “Undetermined” when the case was closed?

STOP

Not a DAWN Case

01 SUICIDE

Legal or illegal drugs

02 HOMICIDE BY DRUGS

Legal or illegal drugs

Drug was weapon

Product tampering

Malicious poisoning

03 ADVERSE REACTION TO

MEDICATION

Legal drugs only

Drug interaction

Allergic reaction or side effect

04 OVERMEDICATION

Legal drugs only

Took more than prescribed or

recommended dose

05 ACCIDENTAL INGESTION

Legal or illegal drugs

Accidental child poisoning

Took wrong medication by accident

06 ALL OTHER ACCIDENTAL

Legal or illegal drugs

Combination of legal and illegal drugs

07 COULD NOT BE DETERMINED

Legal or illegal drugs

Combination of legal and illegal drugs

SUICIDE

HOMICIDE

NATURAL

or

ACCIDENTAL

COULD NOT BE

DETERMINED or

UNDETERMINED

NATURAL

or

ACCIDENTAL

NATURAL

or

ACCIDENTAL

NATURAL

or

ACCIDENTAL

Is this a DAWN Case? Based on available documentation, 

was the death induced by or related to the decedent’s ingestion 

or use of a drug? 

Relationship of drug use to the death was confirmed or presumed. 

Drug use includes appropriate or inappropriate use of legal or illegal drugs or substances. 

Alcohol alone (with no other drug) is a DAWN case for decedents under age 21. 

This is a DAWN Case. 

Answer the following questions in order. Assign DAWN Manner of Death 

to first Yes. 

YES 

1. Does the documentation indicate that the death was ruled a Suicide? 

NO 

2. Does the documentation indicate that the death was ruled a Homicide and the 

method of homicide was poisoning by a drug? 

NO Homicide not poisoning 

Homicide related to drug trafficking 

3. Does the documentation indicate the death was ruled Natural or Accidental and 

the death resulted from an adverse reaction to a prescription drug, over-thecounter medication, or dietary supplement? 

NO Unexpected reaction to illegal drugs 

Took too little medication 

Combination of legal and illegal drugs 

4. Does the documentation indicate the death was ruled Natural or Accidental and 

the death resulted from exceeding the recommended dose of a prescription drug, 

over-the-counter medication, or dietary supplement? 

NO 

Illegal drugs 

Combination of legal and illegal drugs 

Accidental ingestion 

5. Did the documentation indicate the death was ruled Natural or Accidental and 

the death resulted from the decedent accidentally or unknowingly ingesting a 

drug? 

NO 

6. Does the documentation indicate the death was ruled Natural or Accidental and 

the death could not be assigned to another category above? 

NO 

7. Does the documentation indicate the manner of death was “Could not be 

determined” or “Undetermined” when the case was closed? 

STOP

Not a DAWN Case

STOP 

Not a DAWN Case 

01 SUICIDE 

Legal or illegal drugs 

02 HOMICIDE BY DRUGS 

Legal or illegal drugs 

Drug was weapon 

Product tampering 

Malicious poisoning 

03 ADVERSE REACTION TO 

MEDICATION 

Legal drugs only 

Drug interaction 

Allergic reaction or side effect 

04 OVERMEDICATION 

Legal drugs only 

Took more than prescribed or 

recommended dose 

05 ACCIDENTAL INGESTION 

Legal or illegal drugs 

Accidental child poisoning 

Took wrong medication by accident 

06 ALL OTHER ACCIDENTAL 

Legal or illegal drugs 

Combination of legal and illegal drugs 

07 COULD NOT BE DETERMINED 

Legal or illegal drugs 

Combination of legal and illegal drugs 

NO 

YES 

YES 

YES 

YES 

YES 

YES 

YES 

SUICIDE 

HOMICIDE 

NATURAL 

or 

ACCIDENTAL 

COULD NOT BE 

DETERMINED or 

UNDETERMINED 

NATURAL 

or 

ACCIDENTAL 

NATURAL 

or 

ACCIDENTAL 

NATURAL 

or 

ACCIDENTAL 

1

Discontinued in 2006. In order to align the DAWN case types with the categories with the death certificate and improve data consistency, 

DAWN replaced its case types with the Manner of Death categories from the standard death certificate, effective January 1, 2006. 

Because the Manner of Death is obtained directly from the death certificate, a Decision Tree is no longer needed. 

SOURCE: Diagram adapted from DAWN, OAS, SAMHSA, 2005, page 10 
Part II. Accessing and Analyzing Data from Different Sources 

Because DAWN data 

are collected directly 

from death investigation records, they 

reflect any differences in the way 

deaths are investigated and documented 

by ME/Cs in different 

jurisdictions. 

The 2003 Area Profiles of Drug-Related Mortality focuses on deaths from 

drug misuse and drug-related suicides. Profiles of illicit drugs also include all 

case types and manners of death. The drug categories included in the 2003 

mortality publication are illustrated in exhibit 2 for the Boston-CambridgeQuincy metropolitan area (see below); rates per 100,000 population are 

illustrated for each participating jurisdiction in the metropolitan area for drug 

misuse and suicide cases (exhibit 3). Alcohol is reported if at least one other 

drug is involved in the death. Deaths involving alcohol alone are only 

reported to DAWN for persons under age 21. For drug misuse and suicide 

cases, the number of single-drug deaths (those involving only one drug) are 

published. 

There are a number of things to keep in mind when using DAWN mortality 

data... 

 Participation in DAWN is voluntary, and the number of participating 

jurisdictions is likely to vary from year to year. It is therefore important 

for DAWN users to note which jurisdictions did and did not participate in 

DAWN in any given year. 

 The jurisdictions in DAWN do not represent a statistical sample; 

therefore, the counts do not represent the Nation as a whole. 

 The mortality data for a metropolitan area are only representative if all of 

the jurisdictions in the metropolitan area participated. 

 Because different areas have different population sizes, they should only 

be compared using rates, which take population size into account. 

 Because DAWN data are collected directly from death investigation 

records, they reflect any differences in the way deaths are investigated and 

documented by ME/Cs in different jurisdictions. For example, some 

jurisdictions may report cases as drug-related based on circumstantial 

evidence, while others may only consider a death as drug-related if it is 

confirmed by toxicology. The types of toxicology tests used may also 

differ; for example, some jurisdictions do not test for marijuana. 

 Death investigations are often complex, and reporters may have to wait for 

the results of autopsies and laboratory tests to determine whether a death 

involved drug abuse. This can affect data completeness. 

 The case types used by DAWN in 2003 (exhibit 1) differed from the case 

types on death certificates, which was confusing for DAWN Reporters and 

data users. Therefore in 2006, DAWN adopted the categories from the 

“manner of death” on the standard death certificate: Natural; Accident; 

Suicide; Homicide; Could not be determined; and Other. The new DAWN 

categories now align with the death certificate and will improve data 

consistency. DAWN will still report drug misuse deaths, and it will still 

be possible to examine trends from 2003 on because data from the old 

case types will be mapped to the new case types. 

66 Assessing Drug Abuse Within and Across Communities: Second Edition 
4. Drug-Related Mortality Data 

Where to Start: Accessing DAWN ME/C Data 

...States and metropolitan areas that 

participated in DAWN 

in 2003 can be found 

at <http://dawninfo. 

samhsa.gov>. 

The first publication from the new DAWN ME/C component provides 

mortality data from 2003 for 122 jurisdictions in 35 metropolitan areas for 

2003 (SAMHSA 2005). Based on participating jurisdictions, the overall 

population coverage for the metropolitan areas was 64 percent, with coverage 

exceeding 90 percent in 13 metropolitan areas. Data are also presented for six 

States. Information about the States and metropolitan areas that participated 

in DAWN in 2003 can be found at <http//:dawninfo.samhsa.gov>. Network 

members should periodically check the DAWN Web site to determine 

whether data are available for their area in any given year. Mortality 

publications can be accessed at <http//:dawninfo.samhsa.gov/pubs/mepubs/>. 

What to Access from DAWN ME/C 

The following information in the DAWN system would be useful to an 

epidemiology network: 

 Number of death cases by category and by drug or drug category 

 For each drug, the number of single-drug deaths (i.e., deaths that involved 

only that drug) 

 Demographic characteristics (gender, age, race/ethnicity) of the decedents 

 Cause of death (e.g., drug abuse, body systems [includes infections], 

accident and/or injury) 

 Alcohol involvement in drug-related deaths and, for decedents younger 

than age 21, deaths in which alcohol was the only substance involved 

As the redesigned system matures, the mortality publications will add data 

from multiple years, which will enable networks to monitor the trends in drugrelated deaths, the involvement of particular drugs, and other factors in their 

areas. 

Uses of DAWN ME/C Data 

Exhibit 2 shows the number of drug-related deaths by drug category for the 

DAWN area that includes the Boston, Massachusetts, metropolitan area in 

2003. This is one of the areas where the entire population is covered by the 

DAWN mortality system. As shown, opiates/opioids, heroin, and cocaine 

were the most frequently recorded drugs of misuse, while cocaine and 

opiates/opioids accounted for the largest numbers in the suicide category. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 67 
 

 

 

 

Part II. Accessing and Analyzing Data from Different Sources 

Exhibit 2. Drug-Related Deaths by Drug Category in the Boston-Cambridge-Quincy, MA-NH Area: 2003 

Drug Category 

Illicit Drugs 

(All Case Types) Drug Misuse Suicide 

Deaths Single-drug 

Deaths Deaths Single-drug Deaths Deaths Single-drug Deaths 

All Drugs 334 135 486 206 63 31 

Alcohol1 114 –2

 15 0 

Cocaine 237 80 216 72 21 8 

Marijuana 18 – 18 – 0 0 

Stimulants – 0 – 0 0 0 

Club Drugs3 – 0 – 0 0 0 

Hallucinogens4 0 0 0 0 0 0 

Inhalants 6 4 5 – – – 

Antidepressants 32 6 11 – 

Antipsychotics 10 – 5 – 

Benzodiazepines 88 16 7 – 

Misc. Anxiolytics, Sedatives, and 

Hypnotics 5 – 5 – 

Opiates/Opioids 316 99 23 7 

Heroin (specified) 111 50 109 50 – 0 

Methadone 35 8 – 0 

All other opiates/opioids 118 41 20 7 

Nonsteroidal anti-inflammatory 

agents 0 0 0 0 

Salicylates/Combinations – 0 – – 

Misc. Analgesics/Combinations 4 – – – 

Anticonvulsants – – 0 0 

Muscle Relaxants – 0 0 0 

1

Includes alcohol in combination with other drugs (all ages) and alcohol alone in decedents under age 21. 2

Dashes indicate a number less than 4 has been suppressed.

3

Includes MDMA (ecstasy), GHB, flunitrazepam (Rohypnol), and ketamine. 

4

Includes PCP, LSD, and miscellaneous hallucinogens. 

SOURCE: Adapted from DAWN, OAS, SAMHSA, 2005, page 53 

DAWN also provides mortality rates for drug misuse and suicide cases in each 

reporting jurisdiction in a metropolitan area. Exhibit 3 illustrates these data 

for the Boston-Cambridge-Quincy, Massachusetts, and New Hampshire 

DAWN metropolitan area. 

68 Assessing Drug Abuse Within and Across Communities: Second Edition 
4. Drug-Related Mortality Data 

Exhibit 3. Boston-Cambridge-Quincy, MA-NH Area Overview: Deaths and Population by County: 2003 

1

2

3

3

4

5

6

7

Boston

 

 

1 

2 

3 

3 

4 

5 

6 

7 

Boston 

 

 

 

D

M

P

P

eaths reported to DAWN 

 Drug Misuse 486 

 Suicide 63

etro area population, 2003 

4,439,971 

opulation covered by DAWN 

4,439,971 

ercent of population covered by DAWN 

100% 

Metro Area Overview: Deaths and Population by County, 2003 

Metro Area Component Drug Misuse Suicide Total Population Deaths Rate1 Deaths Rate1 

Total Participating (7) 486 109.5 63 14.2 4,439,971 

1. Essex County, MA 93 126.0 13 17.6 737,848 

2. Middlesex County, MA 108 73.4 14 19.5 1,471,724 

3. Norfolk County, MA 56 85.6 11 16.8 654,331 

4. Plymouth County, MA 51 104.6 4 8.2 487,521 

5. Suffolk County, MA 132 193.9 14 20.6 680,705 

6. Rockingham County, NH 31 106.9 6 20.7 290,102 

7. Strafford County, NH 15 127.4 1 8.5 117,740 

1

Deaths per 100,000 population. 

SOURCE: Adapted from DAWN, OAS, SAMHSA, 2005, page 52
 

Local Mortality Data 

...access the 

information directly 

from local medical 

examiners or 

coroners... 

Another way to obtain mortality data related to drug abuse is to access the 

information directly from local medical examiners or coroners, as is done by 

some CEWG representatives. Medical examiners in these jurisdictions vary 

somewhat in their classification of death cases in which drugs are detected, as 

will be illustrated by information from two CEWG representatives––Caleb 

Banta-Green, Seattle, and Samuel Cutler, Philadelphia. Additional 

information on accessing mortality data was provided by the St. Louis 

representative, Heidi Israel, Ph.D. 

Because there are no standardized ways of classifying death cases, and 

because the data are complex, it is important that network members establish a 

continuing and fruitful working relationship with the ME’s office. The 

following strategies have proven useful to one or more of the CEWG 

representatives mentioned above, resulting in longstanding collaboration 

between the representatives and their local MEs: 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 69 
Part II. Accessing and Analyzing Data from Different Sources 

Begin by sending 

a letter of 

introduction to 

the chief ME. 

Once an initial 

contact has been 

identified, set up a 

meeting... 

 Begin by sending a letter of introduction to the chief ME. The letter might 

include... 

3⁄4 A statement that a new work group is being formed, with a brief 

description of its mission and goals, how it will function, and the types 

of agencies/organizations involved in the group 

3⁄4 An emphasis on the importance of mortality data in the array of 

indicators that will be analyzed and used by the group to portray drug 

abuse patterns and trends in the area 

3⁄4 An invitation to the ME to attend the next meeting of the group, or to 

send an assigned staff member to the meeting 

3⁄4 A request for the ME to assign a representative to be a permanent 

member of the group 

3⁄4 An inquiry as to the most appropriate person to contact about 

obtaining information on deaths in which there is a presence of illicit 

drugs and probable abuse of licit drugs, with a mention that the 

network will follow all ME regulations related to confidentiality 

3⁄4 Inform the ME that his/her office will receive network reports and that 

they may review summaries of their data prior to release if they 

request 

 Once an initial contact has been identified, set up a meeting to define the 

network’s needs and to obtain relevant information, such as... 

3⁄4 Reports by the ME’s office. There will probably be a “Glossary” that 

defines terms. Familiarizing yourself with these terms is a good way 

to learn about and understand the language used by the ME’s office. 

Study the data (e.g., abbreviations that appear in case reports, such as 

“6-MAM, heroin” and “PND,” presumed natural death). 

3⁄4 A clear understanding of how the ME’s office defines “drug 

mortality.” In Philadelphia, the case definition is “deaths with the 

presence of drugs,” and alcohol is not counted. To meet this 

definition, a decedent must have at least one drug that is not alcohol in 

his/her system. In other areas, the data may be subsumed under “drugrelated” or “drug-induced,” as noted earlier in the DAWN ME/C 

database. As Samuel Cutler notes, there are difficulties in assigning a 

case using definitions such as drug-related and drug-induced (e.g., a 

pedestrian stricken and killed by a vehicle may be found to have 

heroin, cocaine, and alcohol in his/her system, but whether use of the 

drugs was “related” or “involved” in the death is probably unknown). 

The definitions used by the Philadelphia ME to classify “deaths with 

the presence of drugs” are summarized at the conclusion of this 

chapter in Addendum A. 

3⁄4 A clear understanding of the confidentiality “laws” followed by the 

ME’s office. Generally the death certificate data are public, while the 

case file data are not. Find out which data are considered “sensitive” 

70 Assessing Drug Abuse Within and Across Communities: Second Edition 
4. Drug-Related Mortality Data 

...it is useful to 

call the ME 

representative from 

time to time to 

share information. 

and which are actually “confidential.” Make it clear that the network 

will never report data that could identify an individual (e.g., by 

reporting date of death, an individual’s demographic characteristics). 

 Find out whether the ME data are automated. If not, work with staff to 

develop a system. As Caleb Banta-Green notes “This might take some of 

your time, but then you are ‘giving’ them something in return and you will 

be getting the data in the format you require. Someone with a moderate 

level of analytic skill can easily create a useful database in a relatively 

short amount of time.” 

Note that between network meetings, it is useful to call the ME representative 

from time to time to share information. For example, the Philadelphia CEWG 

representative shares with the ME representative information obtained from 

conversations with drug users and outreach workers about a new drug or 

combination of drugs being used in the area, and any information obtained on 

new drug-using groups. This may alert the ME to conduct tests on new drugs. 

An inquiry is also made with the ME representative as to whether the ME staff 

is witnessing any new drug trends. 

Accessing Local Mortality Data 

If ME data are not available electronically, it will be necessary to pull the 

charts on a regular basis (e.g., the Philadelphia CEWG representative did this 

every 6 months for many years before the system was automated). This will 

be time consuming because not all deaths will be drug-related, and it will 

involve a “learning curve” on the network’s part. In either case, the task will 

be facilitated by knowing which data and case types to request and having a 

system for recording the data. 

At a minimum, network members will want to request the following, as is the 

case in Seattle: 

 The case number (this will be useful if there are any questions about a 

case) 

 Date of the death 

 Demographic characteristics of the decedent (e.g., age, gender, 

race/ethnicity) 

 Manner of death (e.g., accident, suicide, undetermined, or “other”) 

 “BAC” for alcohol (this may be inconsistently coded) 

 Primary, secondary, tertiary, and quaternary causes of death 

 Other conditions 

 Zip Code (last known residence of the decedent) 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 71 
 

 

Part II. Accessing and Analyzing Data from Different Sources 

Use of statistical 

software allows for 

additional 

analyses... 

(Similar data are retrieved in Philadelphia, following the definitions shown in 

Addendum A.) 

In Seattle, Caleb Banta-Green receives data in Excel format and has created 

an SPSS program to recategorize drugs identified under causes of deaths into 

drug types, e.g., prescription opiates and sedatives/depressants. Use of 

statistical software allows for additional analyses, including the total number 

of drugs, counts for multiple drugs of the same type, and counts of specific 

combinations of drugs. An example of the recategorized data that are ready 

for analysis is illustrated in exhibit 4. Note that this table is a simplified form 

of the necessary data. One would want to collect information on at least six 

drugs; data on additional drug categories such as muscle relaxants and 

hallucinogens would need to be included, and Zip Code should be gathered if 

available. 

Exhibit 4. Example of Method for Documenting Drug Deaths in King County, Washington 

Case Descriptors Original Data 

Disaggregated Manually 

Data Recategorized 

Automatically with Statistical Software 

DOD Age Sex Race Manner Drug 1 Drug 2 Drug 3 Cocaine Heroin/ 

Opiate 

Other 

Opiate 

Amphetamine Depressant 

1/1/09 22 F Nat. 

Amer. Accident Opiate Cocaine 1 1 0 0 0 

1/2/09 33 F White Suicide Meprobamate 0 0 0 0 1 

1/3/09 44 F White Undetermined Clozapine 0 0 0 0 0 

1/4/09 55 M Black Accident Methamphetamine 

Methadone Oxycodone 0 0 2 1 0 

1/5/09 66 M White Accident Opiate Cocaine 1 1 0 0 0 

1/6/09 77 M Asian Accident Methadone 

Oxycodone Promethazine 0 0 2 0 1 

SOURCE: Caleb Banta-Green; information provided for this publication 

Uses of Local Mortality Data: King County, Washington, Example 

Both the Philadelphia and the Seattle CEWG representatives have developed 

methods for analyzing drug death data received from the local MEs. Both use 

descriptive statistics (e.g., frequencies, percentages, averages) in reporting 

data, and both report trends over time. The Seattle representative notes that 

when the data are received from the ME, drug names are often collapsed 

within one cell and need to be disaggregated manually. For example, Primary 

Cause may read as “combined effects of methamphetamine, oxycodone, 

citalopram, and dextromethorphan." In this case, four new variables are 

created: drug 1=methamphetamine, drug 2=oxycodone, and so on. 

Occasionally, data are received for deaths involving only drugs that cannot be 

abused (e.g., acetaminophen, aspirin), and such cases are excluded. 

Exhibit 5 illustrates one of the ways the data are reported for King County 

over an 8-year period (see Banta-Green et al. 2006). As can be seen, deaths 

72 Assessing Drug Abuse Within and Across Communities: Second Edition 
# of Times Drug Identified

 

4. Drug-Related Mortality Data 

involving heroin and cocaine have tended to account for more deaths than the 

other drugs in most years; however, the increases in deaths involving 

depressants and prescription (Rx) opiates are substantial when 1997 data are 

compared with 2004 data for these two drug types. 

Exhibit 5. Deaths in King County, Washington, Related to Illicit and Prescription (Rx) Drugs: 1997–2004 

Number of Times Drug Identified 1997 1997 

1997 

1997 

19971997

1997 

2004 

2004 

2004 

2004 

2004

2004

2004 

0 

25 

50 

75 

100 

125 

150 

Cocaine 

Heroin/ 

Opiates/ 

Morphine 

Rx Opiate Depressant 

Methamphetamine Rx Stimulant DXM, MDMA, 

PCP 

1997 66 111 28 45 3 3 2 

1998 69 144 44 51 3 0 0 

1999 76 117 32 28 13 1 1 

2000 89 102 50 33 10 2 2 

2001 49 61 53 40 5 0 3 

2002 79 87 66 54 13 1 9 

2003 52 62 84 71 18 1 11 

2004 92 75 118 82 18 4 9 

SOURCE: Medical Examiners Office, Public Health Seattle – King County 

Heroin and Prescription Opiates—Categorization Issues 

Recent data 

indicate that 

deaths involving 

prescription opiates 

have surpassed 

those involving 

heroin in some 

cities... 

As Caleb Banta-Green notes, heroin is identified in a large proportion of druginvolved deaths in many areas. Recent data indicate that deaths involving 

prescription opiates have surpassed those involving heroin in some cities 

across the Nation. It is therefore vital to disaggregate heroin-involved deaths 

from opiate prescription drug-involved deaths whenever possible. Recent data 

indicate important similarities and differences for heroin- and prescription 

opiate-involved deaths that would be undetectable if these two substances 

were aggregated into a single category. While it is impossible to perfectly 

disaggregate these two types of opiates, it is possible to separate them in the 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 73 
Part II. Accessing and Analyzing Data from Different Sources 

majority of cases if sophisticated equipment is used. Many toxicology labs, 

including the labs in Washington State, use the type of equipment that will 

detect most prescription-type opiates in the blood or other bodily fluids of a 

decedent. Urine screens alone do not detect all prescription-type drugs. 

Heroin can be definitively identified by the presence of a heroin-specific 

metabolite (monoacetylmorphine); however, this metabolite degrades quickly 

and is often not detected by toxicological analysis. Often, other evidence 

obtained by the ME/Cs or the death investigator points to use of heroin. 

Heroin may be noted in the death record even if only more general opiate 

metabolites are detected by toxicology. The ME in King County, Washington, 

recently added a “flag” to its database so that any ME entering “opiate” into 

the death record must indicate whether the death was heroin-related. 

Frequently, opiate or morphine is noted in the toxicology report. Some ME/Cs 

will aggregate heroin, morphine, and opiate into a “presumed heroin” 

category. This probably slightly overestimates heroin-involved deaths. 

It is most appropriate to create a “presumed heroin” case type if there are 

detailed data on which prescription opiates are present, and it is possible to 

create a very specific prescription opiates category. Most prescription opiates 

are readily detectable and identifiable via toxicological analysis, including 

oxycodone, methadone, hydrocodone, hydromorphone, meperidine, and 

propoxyphene. Fentanyl is difficult to detect for some toxicologists. Codeine 

may be pharmaceutical or it may be secondary to heroin. However, as noted 

earlier, the range of prescription-type opioids are easily detected only by the 

highly specific screens, not by the “run of the mill” urine screens. 

These are general rules that can be followed in identifying and categorizing 

heroin/morphine/opiate versus prescription opiates, and these should be 

verified with local experts. 

74 Assessing Drug Abuse Within and Across Communities: Second Edition 
4. Drug-Related Mortality Data 

ADDENDUM A. Classification of Mortality Cases in 

Philadelphia 

Samuel Cutler 

Deaths with the presence of drugs, based on the cause of death determined at 

the Philadelphia ME’s Office, are placed into the following five groups for 

CEWG reporting. 

1. Adverse Effect of Drugs (AED) or Adverse Reaction to Drugs 

AED cases are deaths attributable to the ingestion of drugs. These cases may 

have just one drug present; however, they often involve positive toxicology 

reports for more than one drug, although not necessarily in excessive 

quantities. It is the action of one or more drugs, or the interaction of the drugs 

with each other or on the body, that cause the adverse (and unexpected) 

reaction. 

The Philadelphia ME records the levels of drugs detected by the toxicology 

screen and uses this information to attempt to distinguish the intent of the 

decedent. AED is the most common cause of death with drugs in the system in 

Philadelphia. 

2. Overdose 

The most rare cause of death with drugs in the system is overdose. In 

overdose cases, there is a toxic level of a drug or drugs detected by the 

toxicology screen. Sometimes there is even a suicide note. Other factors may 

help distinguish adverse reaction cases from overdose cases, especially if 

there are notes in the record that came from the scene of the death. 

The CEWG representative from Philadelphia has always taken pains to use 

the precise expression to convey what we mean by “overdose.” Overdose 

usually implies intent to die, and definitely includes findings of abnormally 

high levels of a drug or drugs. Conversely, “adverse reactions” are absent of 

the intent to die and such cases generally have lower levels of drugs than 

“overdose” cases. Overdose, in fact, is a relatively uncommon event, so it is 

important to define and provide information about AED and the other causes. 

3. Violence—Other and 4. Violence—Self 

Violence is often the attributed cause of death with drugs in the system. In 

Philadelphia, it is broken down by “violence inflicted by another person” 

(called “Violence–Other”) or “violence to oneself” (called “Violence–Self”). 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 75 
Part II. Accessing and Analyzing Data from Different Sources 

The most common forms of violence encountered are gunshot wound, 

stabbing, and hanging; however, there are other, less common ways, such as 

being pushed or jumping from a roof or bridge, jumping in front of a moving 

train or other vehicle, and bleeding to death from cutting. Generally speaking, 

homicides are “Violence–Other” cases, but not all homicide victims have 

positive toxicology reports. 

5. Other Causes 

There are other ways to die with drugs in the system (or not), and these are 

lumped into the catchall "Other" category in dealing with Philadelphia ME 

data. These include vehicular deaths (driver, passenger, or pedestrian), a 

variety of accidents (such as falling off the roof while working as a roofer), 

other accidents (such as falling in the home and hitting the head in such a way 

that death results), and people who die from illnesses or natural causes (e.g., 

liver failure). For the CEWG reports and other purposes, such information 

(e.g., falling from the roof) is recorded. 

76 Assessing Drug Abuse Within and Across Communities: Second Edition 
5. Other Drug-Related Health Data 

5. OTHER DRUG-RELATED HEALTH DATA 

This chapter focuses on other sources of drug-related health data that may be 

useful to epidemiology work groups: 

 Poison Control Center Data. In areas where a poison control center 

operates, network members can access drug-specific data on illegal, 

prescription, and over-the counter drugs. These data can be analyzed and 

are often summarized in reports. 

 Telephone Hotline Data. These data represent both the level of drug use 

and the level of concern about drugs; some hotline calls represent 

informational calls. 

 HIV/AIDS and Hepatitis B and C Data. These data are important 

population-level indicators of specific risk factors associated with 

transmission of these blood-borne diseases, including drug use in some 

proportion of the population. 

Poison Control Center Data 

Jane C. Maxwell, Ph.D., and William A. Watson, Pharm.D. 

Poison Control Centers (PCCs) are a potential source of current information 

on trends and patterns of the abuse of illicit and licit drugs. The primary 

purpose of PCCs is to provide information and management guidelines to 

callers from designated geographical areas. Trained professionals are 

available by telephone to respond to concerns and emergency situations 

related to exposures to a chemical, environmental, or drug product. The 

specialists in poison information offer telephone advice, treatment 

recommendations, and referral sources. Profiles, problems, and procedures are 

recorded by PCC staff to ensure appropriate practices and procedures are 

followed. 

...a particularly 

important value of 

PCC data relates to 

emerging drug 

trends... 

With regard to misuse and abuse of illicit and licit drugs, a particularly

important value of PCC data relates to emerging drug trends (e.g., as in the

use of dextromethorphan illustrated later in this paper). The system can

provide data on new patterns of abuse that have only been heard anecdotally 

elsewhere. PCCs can report leading data, incidents that can occur early in the 

abuse cycle of a substance, rather than lagging data, such as after the users 

have become dependent and are reported in treatment data years later. 

Information is uploaded to the database in real time, so data are available for 

analysis almost immediately. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 77 
Part II. Accessing and Analyzing Data from Different Sources 

Where to Start: Accessing PCC Data 

There are currently 76 PCCs in the United States. They provide services to all 

50 States, the District of Columbia, and Puerto Rico. More detailed informaAll PCCs in the 

United States can be 

contacted using a 

single toll-free 

telephone number... 

tion about PCCs and the American Association of Poison Control Centers is 

provided in Appendix B. All PCCs in the United States can be contacted using

a single toll-free telephone number, 800-222-1222, which routes the call to the 

center providing service for the caller area. The administrative telephone 

numbers of each poison control center can be found on the AAPCC Web site 

in the Poison Center Lists section <http://www.aapcc.org/director2.htm>. 

What to Request 

To track patterns of drug use, a request can be made for PCC data. The Toxic 

Exposure Surveillance System (TESS) is a database of all human exposures; 

more recently added to the database are requests for information that are 

received by poison control centers when no exposure has occurred. All PCCs 

use the same dictionary of terminology and case coding. 

For substance abuse, confirmed human exposures, as well as the age, age 

group, and gender of each case, together with the county from which the call 

was made, are documented for each case when the data are available. In 

addition, the substance(s) involved in the exposure is coded both as the

specific substance (including slang terms) and also into larger categories, such

as “hallucinatory amphetamines.” Information about the route of drug 

administration, and whether it is acute, acute or chronic, or chronic is also

documented. Also of interest is information collected on the exposure site, 

where the patient was taken for health care, treatments provided, medical 

outcome, clinical effects, and duration of clinical effects. These latter 

variables can be used for special studies. 

Before requesting data, the Annual Report of the American Association of 

Poison Control Centers Toxic Exposure Surveillance System should be 

reviewed to understand the various data fields that are collected. The Annual 

Reports are also available on the AAPCC Web site. 

...the substance(s) 

involved in the 

exposure is coded 

both as the specific 

substance (including 

slang terms), and 

also classified into 

larger categories... 

There are five major 

categories of reasons 

for exposure: 

unintentional, 

intentional, adverse 

reaction, other, and 

unknown... 

There are five major categories of reasons for exposure: unintentional,

intentional, adverse reaction, other, and unknown...

 Unintentional reasons for exposure include subcategories of general, 

therapeutic error, bite/sting, misuse, environmental, food poisoning,

occupational, and unknown. Unintentional exposures are unplanned or 

unforeseen events. Unintentional misuse involves the improper or 

incorrect use of a nonpharmaceutical substance. 

 Intentional reasons for exposure include suspected suicides, abuse, 

misuse, and unknown. Intentional misuse is defined as an exposure 

resulting from the improper or incorrect use of a substance for reasons 

78 Assessing Drug Abuse Within and Across Communities: Second Edition 
5. Other Drug-Related Health Data 

other than the pursuit of a psychotropic or euphoric effect. Intentional 

abuse is an exposure resulting from the improper or incorrect use of a 

substance, where the likely intent of the victim was to achieve a euphoric 

or psychotropic effect. All recreational uses of substances for any effect 

are included in this category. Intentional unknown is an exposure 

determined to be intentional but the specific motive is unknown. 

 Adverse reaction is an adverse event occurring with normal, prescribed, 

labeled, or recommended use of a product. This includes cases caused by 

allergic reactions to a drug or food. 

 Other includes “contamination or tampering” that occurs when the 

patient is an unintentional victim of exposure to a substance that has been 

adulterated either maliciously or unintentionally; “malicious” is used to 

capture data on patients who are victims of another person’s intent to harm 

them. “Withdrawal” is a recently added code. 

 Unknown includes those exposures for which the reason for exposure is 

unknown. 

Uses of PCC Data: Texas Highlights 

In the remainder of this paper, several examples of ways PCC data can be 

used are provided from the Texas PCC data. Persons need to confirm the 

accessibility of data with the PCCs in their locale. 

Exhibit 1 on the following page shows categories of drugs that can be 

requested. For illicit drugs listed in the A column (e.g., cocaine, heroin, 

marijuana, and ecstasy), it is important to gather data on all calls that involved 

direct human contact with the drug, regardless of reason for exposure (or 

“intent codes”). Illicit drugs are not normally available except in drug-using 

situations, so all cases are of interest. Using census data, the number of 

human poison exposure cases reported per 1,000 individuals per year in the 

population served can be determined, and using the penetrance rate, 

comparisons of a single substance, or various substances, can be made over 

time. 

For prescription drugs or substances that have common household use (but 

can also be abused), the intent codes are needed to separate cases in which 

there was an adverse reaction or unintentional use, as compared with 

intentional misuse or abuse for euphoric effects. These drugs are listed in 

column B in exhibit 1. Because some users may not admit to having used the 

substance specifically for euphoric or psychotropic effects, researchers should 

use both the intentional misuse and abuse categories listed in the footnote in 

exhibit 1. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 79 
A. Drugs—All Reasons/Codes 

Cocaine 

Heroin 

Marijuana 

Ecstasy 

Rohypnol/Flunitrazepam 

Gamma Hydroxybutyrate 

Phencyclidine/AMP/Fry 

Lysergic Acid Diethylamide 

Part II. Accessing and Analyzing Data from Different Sources 

Exhibit 1. Suggested Categories of Substances and Exposure Reasons1 

B. Drugs—Separate Intent Codes 

Hydrocodone 

Oxycodone 

Methadone 

Amphetamine/Methamphetamine 

Ketamine 

Formaldehyde/Formalin 

Dextromethorphan 

Coricidin HBP 

Mushrooms 

Ritalin 

Alprazolam/Xanax 

Diazepam/Valium 

Clonazepam/Clonopin 

Fentanyl 

Hydromorphone 

Codeine 

Meperidine 

Inhalants 

1

Exposure/Intent Codes 

a Intentional – Misuse 

b Intentional – Abuse 

c Intentional – Unknown 

d Contamination/tampering 

e Other – Malicious 

f Withdrawal 

SOURCE: Texas Poison Control Center Network, Texas Department of Public Health 

...PCC data can also

be triangulated 

with other drug 

indicators to 

provide a clearer 

picture of trends. 

The PCC data can also be triangulated with other drug indicators to provide a

clearer picture of trends. Exhibit 2 presents data on four phencyclidine (PCP)

abuse indicators in Texas from 1998 to 2003. PCC calls involving PCP

increased each year. PCP treatment admissions followed a similar trend, as

did the number of PCP exhibits identified in the Department of Public Safety 

labs. Overdose deaths involving PCP increased from 1999 to 2002, but 

declined in 2003. 

80 Assessing Drug Abuse Within and Across Communities: Second Edition 
5. Other Drug-Related Health Data 

Exhibit 2. PCP Indicators in Texas: 1998–2003 

PCC Calls 

Treatment 

Admissions 

Department Department of 

Public SPublic Safety 

Labs 

Deaths 

1998 

1999 

2000 

2001 

2002 

2003 

1998 

1999 

2000 

2001 

2002 

2003 

1998 

1999 

2000 

2001 

2002 

2003 

1998 

1999 

2000 

2001 

2002 

2003 

103

164

10

0

169

243

84

3

175

250

104

3

198

245

163

5

237

321

95

8

294

417

135

2

103 

164 

10 

0 

169 

243 

84 

3 

175 

250 

104 

3 

198 

245 

163 

5 

237 

321 

95 

8 

294 

417 

135 

2 

SOURCES: Texas Poison Control Center Network, Department of Health; Texas Commission on Alcohol and Drug 

Abuse; Texas Department of Public Safety; and Bureau of Vital Statistics, Texas Department of State Health Services 

...PCC data... 

may provide 

information about 

substance abuse that 

is usually 

not available 

from other data 

sources. 

One advantage of PCC data is that they may provide information about 

substance abuse that is usually not available from other data sources. Inhalant 

abuse, for example, appears to be one of the most hidden substance abuse 

problems. Death data are often underreported, the proportion of treatment 

admissions is often low (less than 1 percent in Texas), and users are not seen 

in large numbers in surveys of older youth and adults. Yet, the Texas PCC 

data for 1998–2003 show that inhalant abuse occurs not only among young 

teenagers, but also among persons in their twenties. This phenomenon is 

illustrated in exhibit 3, which shows the number of misuse and abuse cases 

involving the inhalation of various substances during that time period. 

Persons who misused or abused typewriter correction fluid were young, with 

an average age of 12.9 years. Persons who used amyl or butyl nitrite 

(“poppers”) were age 27.6, on average. Those who misused paint and other 

products used in painting were in their early twenties. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 81 
Part II. Accessing and Analyzing Data from Different Sources 

For a study of inhalants, request all substances (not just those listed in exhibit 

1) by inhalation as route of administration and then delete those that are not 

substances of interest. Also, delete all that were not intentional abuse or 

misuse cases, since many products can be misused unintentionally in an 

accident. 

Exhibit 3. Exposures Involving Misuse or Abuse of Inhalants Reported to the Texas PCC, by Year and Average 

Age: 1998–2003 

Product Year Total Average Age 

1998 1999 2000 2001 2002 2003 1998–2003 1998–2003 

Air Freshener: Aerosol 4 3 9 3 10 4 33 14.6 

Amyl/Butyl Nitrite 1 2 1 1 – 8 13 27.6 

Automotive Product: Hydrocarbon 

(Transmission Fluid, Power Steering Fluid) 6 7 10 16 16 23 78 20.2 

Automotive Product: Methanol (Dry Gas, 

Windshield Washing Solution) 5 5 9 14 18 23 74 25.3 

Freon/Other Propellant 23 24 21 20 23 15 126 17.6 

Gasoline 24 19 16 18 18 6 101 14.8 

Mineral Spirits/Varsol/Stoddard Solvent 3 6 5 6 4 2 26 23.5 

Nitrous Oxide 4 4 2 5 4 2 21 23.4 

Paint: Oil-Base 30 22 17 18 20 7 114 23.6 

Propane and Other Simple Asphyxiant 18 14 10 4 10 7 63 15.5 

Toluene/Xylene (Excluding Adhesives) 10 19 14 10 10 4 67 24.3 

Typewriter Correction Fluid 2 4 3 1 3 2 15 12.9 

Unknown Paint, Varnish or Lacquer 16 7 14 8 10 7 62 23.8 

Varnish and Lacquer – 6 2 – 1 1 10 20.2 

SOURCE: Texas Poison Control Center Network, Texas Department of Public Health 

Exhibit 4 provides another example of an emerging drug, but one that seldom 

appears with any frequency in other indicators––dextromethorphan (DXM). 

The over-the-counter DXM-containing products most commonly abused 

include Robitussin-DM, Tussin, and Coricidin Cough and Cold Tablets HBP. 

The drug has also been linked to deaths among those who obtained it in pure 

bulk form via the Internet. Exhibit 4 shows that not only have the number of 

abuse and misuse cases of human exposure to DXM increased in Texas, but 

also that this increase has occurred even when the increase in population is 

considered, which is shown in the penetrance rate per 1,000 persons. 

82 Assessing Drug Abuse Within and Across Communities: Second Edition 
5. Other Drug-Related Health Data 

Exhibit 4. Dextromethorphan Abuse and Misuse Calls to Texas PCCs: 1998–2003 

0 

100 

200 

300 

400 

500 

600 

Cases 97 200 262 366 429 373 

Penetrance 0.0004 0.0010 0.0012 0.0017 0.0020 0.0017 

1998 1999 2000 2001 2002 2003 

1 

0.0025 

0.0020 

0.0015 

0.0010 

0.0005 

0.0000 

1

Rate per 1,000 population. 

SOURCE: Texas Poison Control Center Network, Texas Department of Public Health 

For additional information, see Watson, W.A. et al. 2003 Annual Report of 

the American Association of Poison Control Centers Toxic Exposure 

Surveillance System, American Journal of Emergency Medicine 22(5): 335-

404, 2004. 

For additional information on accessing a relevant Web site, see Appendix B. 

Telephone Helpline Data 

Drug helplines provide confidential telephone-based treatment referral and 

assistance. Typically, helplines operate on a 24-hour basis, and are organized 

to provide education and counseling services to individuals concerned about 

or experiencing problems after using drugs. Caller data are recorded and can 

be a useful source of information about drugs and drug abusers. 

By quantifying information collected by helplines in a systematic way, it is 

possible to detect potential changes in the use of particular drugs and the 

emergence of new drugs of abuse. However, one should keep in mind that 

helpline information cannot be used to determine the actual prevalence of use 

of specific drugs in the population. Furthermore, the caller may not inquire 

about his or her own drug use but because he or she is concerned about 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 83 
 

Part II. Accessing and Analyzing Data from Different Sources 

[Helpline] data may 

be considered an 

indicator of drug 

use in a community 

but also an indicator 

of community 

concern about use 

of a particular 

drug... 

someone else’s drug use. The data may be considered an indicator of drug use

in a community and also an indicator of community concern about use of a

particular drug or drugs in an area, sometimes in response to community 

education forums. 

These data are particularly subject to historical context, both on the part of 

callers and of staff. For example, a call that might have been recorded as a 

“pain pill” in 1999 might be recorded in 2004 as OxyContin if the staff person 

probed the caller about the specific name of the pill they took. 

Generally, helpline counselors fill out forms to record information about each 

telephone contact, including the types of problems of concern to the caller, 

drugs involved, services needed, and assistance/information provided to the 

caller. The information is often recorded on a standardized form by trained 

staff so it can be aggregated and analyzed systematically and efficiently. 

Where to Start: Accessing Helpline Data 

Network members need to identify the helpline agency. For example, in 

Washington State the agency is the Alcohol/Drug Help Line. This confidential 

24-hour helpline has a computerized database that maintains and quantifies 

information from callers throughout the State. CEWG representative Caleb 

Banta-Green utilizes this database semiannually to analyze data for various 

counties, particularly for King County (in which Seattle is located); the 

information is documented regularly in his CEWG paper. In Massachusetts, 

CEWG representative Daniel Dooley accesses such data semiannually from 

the Massachusetts Substance Abuse Information and Education Hotline for 

the Boston region (comprising the cities of Boston, Brookline, Chelsea, 

Revere, and Winthrop) and reports findings in the Boston CEWG paper. 

What to Request 

...first become 

familiar with the 

helpline’s 

database... 

Before you request helpline data, first become familiar with the helpline’s

database so you can be specific about the types of information that will be

most useful to the network. The number of mentions for each drug will 

exceed the number of calls, because some callers inquire about more than one 

substance. Besides requesting numeric data (number of calls for each drug 

within a specific time period), network members may wish to talk with 

helpline counselors. Counselors can provide valuable explanations and 

insights into what appear to be new drug abuse trends and “fads.” 

It may be possible to obtain the helpline datafile electronically in an Excel 

format, which will clearly show any small numbers for a particular drug (or 

area). The Seattle CEWG representative, Caleb Banta-Green, is sent the data 

in an Excel format; the “threshhold” set for noting a change for a particular 

84 Assessing Drug Abuse Within and Across Communities: Second Edition 
 

5. Other Drug-Related Health Data 

drug is a substantial change from the previous reporting period (e.g., if 

cocaine were to increase from 30 to 40 percent of the calls, but 

benzodiazepines were to increase from only 5 to 8 percent, only the cocaine 

data are reported for that time period). 

Uses of Helpline Data: Boston Example 

Exhibit 1, developed by CEWG representative Daniel Dooley (in publication), 

exemplifies the type of information that can be accessed and analyzed from 

helplines. Like other Boston drug abuse indicators, these helpline data 

substantiate alcohol, heroin, and cocaine/crack abuse in the city. The 6-year 

trend data also substantiate findings from other indicator data that point to the 

increased abuse of narcotic analgesics (especially oxycodone) the Boston area. 

As shown in exhibit 1, the proportion of calls involving narcotic analgesics 

rose from 6 percent of the calls in FY 2000 to 19 percent in FY 2005. 

Exhibit 1. Helpline Calls in Greater Boston,1 by Drug and Percent: FYs 2000–2005 

Drug2 FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 

No. (%) No. (%) No. (%) No. (%) No. (%) No. (%) 

Alcohol-only 2,034 (37) 2,206 (39) 1,965 (34) 1,627 (31) 1,597 (28) 1,730 (35) 

Cocaine/ 

Crack 1,118 (20) 1,1068 (19) 1,072 (18) 1,041 (20) 1,017 (18) 949 (19) 

Heroin 1,832 (33) 1,862 (33) 2,038 (35) 1,895 (36) 2,230 (40) 1,562 (31) 

Narcotic Analgesics 344 (6) 508 (9) 785 (14) 832 (16) 1,025 (18) 931 (19) 

Marijuana/ 

Hashish 309 (6) 291 (5) 339 (6) 261 (5) 253 (5) 226 (5) 

Benzodiazepines 151 (3) 154 (3) 204 (4) 187 (4) 175 (3) 168 (3) 

Methamphetamine 2 (<1) 7 (<1) 11 (<1) 10 (<1) 14 (<1) 16 (<1) 

MDMA 43 (1) 40 (1) 45 (1) 32 (1) 24 (<1) 17 (<1) 

Hallucinogens 17 (<1) 24 (<1) 8 (<1) 14 (<1) 8 (<1) 6 (<1) 

Inhalants 100 (2) 55 (1) 40 (1) 15 (<1) 25 (<1) 12 (<1) 

Total Number of Calls 5,478 5,695 5,814 5,221 5,627 4,977 

1

Greater Boston includes Boston, Brookline, Chelsea, Revere, and Winthrop (CHNA 19). 2

Narcotic Analgesics include codeine, methadone, morphine, oxycodone (incl. OxyContin), Percocet, Roxicet, Vicodin and other opiates. 

Benzodiazepines include Ativan, Halcion, Klonopin, Librium, Rohypnol, Valium, and Xanax. Hallucinogens include LSD, PCP, psilocybin, 

and mescaline. Inhalants include acetone, aerosols, glue, markers, paint, and other inhalants. 

SOURCE: Massachusetts Substance Abuse Information and Education Helpline; data analysis by the Boston Public Health Commission 

Research Office 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 85 
Part II. Accessing and Analyzing Data from Different Sources 

HIV/AIDS and Hepatitis B and C Data 

HIV/AIDS, hepatitis B (HBV), and hepatitis C (HCV) may be transmitted 

through the use of contaminated needles and other paraphernalia by injection 

drug users (IDUs) and from having unprotected sex with an IDU. 

For more than two decades, studies of HIV seroprevalence among IDUs have 

shown that spread of this infection can occur rapidly among IDUs and their 

sexual partners, especially among men who have sex with men (MSM) and 

are also IDUs. Studies have also shown considerable variation in HIV 

seroprevalence by geographic area and by demographic characteristics such as 

age, gender, and race/ethnicity. 

Where to Start: Accessing HIV, HBV, and HCV Data 

The Centers for Disease Control and Prevention’s Divisions of HIV/AIDS 

Prevention Web site offers easily accessible information on HIV/AIDS by 

region and for the Nation overall <www.cdc.gov/hiv/dhap.htm> (click on

Statistics & Surveillance, then Reports). Another CDC Web site offers links

for State and local HIV/AIDS surveillance reports: <http://www.cdc.gov/hiv/ 

stats/hasr1402/website.htm>. The link will lead to the Web site by State (e.g.,

Alabama) <http://www.adph.org/aids>. After you click on the URL for the 

State, click on Annual Report for several options to access the data by region 

of the State (counties are combined in regions) or HIV/AIDS Cases 

Countywide and Statewide. States vary in how this information is presented. 

Another CDC Web 

site offers links 

for State and local 

HIV/AIDS surveillance reports: 

<www.cdc.gov/hiv/ 

stats/hasr1402/ 

website.htm>. 

Other sources of 

HIV/AIDS data 

include State health 

departments, local 

health departments, 

local AIDS 

programs, 

universities, and 

outreach programs. 

Other sources of HIV/AIDS data include State health departments, local

health departments, local AIDS programs, universities, and outreach

programs. The Chicago CEWG representative and colleagues, for example, 

use CDC data in reporting HIV/AIDS patterns and trends, but also use

information from State and city health departments and data from studies

conducted by the University of Illinois at Chicago (see, e.g., Broz et al. 2005).

Some local health departments, as in the State of Washington, have 

increasingly maintained trend data on HIV exposure categories. Network 

members may wish to contact their local health department and inquire 

whether such data are available for their area. 

The CDC also collects 

information on 

hepatitis, including 

HBV and HCV. These 

data are reported 

weekly to CDC... 

The CDC also collects information on hepatitis, including HBV and HCV.

These data are reported weekly to CDC by State and territory health

departments. The data are prepared in reports by CDC that are available at 

<www.cdc.gov/hepatitis> (see also below). Most local health departments

have infectious diseases epidemiologists who track HBV and HVC. 

86 Assessing Drug Abuse Within and Across Communities: Second Edition 
5. Other Drug-Related Health Data 

State epidemiologists 

are listed on the 

Council of State and 

Territorial Epidemiologists Web site... 

State epidemiologists are listed on the Council of State and Territorial 

Epidemiologists Web site at <http://www.cste.org/members/state 

_and_territorial_epi.asp>. 

Hepatitis Surveillance Report No. 60, September 2005, as an example, 

includes data from 1975 through 2003. Figure 12 of the report shows the Rate 

Per 100,000 Population of Incidence of Acute Hepatitis by Region of the 

Nation; Figure 13 shows the same data by county (see http://www.cdc.gov/ 

ncidod/diseases/hepatitis/resource/index.htm; click on Hepatitis Surveillance 

Report). Network members may find State and local health departments, 

outreach programs, and universities useful sources of data on HVB and HVC. 

Sources of information on HBV and HCV found useful by CEWG 

representatives are shown later in exhibit 2. 

What to Request 

For diagnosed AIDS cases, request the following types of information by year 

(e.g., 1999 through 2005) and for “cumulative” cases (e.g., 1981–2005): 

 Gender (male, female) 

 Race/ethnicity (e.g.,White, Black, Hispanic, Asian/Pacific Islander, 

Unknown) 

 Age group (e.g., 0–12, 13–19, 20–29, 30–39, 40–49, 50–59, 60 and older) 

 Mode of exposure 

3⁄4 MSM 

3⁄4 IDU/MSM 

3⁄4 IDU 

3⁄4 Heterosexual contact 

3⁄4 Mother with HIV 

3⁄4 Others that may be of interest (e.g., hemophilia, transfusion/transplant, 

other) 

 Deaths during each year 

Similar data can be requested for HIV cases and, if available, for HBV and 

HCV cases. 

...be sure to inquire 

about case coding 

protocols... 

For these data, be sure to inquire about case coding protocols. For example, in

some areas heterosexual contact will only be recorded for women if they have

never injected drugs or had sex with an MSM. This rules out many prostitutes 

who may have contracted HIV through sex with a man. 

Uses of the Data on AIDS and Hepatitis B and C 

CEWG representatives regularly report data on HIV/AIDS. An example is 

provided in exhibit 1, as reported by CEWG representative Heidi Israel, 

Ph.D., and James Topolski, Ph.D. (2006). These data show, for example, that 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 87 
 

 

 

 

 

 

Part II. Accessing and Analyzing Data from Different Sources 

the majority of persons living with HIV in St. Louis are male, White or 

African-American, and between the ages of 30 and 49. Injection drug use and 

combined male-to-male sex and injection drug use accounted for 10 percent of 

the positive cases through June 2004. 

Exhibit 1. Persons Living with HIV Disease in St. Louis Metropolitan Area by Exposure Category, Gender, 

Race/Ethnicity, and Age: Year-to-Date and Cumulative Totals: 1995–June 2004 

Category 

HIV-Positive Test Results 

January 2004–June 2004 Cumulative from 1995 

through June 2004 

Number Percent Number Percent 

Exposure Category 

MSM 61 50.0 4,583 70.0 

IDU 6 5.0 301 5.0 

IDU/MSM 3 2.0 319 5.0 

Hemophilia 0 0.0 58 1.0 

Heterosexual 12 10.0 920 14.0 

Blood transfusion 0 0.0 34 0.2 

Perinatal 0 0.0 41 1.0 

Unknown 41 33.0 416 6.0 

Total 123 6,672 

Gender and Race/Ethnicity 

Male 

White 40 33.0 2,914 45.0 

African-American 62 51.0 2,582 40.0 

Hispanic 1 0.0 79 1.0 

Other 1 0.0 19 0.0 

Unknown 

Female 

0 0 208 3.0 

White 4 3.0 170 2.0 

African-American 14 12.0 671 10.0 

Hispanic 2 0.0 15 0.0 

Other 0 0.0 13 0.0 

Age 

12 and younger 0 0.0 53 1.0 

13−19 5 4.0 160 2.4 

20−29 39 32.0 1,644 25.2 

30−39 30 24.0 2,799 43.0 

40−49 41 33.0 1332 20.4 

50 and older 8 7.0 522 8.0 

Unknown 0 0 162 2.0 

Total 123 6,672 

SOURCE: St. Louis Metropolitan AIDS Program 

Some CEWG representatives also reported available information on hepatitis 

B and C at the June 2004 CEWG meeting. Their findings are summarily 

presented in exhibit 2, together with information on the data sources, methods, 

and population covered by the data source. As can be deduced, reports and 

estimates of HBV and HCV infection among the populations studied are 

alarmingly high. New networks need to monitor these diseases as data 

become increasingly available. 

88 Assessing Drug Abuse Within and Across Communities: Second Edition 
 

 

 

 

5. Other Drug-Related Health Data 

Exhibit 2. Data on HBV and HCV Reported by CEWG Representatives1 from 7 Areas 

Site/Data Source/Year Method/Population Major Findings 

Hawaii: State Department of 

Health, Hawaii, 2003 

Testing 

113–114 Syringe Exchange 

Program participants 

69.3 percent tested HBV positive; 54.0 

percent tested HCV positive 

Maryland: Department of Health 

and Mental Hygiene, 2002 

Survey and testing 

Persons entering Baltimore 

detention centers 

30 percent tested HBV positive; 9 percent 

tested HCV positive 

Michigan: Department of 

Community Health, Immunization 

and Communicable Disease 

Division, 2003 

Estimates 

General population 

Prison inmates (48,000) 

179,000 in the general population are HCV 

infected 

18,000 inmates are HCV infected 

Minnesota: Department of 

Health, 2003 

Estimates 

Methadone maintenance patients Up to 90 percent HCV infected 

San Francisco: Urban Health 

Study, 2003 

University of California at San 

Francisco, 2003 

Self-reports 

IDUs 

Estimates based on earlier 

testing 

IDUs 

Research study 

Homeless and marginally housed 

HIV-infected persons 

67 percent said they were infected with 

HCV 

90–95 percent are HCV positive 

73 percent were HCV and HIV “co-infected” 

Seattle: Public Health-Seattle & 

King County, HIV-AIDS 

Epidemiology Program, 1994– 

2003 

Local researchers 

Estimates 

King County IDU population 

(based on a sample of more than 

4,000 since 1994) 

Local incidence studies 

IDUs who were not HCV infected 

IDUs who were not HBV infected 

85 percent may be infected with HCV; 70 

percent show markers of prior HBV infection 

21 percent acquire HCV each year 

10 percent acquire HBV each year 

Texas: Department of Health, 

2003 

Research study (NIDA Grant R21 

DA014744, Maxwell and Spence 

2004) 

Testing 

8,798 persons 

Self-report 

Heroin addicts 

18 percent were HCV positive (41 percent 

of positives were IDUs) 

48 percent said they were HCV infected 

1

Data were extracted from papers by D. William Wood, Ph.D. (Hawaii), Leigh Henderson, Ph.D. (Maryland), Phil Chvojka (Michigan), 

Carol Falkowski (Minnesota), John Newmeyer, Ph.D. (San Francisco), Caleb Banta-Green (Seattle), and Jane Maxwell, Ph.D. (Texas). 

SOURCE: NIDA 2005 (Volume II CEWG reports) 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 89 
 

Part II. Accessing and Analyzing Data from Different Sources 

6. LAW ENFORCEMENT/CRIMINAL JUSTICE 

SYSTEM DATA 

There are many 

sources of law 

enforcement data 

that can provide 

useful information 

to network 

members. 

...tips to persons 

requesting law 

enforcement data... 

There are many sources of law enforcement data that can provide useful 

information to network members. They are subsumed in this chapter under 

the following broad headings: 

 Drug-Related Arrest Data. Arrest and/or criminal file data can provide 

interesting information; however, data quality and availability vary by 

area. 

 Crime Laboratory Drug Data. These data are available in most States; 

they provide considerable detail about specific drugs and require no 

analyses. 

 Drug Trafficking Data. These data, if available, are in an easily usable 

format and provide an essential context to other drug indicator data. 

Major contributions to portions of this chapter were provided by CEWG 

representative Erin Artigiani and her colleague Eric Wish, Ph.D., Center for 

Substance Abuse Research (CESAR), University of Maryland, who regularly 

monitor such data for the State of Maryland. Other contributions were made 

by Dr. Jane Maxwell and Caleb Banta-Green in their review of the material, 

and some data are extracted from recent papers of other CEWG 

representatives. 

Erin Artigiani and Dr. Eric Wish offer the following tips to persons requesting 

law enforcement data: 

 Know the agency contact 

 Identify existing data sets and review existing reports to ensure that the 

right person is approached at the right time 

 Follow agency procedures for making data requests 

 Ask for everything at once 

 Be detailed and specific 

 Be patient 

 Build a rapport and express gratitude for the information 

90 Assessing Drug Abuse Within and Across Communities: Second Edition 
6. Law Enforcement/Criminal Justice System Data 

Drug-Related Arrest Data 

Local police and sheriffs’ departments can often provide information on the 

number of arrests for different drugs, as well as data on the characteristics of 

arrestees. 

...source of 

information on 

drug-related 

arrests... 

Another source of information on arrestees is the Uniform Crime Report

(UCR), maintained by the Federal Bureau of Investigation (FBI). The UCR

provides information on drug-related arrests for several broad drug categories. 

UCR data, by State, can be found at <http://www.fbi.gov/ucr/ucr.htm>; local 

officials will need to be contacted for county-level data. In some areas, there 

are agencies that conduct urinalysis; such data provide especially valid information on the particular drugs used by arrestees and information on their 

demographic characteristics. Another data source on drug-abusing arrestees is 

the Treatment Accountability for Safer Communities (TASC) programs; a 

description of TASC can be found at <www.nationaltasc.org>. Still another 

potential data source is the drug courts (see <http://www.nadcp.org>). These 

and other data sources are covered in this section. 

Police Department and Sheriff’s Office Data 

Police departments generally assign someone the primary responsibility for 

the task of collecting, managing, and reporting arrest data. If a police 

department is relatively large, this responsibility is likely to be delegated to a 

particular division (e.g., narcotics unit). 

While a particular police department may use a standard format to collect data 

on arrestees, the format is likely to vary across different towns and cities. 

Some departments may have only one category for drug-related offenses, and 

the types of drugs may not be specified. Others will have detailed information. 

...police departments differ with 

regard to how drugarrests are 

classified and 

recorded. 

Also, police departments differ with regard to how drug arrests are classified

and recorded. For example, the Boston Police Department, Office of Planning

and Research, categorizes drug arrests by class (see exhibit 2 below). Or, in 

some areas, if a person is arrested while driving under the influence (DUI) and

drugs are found, the arrest report may include only the DUI (the greater of the 

two offenses). Some police departments may not consider an arrest for 

injection equipment as a major arrest and would not record it in the database. 

Some departments may test arrestees for drug use (e.g., by urinalysis). While 

testing is not a common practice, such data are particularly useful, since they 

provide a valid estimate of recent use of specific drugs. 

Some police departments may make use of several types of law enforcement 

data/information to assess local drug abuse patterns and trends. A case in 

point is the Phoenix Police Department. Indicators used by the Phoenix Police 

Department include data on drug seizures, arrests, and bookings. For example, 

the Department’s Drug Enforcement Bureau (DEB) made 1,384 drug-related 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 91 
Part II. Accessing and Analyzing Data from Different Sources 

arrests in 2005 (see exhibit 1 below). From 2003 to 2005, there was a 69-

percent increase (from 241 to 362) in methamphetamine-related arrests. 

Methamphetamine seizures increased from 42 in 2004 to 68 in 2005, despite 

the fact that the number of small clandestine methamphetamine labs decreased 

during this time period. According to the DEB, increasing amounts of 

methamphetamine were being transported into Phoenix from Mexico, and the 

purity of the Mexican methamphetamine was much higher than the 

methamphetamine that was produced in local labs (Vermeer in publication). 

Network members should inquire about the different types of drug-related 

information/data available from a police department or Sheriff’s Office. 

Where to Start: Accessing Police/Sheriff’s Office Arrest Data 

One very useful source of information is USACOPS. Through the USACOPS 

Web site, it is possible to access the names, addresses, and phone numbers for 

local law enforcement agencies. Relevant information on how to access data 

from the USACOPS Web site, and a minimal list of questions network 

members should ask of police informants, are shown in the box below. (See 

also Appendix B.) 

Accessing USACOPS Web Site and Questions to Ask 

A. Access online at <http://www.usacops.com> 

First: On the map, click on the State you want (e.g., Minnesota) 

Second: On the State map, click on the county you want (e.g., Hennepin County) 

Third: Click on the county site of interest (e.g., Minneapolis SO) 

Summary: (1) Minnesota (2) Hennepin County (3) Minneapolis SO 

B. Accessing Data from the Law Enforcement Agency (e.g., Sheriff’s 

Office, Police Department) 

By phone or in person: 

1.	 Find the best “informant” (e.g., the officer who has information on drug arrests or 

the person in charge of data entry). 

2.	 Ask the informant specific questions for a specific time period (e.g., year) on the 

number of arrests (cases) for each drug of interest; if data are available, request the 

number of cases for manufacture/sales versus possession for each drug of interest. 

Inquire also and obtain any information available on seizures and trafficking of drugs of 

interest, and any other insights the informant may have on drug use in your community. 

92 Assessing Drug Abuse Within and Across Communities: Second Edition 
6. Law Enforcement/Criminal Justice System Data 

...first check on how 

the local sheriff’s 

office or police 

department 

maintains data on 

drug arrests... 

Network members should first check on how the local sheriff’s office or 

police department maintains data on drug arrests, how arrests are recorded, 

and what types of changes (if any) have been made in how the data were 

recorded over, say, the past 5 years. If there have been major changes in how 

arrests are recorded, it would be advisable to collect the data only for the most 

recent years in which uniform data have been collected so that trend data will 

be comparable over time. If the information must be accessed from existing 

records (rather than online), it would be useful to develop a form for 

requesting or accessing the data before the task begins. It is also useful to find 

out whether there have been any changes in a policy, formal or informal, that 

have led to a changing focus on any specific populations, neighborhoods, or 

specific drugs. 

What to Request 

The types of information to be requested depend, of course, on the types of 

data the police department collects. If the data are available, focus on the 

following types of information: 

 The total number of arrests for a specific time period 

 The number of arrests for each type of drug (and for DUI, if the network 

chooses to include DUI data) 

 The demographic characteristics of arrestees by type of drug and by type 

of arrest (e.g., possession, sales) 

 Any testing data (e.g., urinalysis, hair testing, or testing of evidence) 

Uses of Police/Arrest Data: Examples from the CEWG 

The Phoenix Police Department, Drug Enforcement Bureau, maintains 

information on arrests for various illicit drugs. Data show a sharp rise in 

cocaine arrests from 2003 to 2004, followed by a sharp decline in 2005. 

Arrests for methamphetamine show an opposite trend, that is, an increase in 

2005 from 2003 and 2004 (Vermeer in publication). 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 93 
Part II. Accessing and Analyzing Data from Different Sources 

Exhibit 1. Number of Drug Arrests Made by the Drug Enforcement Bureau,1 Phoenix Police Department: 

2003–2005 

2003

2004

2005

2003 Marijuana 

Cocaine 

Methamphetamine 

Heroin 

2004 Marijuana 

Cocaine 

Methamphetamine 

Heroin 

2005 Marijuana 

Cocaine 

Methamphetamine 

Heroin 

283 

319 

289 

380 

538 

298 

241 

238 

363 

14 

47 

34 

1

These numbers do not include arrests made by patrol precincts or other bureaus. 

SOURCE: Phoenix Police Department 

In Boston, drug arrests are categorized by “class.” These data are reported 

regularly in tabular form by CEWG representative Daniel Dooley (2006). 

Exhibit 2 shows the number of arrests and the percentage of the total for each 

class of drug from 1998 to 2004 (drugs included in each class are shown in 

footnotes). The predominance of Class B arrests reflects the high level of 

cocaine abuse in the Boston area. 

Exhibit 2. Boston Police Department Arrests for Possession, Distribution, Manufacturing, and Trafficking 

of Drugs, by Class of Drug and Percent: 1998–2004 

Drug Class 1998 1999 2000 2001 2002 2003 2004 

A1 22.5 24.0 27.1 26.4 22.5 22.5 20.7 

B2 47.1 45.1 40.6 41.7 41.9 41.6 43.3 

D3 25.6 27.7 29.0 28.7 32.7 32.7 32.8 

Other 4.8 3.3 3.3 3.2 3.0 3.2 3.2 

Total Drug Arrests (N) (4,723) (4,097) (3,770) (3,426) (4,209) (4,174) (3,807) 

Total Arrests (N) (25,481) (23,592) (22,216) (20,470) (21,025) (20,686) (19,577) 

Drug Percentage of Total 18.5 17.4 17.0 16.7 20.0 20.2 19.4 

1

Heroin, morphine, gamma hydroxybutyrate, ketamine, and other opiate derivatives. 2

Cocaine, “other opiates,” MDMA, lysergic acid diethylamide, phencyclidine, methadone, fentanyl, amphetamines, 

 methamphetamine, methaqualone, and others.

3

Marijuana, barbital, butyl nitrite, and others. 

SOURCE: Boston Police Department, Office of Planning and Research 

94 Assessing Drug Abuse Within and Across Communities: Second Edition 
 

6. Law Enforcement/Criminal Justice System Data 

Uniform Crime Report Data 

...17,000 jurisdictions report UCR 

data to the FBI... 

UCR data are 

collected regularly 

and consistently... 

...see whether 

recent data are 

available either 

online or in hard 

copy. 

...request data for 

the most recent 

year and for 3–5 

prior years... 

UCR programs in States collect, evaluate, and process uniform statistical 

arrest data, and, in turn, report the data to the FBI; 17,000 jurisdictions report 

UCR data to the FBI in a given year. Because of computer problems, changes 

in record management systems, personnel shortages, or a number of other 

reasons, some agencies cannot provide data for publication in a given time 

period. 

UCR data are collected regularly and consistently and provide State, county, 

and local measures of crime. State, county, and municipal law enforcement 

agencies are required by law to submit monthly Uniform Crime Reports on 

the number of offenses known to have occurred in their locality and the 

number of arrests made. Data are provided in a format that has remained 

unchanged since 1994. Annual statistical publications, such as the 

comprehensive Crime in the United States, are available. 

There are a number of limitations in the UCR data. The UCR does not 

measure the prevalence of crime. Drug categories are not drug specific and are 

limited to four: (1) opium, cocaine, and derivatives; (2) marijuana; (3) 

synthetic narcotics; and (4) dangerous non-narcotics. Arrests for two major 

drugs, such as heroin and cocaine, cannot be separated for analysis. Rules on 

how methamphetamine should be coded are not specified. Only the most 

serious charge is recorded. The UCR is not a measure of drug use, since 

many persons committing other types of crime or not getting arrested at all 

use drugs. Nor does the UCR measure the number of different individuals 

arrested. The data reflect the level of law enforcement concentrated on the 

problem, not the magnitude of the crimes committed. Dr. Jane Maxwell, 

CEWG representative, has found that local UCR data may contain duplicates, 

because each assigned department is required to complete the UCR. For this 

reason, it may be preferable to obtain UCR data from the State agency and to 

request relevant data on specific drugs for the network’s local area. 

Where to Start: Accessing UCR Data 

Statewide data are available through national reports prepared by the FBI and 

may be found at: <http://www.fbi.gov/ucr/ucr.htm>. (See also Appendix B.) 

Network members may also wish to confer with local law enforcement 

personnel to see whether recent data are available either online or in hard 

copy. 

What to Request 

Ideally, network members will request data for the most recent year and for 3– 

5 prior years, depending on the time span selected for trend analyses of 

different indicator data. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 95 
 

Part II. Accessing and Analyzing Data from Different Sources 

Requests can be made for Total Arrests and for (1) Possession and (2) Sales 

and Manufacturing of (a) Opium Cocaine/Derivatives, (b) Marijuana, (c) 

Synthetic Narcotics, and (d) Other Dangerous Non-Narcotics. 

Members might also be interested in the demographic characteristics of 

persons arrested for particular drug charges. Data are available by gender, 

race/ethnicity, and age group. 

Uses of UCR Data: Baltimore City/Maryland Example 

Exhibit 3 shows the 2003 Maryland UCR data at one substate level–– 

Baltimore City. As depicted in the exhibit, Baltimore City accounted for 53 

percent of all drug possession arrests in the State and 69 percent of all sales 

and manufacturing arrests in 2003. Opium or cocaine and their derivatives 

accounted for 80 percent of the combined possession and sales/manufacturing 

violations for that drug category in Maryland in 2003. 

Exhibit 3. Number of UCR Drug-Related Arrests in Baltimore City, by Type of Violation and Drug, and 

Percentage of All Drug Arrests in Maryland: 2003 

Violation Opium or Cocaine/ 

Derivatives Marijuana Other1 Total 

Baltimore City 

Possession 

Sales and Manufacturing 

Subtotal 

15,544 

10,858 

26,402 

4,710 

348 

5,058 

38 

31 

69 

20,292 

11,237 

31,529 

Percentage of All Maryland Drug Violations 

Possession 79 

Sales and Manufacturing 81 

All Drug Violations 80 

26 

<2 

25 

0.5 

0.4 

0.4 

53 

69 

58 

1

Other includes “Synthetic Narcotics” and “Other Dangerous Non-Narcotics.” 

SOURCE: Crime in Maryland: 2003 Uniform Crime Report, Maryland State Police (2004)
 

Network members 

may wish to 

convert UCR drug 

arrests into rates 

per 100,000 

population... 

Network members may wish to convert UCR drug arrests into rates per 

100,000 population for juveniles (persons under age 18) and adults (18 and

older), based on the most recent census data, as has been done by the CESAR 

research team. 

Other Sources of Arrest Data 

TASC. The Treatment Accountability for Safer Communities (formerly called 

Treatment Alternatives to Street Crime) has operated in many States since the 

early 1970s. Currently, the Bureau of Justice Assistance provides grants to the 

National TASC organization, which advocates to improve and expand

services for offenders. There are 203 TASC offices located in 29 States and

Puerto Rico. TASC is heavily represented in States such as Arizona, 

96 Assessing Drug Abuse Within and Across Communities: Second Edition 

There are 203 TASC 

offices in 29 States
 

and Puerto Rico. 
6. Law Enforcement/Criminal Justice System Data 

...inquire as to the 

type of information 

that can be obtained 

on drug use among 

offenders... 

Colorado, Florida, Illinois, North Carolina, New York, Ohio, and 

Pennsylvania. Funding is provided by a variety of sources, including State 

legislatures and State legislative initiatives, local earmarked funds, criminal 

justice system agencies, private organizations, and client fees. A more detailed 

description of this program can be found at <http://www.nationaltasc.org>. 

Network members may find TASC data useful if there is a TASC program in 

their locality. However, programs may be quite complex in a given locality, 

operate under an organizational name other than TASC, and have ties to 

various service organizations. If a TASC-type program cannot be easily 

identified through the telephone directory, members could contact local law 

enforcement personnel or the county superior court to inquire whether a 

program exists in their community. 

TASC staff work with arrestees and other criminal offenders to conduct 

assessments, place the arrestees into treatment, and monitor the progress of 

their clients. Some programs serve juveniles as well as adults. Some conduct 

urine toxicology screens to assess drug use among offenders. TASC also 

reports back to the referring criminal justice agency. TASC programs vary 

widely in terms of the services they provide, the characteristics of their target 

groups, and their niche in the criminal justice system. 

If a TASC program is operating in your community, inquire as to the type of 

information that can be obtained on drug use among offenders and whether 

the information is available for both adults and juveniles. Urinalysis data 

would be especially useful. 

The TASC program in Arizona, called Treatment Assessment Screening 

Center, provides a variety of services to criminal justice agencies and courts in 

Arizona, including intake management, evaluation/diagnosis, psychological 

evaluations, counseling, psychotropic medications, and education. TASC data 

are regularly reported by the Phoenix CEWG representative Ilene Dode, Ph.D. 

(see Dode 2006). TASC toxicology laboratories processed more than 4 

million urinalysis tests of individuals in the criminal justice system in 2005. 

Data from the testing are used to assess the drug abuse patterns and trends of 

the criminal justice populations by geographic area and type of drug. For 

example, of the 34,408 positive drug screens reported for adults (e.g., in 

Deferred Prosecution, pretrial, drug courts, probation and the Department of 

Corrections) in Maricopa County, Arizona, in 2005, 51 percent were for 

methamphetamine/amphetamine. As shown in exhibit 4, the Arizona TASC 

data can be used to make comparisons by area and type of drug (Zugor in 

publication). 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 97 
Part II. Accessing and Analyzing Data from Different Sources 

Exhibit 4. Percentage of Positive Drug Tests for Adults in Criminal Justice Programs in Maricopa County, Pima 

County, and Arizona Rural Areas, by Percent: 2005 

Area Number of 

Positive Tests 

Amphetamines/ 

Methamphetamine 

THC 

(Marijuana) Cocaine Opiates Other1 

Maricopa 34,408 41 33 16 7 3 

Pima 7,672 20 34 36 8 2 

Rural 2,753 51 31 3 10 5 

1

Includes mostly alcohol but also benzodiazepines, barbiturates, lysergic acid diethylamide (LSD), phencyclidine (PCP), and 

methylenedioxymethamphetamine (MDMA). 

SOURCE: Treatment Assessment Screening Center, Arizona 

Most jurisdictions 

have an agency that 

provides pretrial 

services to persons 

charged with
 

crimes. 

Pretrial Services. Most jurisdictions have an agency that provides pretrial 

services to persons charged with crimes. The Washington, DC, Pretrial Services 

Agency (PSA) is a “premiere example of this type of agency” (Artigiani, Hsu, 

and Wish 2006). PSA has conducted drug testing of adult and juvenile arrestees 

in the District of Columbia since 1984, operating as an independent entity 

within the Court Services and Offender Supervision Agency. More than 2,000 

arrestees are tested each month. Network members can check in their area to see 

whether a similar service is provided. Exhibit 5 exemplifies the types of 

information provided by the PSA. As shown, around 45 percent of the adult 

arrestees in 2004 tested positive for a drug. Throughout the 21-year time period, 

cocaine dominated among the three drugs shown. 

Exhibit 5. Percentages of Adult Arrestees in Washington, DC, Testing Positive for Any Drug, Cocaine, 

PCP, and Opiates: 1984–2004 

0 

10 

20 

30 

40 

50 

60 

70 

80 

Percent Any Drug 

Cocaine 

Opiates 

PCP 

198419851986198719881989199019911992199319941995199619971998199920002001200220032004 

SOURCE: Adapted by CESAR from data from the District of Columbia Pretrial Services Agency 

As of April 2006, 

there were 1,557 

drug courts in the 

United States... 

Drug Courts. As of April 2006, there were 1,557 drug courts in the United 

States, and an additional 394 in the planning phases. Fifty States plus the

District of Columbia, North Mariana Islands, Puerto Rico, Guam, and 136 

tribal programs have drug courts in operation or planned. A few are some 

98 Assessing Drug Abuse Within and Across Communities: Second Edition 
 

 

6. Law Enforcement/Criminal Justice System Data 

...data on drugs 

actually involved 

will be more valid 

than arrest data. 

combination of adult/juvenile/family/DUI courts (<http://www.whitehouse 

drugpolicy.gov/enforce/drugcourt.html>). 

Title V of the Violent Crime Control and Law Enforcement Act of 1994 (P.L. 

1-3-322) authorizes the U.S. Attorney General to make grants to States and 

local governments to establish drug courts. Drug courts started out as 

diversionary programs that dealt with less-serious offenders, typically those 

charged with simple drug possession or under the influence charges. As courts 

were proven effective in controlling both drug use and criminality among 

drug-using offenders (see, e.g., Belenko 1998), communities have 

successfully expanded drug courts to probationers, including drug-using 

offenders charged with non-drug offenses. 

Drug courts are given responsibility to handle cases involving substanceabusing offenders through comprehensive supervision, drug testing, treatment 

services, and immediate sanctions and incentives. More information on drug 

courts can be found at the National Association of Drug Court Professionals 

Web site <http://www.nadcp.org/>. 

Given the variation in drug courts, it can only be suggested here that network 

members inquire as to whether a court is operating in their community, and, if 

so, what type of population the court serves. For example, there is a special 

drug court in St. Louis that serves female drug abusers and dually diagnosed 

non-violent arrestees. In an analysis of a random sample of 50 of these 

women, it was possible to obtain information on their sociodemographic 

characteristics and their drug of choice (Sullivan 2004). A majority were 

African-American (64 percent), had less than a high school education (60 

percent), were single (80 percent), and had children (80 percent). Crack 

cocaine was clearly the drug of choice among these women, either singly (24 

percent) or as a first, second, or third drug of choice (70 percent). Network 

members whose community is served by a drug court should request these 

types of data, if they are available. 

Criminal Filings. Data on criminal filings are often available for local 

jurisdictions. These are cases for which there is sufficient evidence to warrant 

the local prosecutor to bring charges against a person. There will be fewer 

cases than arrests; however, the data on the drugs actually involved will be 

more valid than arrest data. Many of the limitations of arrest data also apply 

to criminal filings data. Some States track superior court filings for all 

jurisdictions. Many prosecutors compile annual reports from which data can 

be readily extracted. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 99 
Part II. Accessing and Analyzing Data from Different Sources 

Crime Laboratory Drug Data 

There are 

many forensic 

laboratories... 

making it likely that 

a network will be 

able to identify a 

laboratory in their 

community or State. 

Crime laboratories analyze drug items seized by law enforcement to 

chemically verify which drug or drugs are in the seized evidence. There are 

many forensic laboratories in the Nation, making it likely that a network will 

be able to identify a laboratory in its community or State. As with all law 

enforcement data, forensic laboratory information is subject to law 

enforcement procedures and priorities that may change over time, as well as

available resources. These factors may result in some inconsistencies in the 

laboratory data from different time periods. Also, laboratory procedures may

differ from community to community. Whether an item is analyzed by a lab

may depend on the drug schedule category (e.g., some labs may have the time 

and resources to analyze only the highest schedule drugs). Networks that plan 

to compare their community data to forensic laboratory data from another 

community should first determine whether the data are truly comparable. 

Two crime lab systems are described in this section: the National Forensic 

Laboratory Information System (NFLIS) and the Automation of Reports and 

Consolidated Orders System (ARCOS-2). Both are maintained by the Drug 

Enforcement Administration. 

NFLIS Data 

Network members should determine whether forensic laboratories in their 

area report to the National Forensic Laboratory Information System. The first 

NFLIS annual report was published by DEA in 2000. As of November 2005, 

258 of the Nation’s approximately 300–315 State and local labs participated 

in NFLIS; these represent 41 State systems, 88 local or municipal laboratories, 

and 1 territorial laboratory. Plans are underway to enroll all local, State, and 

Federal labs in the NFLIS. 

...NFLIS 

systematically 

collects results from 

solid dosage drug 

analyses conducted 

by participating 

laboratories. 

The NFLIS systematically collects results from solid dosage drug analyses

conducted by participating laboratories. The NFLIS database consists of caseand item/exhibit-level information. Data are reported by laboratories in a 

convenient format. An Interactive Data Site (IDS), a secure Web site, permits

all NFLIS laboratories to run queries of their own data sets and calculate

regional and national results. NFLIS findings are published in annual, 

semiannual, and special topic reports. 

Within-State comparisons may be possible. For example, in Washington, data 

are available for the entire State, the Seattle-area lab, and for the State 

excluding Seattle (see exhibit 7 below). 

100 Assessing Drug Abuse Within and Across Communities: Second Edition 
6. Law Enforcement/Criminal Justice System Data 

...check with local 

law enforcement 

agencies and 

inquire about 

forensic laboratory 

analyses... 

The limitations of NFLIS are acknowledged. They include differing policies 

and procedures among laboratories, the fact that Federal laboratories are not 

yet in the system, and variations within and across areas that can result in 

differences in drug seizures and analyses (e.g., police priorities, types of 

arrests from which specimens are taken, and other criminal justice 

procedures). Local data are not adjusted for population size, and, thus, are not 

comparable across NFLIS sites. Additional information on NFLIS can be 

accessed at <http://www.deadiversion/usdoj.gov/nflis/index.html>. (See 

Appendix B.) 

Where to Start: Accessing Forensic Laboratory Data 

As noted above, one potential source of forensic laboratory data is the NFLIS. 

Check the DEA Web site or obtain an NFLIS Quarterly Report or Annual 

Report to determine whether such data are available for your community. If 

not, check with local law enforcement agencies and inquire about forensic 

laboratory analyses that may be conducted in the network’s locale. It may be 

necessary to inquire with a State agency; for example, in Texas, it is the 

Department of Public Safety that takes responsibility for forensic laboratory 

analyses in various areas of the State. It is important also to record the type of 

forensic labs that can provide data (e.g., police department, Sheriff’s Office, 

State Police). 

What to Request 

It will be important to access the following for each laboratory included in a 

network’s data collection effort: 

 The total number of items reported to the laboratory 

 The total number analyzed 

 The total number of items by substance (e.g., cocaine, heroin, marijuana) 

 The percentage that each substance represents of the total items analyzed 

If the network is interested in changes in the types of items analyzed over a 

multiyear period, determine whether the data are comparable, and, if so, 

request data for each year of interest. It will be useful also to find out if, and 

why, any particular drug (e.g., marijuana) is not analyzed by the laboratory. 

Uses of Forensic Laboratory Data: Some Examples 

The Drug Enforcement Administration uses NFLIS and similar data to 

monitor and assess drug abuse trafficking across the Nation, including the 

diversion of legally manufactured drugs into illegal markets. For example, in 

Atlanta in 2003 and 2004, major drug abuse indicators, such as treatment 

admissions, toxicology screening of adult male arrestees, and hospital 

emergency department data pointed to cocaine and marijuana (cannabis) as 

the major drugs of abuse in the area, and to the increasing abuse of 

methamphetamine. The Atlanta NFLIS data, as shown in exhibit 6, supported 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 101 
Part II. Accessing and Analyzing Data from Different Sources 

the patterns found in the other drug abuse indicators, e.g., the increase in 

methamphetamine abuse in the city. 

Exhibit 6. Percentages of Drug Items Analyzed by Forensic Laboratory in Atlanta, Georgia: 2003–2004 

Substance 2003 2004 

Cocaine 39.72 44.20 

Methamphetamine 22.97 30.30 

Cannabis 28.03 14.40 

Alprazolam 1.63 2.12 

3,4-Methylenedioxymethamphetamine 1.51 2.00 

Hydrocodone 1.24 1.76 

Heroin 0.99 1.08 

Oxycodone 0.94 0.89 

Methadone 0.31 0.46 

Carisoprodol 0.38 0.37 

Amphetamine 0.37 0.37 

3,4-Methylenedioxyamphetamine 0.16 0.37 

Diazepam 0.43 0.36 

Clonazepam 0.14 0.24 

Psilocin 0.13 0.22 

Codeine 0.11 0.13 

Morphine 0.13 0.11 

Ketamine 0.12 0.09 

Non-controlled Non-narcotic drug 0.11 0.09 

Methylphenidate 0.13 0.06 

Lorazepam 0.06 0.05 

Lysergic Acid Diethylamide 0.04 0.04 

Benzocaine 0.07 0.03 

Meperidine 0.07 0.02 

Other Drugs1

 0.06 1.50 

Total Analyzed 19,632 16,555 

Total Items Reported 19,663 16,583 

1

In 2004, included gamma hydroxybutyrate (GHB), hydromorphone, secobarbital, phentermine, benzphetamine, phencyclidine, and a few 

other drug items; in 2003, included propoxyphene. 

SOURCE: National Forensic Laboratory Information System, Drug Enforcement Administration 

Exhibit 7 illustrates how crime lab data from a major metropolitan area differ 

from that for the State overall (Banta-Green et al. 2005). The data clearly 

indicate the differences in cocaine and methamphetamine analyses, with the 

former being high in Seattle and the latter drug being high in the rest of the 

State (excluding Seattle). 

102 Assessing Drug Abuse Within and Across Communities: Second Edition 
 

6. Law Enforcement/Criminal Justice System Data 

Exhibit 7. Test Results for Law Enforcement Seizures of 4 Drugs1 in Seattle and the Rest of Washington 

State, by Percent: 2004 

Washington State Without Seattle Seattle Area Lab Washington State Without Seattle Seattle Area Lab

Methamphetamine 

Heroin 

Cocaine 

Cannabis 15.3 

40.4 

4.7 

29.4 

15.6 

18.2 

4.8 

51.7 

0 10 20 30 40 50 60

Washington State Without Seattle Seattle Area Lab 

1

N=3,495 items in Seattle and 12,002 for the rest of the State. Another 8 drug items not shown above each accounted for small 

percentages of the reports, with no clear differences between Seattle and the rest of the State. 

SOURCE: National Forensic Laboratory Information System 

ARCOS Data 

ARCOS data are 

reported, by State, 

in PDF format and 

can be accessed at 

<http://www.dea 

diversion.usdoj.gov/ 

arcos/retail_drug_ 

summary>. 

The Automation of Reports and Consolidated Orders System monitors the 

flow of DEA controlled substances from the point of manufacture through 

commercial distribution channels to the point of sale or distribution at the 

dispensing/retail levels. DEA uses the data, together with another DEA 

database, to identify the diversion of controlled substances into illicit channels 

of distribution. ARCOS data are reported, by State, in PDF format and can be

accessed at <http://www.deadiversion.usdoj.gov/arcos/retail_drug_summary>. 

(See also Appendix B.) A Site Map site can be used to access Field Office 

information, including the names of staff and phone numbers (go to

<http://www.deadiversion.usdoj.gov/site.htm> and click on Offices and

Directories, then Field Office Locations). 

Network members may find ARCOS data useful if there is an interest in the 

dispensing of controlled substances to the dispensary/retail level (e.g., 

pharmacies, hospitals, and practitioners) in their area or State. The data are 

available for several reporting periods, beginning with 1997. The controlled 

substances reported in ARCOS include codeine, fentanyl, hydrocodone, 

methadone, morphine, oxycodone, and propoxphene. 

Exhibit 8 shows ARCOS data on selected narcotic analgesics purchased by 

“registrant” pharmacies in Missouri in 2004. The data were accessed through 

the DEA Web site (see above) from “Report 5: Statistical Summary for Retail 

Drug Purchases”––State: Missouri. Data by drug are also available by Zip 

Code for each State, see “Report 1.” 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 103 
Part II. Accessing and Analyzing Data from Different Sources 

Exhibit 8. Retail Distribution of Narcotic Analgesic Drugs to Pharmacies in Missouri, Grams: 2004 

Drug Registrant Pharmacies (Ps) 

Number Ps Sold To Total Grams Sold to Ps1 

Oxycodone 1,147 1,114,260 

Hydrocodone 1,158 432,435 

Morphine 1,110 373,287 

Codeine 1,152 326,392 

Methadone 943 49,990 

Meperidine (Pethidine) 947 45,605 

Hydromorphone 755 7,692 

Fentanyl Base 1,106 7,279 

1

Figures rounded. 

SOURCE: Drug Enforcement Administration, ARCOS-2 

Drug Trafficking and Related Data 

Price and Purity Data—Illicit Drugs 

...can provide 

insights into 

changes in patterns 

of drug abuse and 

consequences... 

Information on the price and purity of different illicit drugs can provide 

insights into changes in patterns of drug abuse and consequences, such as drug 

overdose. As a drug becomes increasingly expensive, users may switch to 

other drugs. Or, conversely, as a drug becomes inexpensive, especially if it is 

popular in the drug scene, use may escalate. Also, when heroin, for example, 

becomes purer and replaces low purity heroin, users may experience an 

overdose, which sometimes proves fatal. In summary, price and purity data 

may help the work group explain a particular drug pattern or trend. 

Network members may find three sources of information on price of illicit 

drugs useful if they cover the network’s community. One is DEA’s Domestic 

Monitor Program (DMP), which provides information on the price and purity 

of different forms of heroin. Another is DEA Reports that may be available 

from local DEA field offices or field divisions; as shown later below, these 

reports may provide price data on several types of illicit drugs. Still another is 

the reports by the National Drug Intelligence Center (NDIC), Department of 

Justice, which covers the wholesale, midlevel, and retail price of major illicit 

drugs. If these systems do not cover your community, ask whether such 

information is available from local law enforcement personnel (e.g., an officer 

in the narcotics unit of the local police department). 

104 Assessing Drug Abuse Within and Across Communities: Second Edition 
 

San Diego

49.7% ($0.20)

6. Law Enforcement/Criminal Justice System Data 

...reports on the 

origin, types, cost, 

and purity of retaillevel heroin 

available in the 

open-air drug 

markets... 

Domestic Monitor Program (DMP) 

The DMP, under the auspices of the Intelligence Division of the Drug 

Enforcement Administration, reports on the origin, types, cost, and purity of 

retail-level heroin available in the open-air drug markets in major 

metropolitan areas of the United States as well as San Juan, Puerto Rico. 

Typically, there is a 1-year lag in reporting, although preliminary data for a 

particular period may be available. In 2005, DMP reported 2004 price and 

purity data for 25 metropolitan areas, including most CEWG metropolitan 

areas (with 4 being in Texas). Network members may wish to contact their 

local DEA field office to determine whether DMP data are available for their 

area, and, if so, how they can be accessed. 

DMP data are based on actual undercover heroin purchases made by the DEA 

on the streets of the metropolitan areas. The heroin buys provide information 

on the type of heroin (Southeast Asian, Southwest Asian, Mexican, South 

American, or underdetermined) and the types of diluents and adulterants 

present in the drug. The reports indicate where the buy was made, the brand 

name (if any), the purity level, and the price per milligram pure. Price and 

purity for particular types of heroin can vary across the years, especially if the 

number of buys made in a particular area was small. 

Exhibit 9 shows price and purity data across CEWG areas, as reported by 

DEA’s DMP in late 2005. 

Exhibit 9. Domestic Monitor Program—Average Heroin Purity and Price Per Milligram Pure in CEWG Areas: 

20041 

South American Heroin

Mexican Heroin

Seattle

10.4%

($1.18)

San Fran.

11.1%

($0.98)

Los Angeles

31.4%

($0.23)

Phoenix

47.7%

($0.49)

Denver

34.4% ($0.46)

El Paso

50.5% ($0.27)

Dallas

16.3%

($0.90)

St. Louis

14.4%

($1.89)

New Orleans

23.6% ($1.69) Miami

15.7%

($1.53)

Atlanta

40.9%

($2.30)

Chicago

13.8%

($0.56)

Detroit

38.9%

($0.86)

Boston 27.8% ($0.87)

New York City 43.3% ($0.62)

Newark 52.7% ($0.50) Philadelphia

51.6% ($0.71)

Baltimore 27.5% ($0.50)

Wash., DC

15.6%

($1.06)

Houston

24.8%

($0.44)

San Antonio

6.4%

($2.24)

South American Heroin

Mexican Heroin

South American Heroin 

Mexican Heroin 

Seattle

10.4%

($1.18)

San Fran.

11.1%

($0.98)

Los Angeles

31.4%

($0.23)

Phoenix

47.7%

($0.49)

Denver

34.4% ($0.46)

El Paso

50.5% ($0.27)

Dallas

16.3%

($0.90)

St. Louis

14.4%

($1.89)

New Orleans

23.6% ($1.69) Miami

15.7%

($1.53)

Atlanta

40.9%

($2.30)

Chicago

13.8%

($0.56)

Detroit

38.9%

($0.86)

Boston 27.8% ($0.87)

New York City 43.3% ($0.62)

Newark 52.7% ($0.50) Philadelphia

51.6% ($0.71)

Baltimore 27.5% ($0.50)

Wash., DC

15.6%

($1.06)

Houston

24.8%

($0.44)

San Antonio

6.4%

($2.24)

Seattle 

10.4% 

($1.18) 

San Fran. 

11.1% 

($0.98) 

Los Angeles 

31.4% 

($0.23) 

San Diego 

49.7% ($0.20) 

Phoenix 

47.7% 

($0.49) 

Denver 

34.4% ($0.46) 

El Paso 

50.5% ($0.27) 

Dallas 

16.3% 

($0.90) 

St. Louis 

14.4% 

($1.89) 

New Orleans 

23.6% ($1.69) Miami 

15.7% 

($1.53) 

Atlanta 

40.9% 

($2.30) 

Chicago 

13.8% 

($0.56) 

Detroit 

38.9% 

($0.86) 

Boston 27.8% ($0.87) 

New York City 43.3% ($0.62) 

Newark 52.7% ($0.50) Philadelphia 

51.6% ($0.71) 

Baltimore 27.5% ($0.50) 

Wash., DC 

15.6% 

($1.06) 

Houston 

24.8% 

($0.44) 

San Antonio 

6.4% 

($2.24) 

1

Not included here are some types, e.g., Southeast and Southwest Asian heroin. 

SOURCE: DMP, DEA 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 105 
Part II. Accessing and Analyzing Data from Different Sources 

Information on heroin purity is of special interest to the researchers in 

Chicago, since heroin abuse indicators continue at high levels in the area 

(Broz et al. 2005). 

DMP annual price and purity data can be compared over time to determine 

whether there are any changes. An example from the most recent Chicago 

CEWG report is depicted below (Broz et al. in publication). As shown, the 

purity of heroin at the retail or street level in Chicago trended down from 

23.80 percent in 2000 to 13.80 percent in 2004. During this time span, the 

price of heroin per milligram pure fluctuated. It is likely that the reduction in 

purity has had an impact on drug abuse patterns in Chicago among heroin 

addicts. 

Exhibit 10. Trends in South American Heroin Purity and Price Per Milligram Pure in Chicago: 2000–2004 

Percent Purity	 Price 

0% 

5% 

10% 

15% 

20% 

25% 

$0.00 

$0.10 

$0.20 

$0.30 

$0.40 

$0.50 

$0.60 

$0.70 

$0.80 

Purity 23.80% 19.50% 20.40% 16.60% 13.80% 

Price $0.48 $0.71 $0.43 $0.45 $0.56 

2000 2001 2002 2003 2004 

SOURCE: Domestic Monitor Program, Drug Enforcement Administration 

DEA Reports 

Intelligence reports published by the Drug Enforcement Administration are 

another useful source of drug price data. For example, the DEA field office in 

New Mexico provided drug price and purity data for several illicit drugs at the 

New Mexico State Epidemiology Work Group (SEWG) meeting held in 

September 2004 (Selander and Monnette 2004). It was reported that... 

 The price for an ounce of methamphetamine in New Mexico in 2004 

ranged from around $500 to $800, while an “8 Ball” (1/8 of an ounce) cost 

$100. The purity of the drug from local manufacturers was 70 to 91 

percent pure. 

 Cocaine sold for approximately $800 to $1,400 per ounce, $100 per gram, 

and $150 for an “8 Ball.” Crack sold for $500 to $1,000 an ounce. 

106 Assessing Drug Abuse Within and Across Communities: Second Edition 
6. Law Enforcement/Criminal Justice System Data 

...National Illicit 

Drug Prices— 

December 2005 

compiles prices for 

the 6 most 

commonly available 

and abused illicit 

drugs in 126 cities 

and Puerto Rico. 

 Black tar heroin cost about $1,200 to $2,900 an ounce and $120 to $180 

per gram. Most of the heroin on the streets was 50 to 70 percent pure. 

Network members may find it useful to contact their local DEA office or field 

division. Local DEA personnel are often a valuable resource for CEWG 

representatives. 

NDIC Data on Drug Prices 

The NDIC Intelligence Bulletin National Illicit Drug Prices––December 2005 

compiles prices for the 6 most commonly available and abused illicit drugs in 

126 cities and Puerto Rico. The cities, listed by State, constitute major drug 

markets that are situated along major transportation corridors, serve as 

regional economic centers, or have high population levels relative to their 

surrounding geographic areas. The cities were not selected randomly, nor can 

statistical comparisons be made between cities or to previously reported drug 

prices for a given city. The drug price data have other limitations. For 

example, while NDIC derives drug prices from undercover purchases, some 

reported prices are derived from informants who may have criminal histories 

and may not provide totally accurate information; the units of weights 

reported may not be exact; and the undercover purchases probably constitute 

only a small percentage of drug transactions within a city. An example of the 

information available in the bulletin referenced above is shown in exhibit 11 

for one city, Detroit. 

Exhibit 11. Prices for 6 Illicit Drugs in Detroit: 2005 

Drug Price in Dollars 

Wholesale Midlevel Retail 

Powder Cocaine $18,500–$24,000/kg1

 $700–$1,500/oz1 $50–$100/g1 

Crack Cocaine – $750–$1,300/oz $10–$20/rock 

Heroin2 $45,000/kg MBT 

$55,000–$80,000/kg SA, SWA 

$2,500/oz MBT 

$5,000/oz SA, SWA 

$150/oz CG 

$10/bag MBT 

$15/bag SA, SWA 

$20/g CG 

Marijuana 

$1,600–$5,000/lb1

 BC 

$1,100–$3,000/lb SN 

$900$1,300/lb CG 

– – 

Methamphetamine4

 $16,000/lb PM $1,200/oz $125/g 

MDMA $3–$15/du1

 – $15$28/du 

1

du=dosage unit; kg=kilogram; oz=ounce; g=gram; lb=pound.

2

MBT=Mexican Black Tar; SA=South American; SWA=Southwest Asian.

3

BC=BC Bud (Canada); SN=sinsemilla; CG=commercial grade.

4

PM=Powder methamphetamine. 

SOURCE: National Drug Intelligence Center, NDIC Intelligence Bulletin National Illicit Drug Prices—December 2005, 

U.S. Department of Justice 

NDIC publications are available on the Web at <http://www.usdoj.gov/ndic>. 

NDIC’s Field Program Specialists (FPSs) regularly conduct interviews with 

Federal, State, and local law enforcement officials and summarize anecdotal 

reporting in Intelligence Information Reports (IIRs); these reports often detail 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 107 
 

Part II. Accessing and Analyzing Data from Different Sources 

trends related to the availability and short-term disruptions in drug prices for a 

region. These reports are available at the following Web sites: <ADNET: 

https://ndicosa/index.htm> and <http://www.iir.com/riss/default.htm>. 

Drug Seizure Data 

...a single source of 

information related 

to drug trafficking 

and abuse trends. 

Twenty-eight 

HIDTAs have been 

established across 

the Nation. 

High Intensity Drug Trafficking Area (HIDTA) Data 

Information on drug seizures at the local level may be available from law 

enforcement agencies. Network members may also extract useful information 

from the HIDTA data briefly described below. 

The National Drug Intelligence Center synthesizes Federal, State, and local 

counterdrug reporting into a single source of information related to drug 

trafficking and abuse trends. NDIC publishes, for example, a State Drug

Threat Assessment Report that provides detailed assessments of drug trends in

a particular State and areas within a State or region. 

The Threat Assessment is an annual compilation of drug-related threats in a 

High Intensity Drug Trafficking Area. The purpose of the HIDTA is to 

disrupt the illegal drug market in the Nation by assisting Federal, State, and 

local law enforcement entities participating in the program to dismantle and 

disrupt drug trafficking organizations. Twenty-eight HIDTAs have been 

established across the Nation. A map and contact information for each is

available through the Office of the National Drug Control Policy at 

<http://www.whitehousedrugpolicy.gov/hidta/index.html>. (See Appendix B.) 

Network members can also access National Threat Assessment reports and 

strategic (Drug Threat) assessments through the NDIC Web site <http://www. 

usdoj.gov/ndic/topics/ndtas.htm>. 

The HIDTA information that follows was provided by Erin Artigiani and Eric 

Wish, Ph.D., CESAR, for this guide, and represents 2003 data from the 2004 

Threat Assessment for the Washington/Baltimore area. 

The Washington/Baltimore HIDTA region covers two distinct population 

centers, Washington, DC, and Baltimore City, and includes 13 separate city 

and county jurisdictions in Maryland and Virginia. HIDTA data show that the 

three jurisdictions plagued with the most serious drug abuse, drug trafficking, 

and drug-related crime problems in the region are Baltimore City and Prince 

George’s County, both in Maryland, and the District of Columbia. The 2004 

Threat Assessment identified marijuana, heroin, powder cocaine, crack 

cocaine, and ecstasy as major threats. Low cost heroin was reportedly 

available primarily in Baltimore City. Methamphetamine was beginning to be 

encountered in the region. 

108 Assessing Drug Abuse Within and Across Communities: Second Edition 
 

6. Law Enforcement/Criminal Justice System Data 

The report also indicated that more than 150 drug trafficking organizations 

(DTOs) were active in the region in 2003. A majority were in Baltimore City 

(60) and Southern Maryland (47), with 26 being in Washington, DC, and 20 

being in Northern Virginia. 

The data also show that marijuana accounted for nearly two-thirds of the 

seizures in 2003 (exhibit 12). 

Exhibit 12. Seizures of Drugs in the Washington/Baltimore Region, by Drug and Percent: 2003 

Crack 

1% 

Marijuana 

64% 

Cocaine 

27% 

Other 

5% 

Heroin 

3% 

SOURCE: Artigiani and Wish, CESAR (based on NDIC’s 2004 Threat Assessment for Washington/Baltimore) 

National Clandestine Laboratory Seizure Database (NCLSD) 

NCLSD was developed by the El Paso Intelligence Center (EPIC), 

Department of Justice, in an effort to stay abreast of changing drug trends. 

The EPIC database 

serves as a 

clearinghouse for 

HIDTA Intelligence 

Centers... 

The EPIC database serves as a clearinghouse for HIDTA Intelligence Centers 

by gathering State and local law enforcement drug information and providing

drug intelligence back to the HIDTA Intelligence Centers. The database is 

often used by the HIDTAs to track the number of clandestine laboratories in 

their region. EPIC data are often cited in the HIDTA reports. The data are 

also available through DEA reports and State factsheets. Additional 

information on drug seizures is available online at <http://www.dea.gov/ 

concern/map_lab_seizures.html>. 

Exhibit 13 depicts the number of methamphetamine laboratory, equipment, 

and dumpsite seizures in 47 reporting States, Guam, and the District of 

Columbia in 2004. As shown, the largest numbers of methamphetamine 

seizures were in Missouri (2,788) and Iowa (1,335). 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 109 
Exhibit 13. Number1

 of Seizures of Methamphetamine Laboratories, Equipment, and Dumpsites2 in 47 

States, Guam, and the District of Columbia: 2004 

 

Part II. Accessing and Analyzing Data from Different Sources 

 

947

42

65 234

168

78

295

286

106

48

3

1

2

165

75

318

170

261

DE

MA

MD

DC

276

267 385

123 452

120

122

764

472

79

72

21

228

584

659 800

1,327

571

1,058 1,074

2,788

1,335

205

31

Guam 1

HI 20

AK 66

947 

42 

65 234 

168 

78 

295 

286 

106 

48 

3 

1 

2 

165 

75 

318 

170 

261 

DE 

MA 

MD 

DC 

276 

267 385

123 452 

120

122 

764 

472 

79 

72 

21 

228 

584 

659 800 

1,327 

571 

1,058 1,074

2,788 

1,335 

205 

31 

Guam 1 

HI 20 

AK 66 

3 

1 

1 

1 

1

N=17,170. Data are for 2004, as reported by DEA; updated August 18, 2005. 2

The States with the 10 highest numbers of statewide seizures are shown in dark gray. 

SOURCE: DEA <http://www.dea.gov/concern/map_lab_seizures.html> 

Customs & Border Protection, U.S. Department of Homeland 

Security 

Customs & Border Protection, U.S. Department of Homeland Security, has 

the responsibility of preventing the entry of terrorists and terrorist weapons 

into the Nation, apprehending contraband smugglers, and protecting the 

Nation from disease and disease carrying creatures. The agency's Web site is 

<http://www.cbp.gov >. The Press Release button on the left hand side of the 

homepage provides information of drug seizures in different areas on specific 

dates. 

110 Assessing Drug Abuse Within and Across Communities: Second Edition 
7. Qualitative Research 

7. QUALITATIVE RESEARCH STUDIES 

...networks may 

want to incorporate 

qualitative data... 

Networks may find qualitative research a valuable supplement to indicator and 

other quantitative data sources described in earlier chapters. For example, indicator data sources may not address an emerging problem of seemingly critical concern in the community, either because the problem was not covered by 

the data source(s) or because the data are not current (e.g., data from largescale surveys and databases such as TEDS may not be available for 1 to 2 

years after the time the data are collected). Conversely, there may be one or 

more findings in the indicator data that pique the interest of network members 

because the findings seem particularly pertinent to the locale and suggest a 

need for more indepth information. In summary, there may be many reasons 

why networks may want to incorporate qualitative data into their surveillance

efforts to provide more current assessments of drug abuse patterns and trends

in their areas. Periodic contact with key informants, identification and use of 

existing local ethnographic studies, or the planning and implementation of 

small-scale focused qualitative studies can be used by networks to add an indepth understanding to indicator data or to examine specific drug trends in 

greater detail. 

Key Informants 

Key informants are individuals who frequent, work, or live in network areas 

and who are knowledgeable about... 

 The community, or specific neighborhoods in the area 

 Drugs of abuse and drug abusers 

 Different populations and their cultures 

Key informants 

can be valuable 

sources... 

Key informants can be valuable sources for helping to understand and interpret indicator data and may offer important observations on drug use patterns

or consequences in local communities. The following section discusses some 

of the challenges in interpreting indicator data and provides some examples of 

how key informants can contribute significantly to epidemiology networks. 

Key Informants: Interpreting Indicator Data 

In assessing drug abuse information from different sources, it is important to 

know what the different indicators represent. Why do the numbers change 

from one period to another? Which factors influence the numbers and types of 

people who are identified through these sources? 

The following examples demonstrate how interpretations are influenced by 

qualitative understanding of indicators. Consider, for example, that... 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 111 
Part II. Accessing and Analyzing Data from Different Sources 

 Police departments change their tactics from time to time in the types of 

drugs, drug problems, and geographic areas they target. 

 Lower income people are more likely than other populations to use emergency rooms for general medical care, while higher income people tend to 

use private health care facilities. 

 The types of clients treated by drug abuse treatment programs vary by type 

of facility, and these patterns may change because of changes in health insurance regulations and government funding policies. 

...why indicator 

data change over 

time may be partially answered... 

It is therefore important to obtain background information on each of the 

sources of indicator data to understand the limitations of the data and gain a 

better understanding of the results. The first step is to ask those who represent 

the sources from which the indicator data are produced to explain how the indicators reflect certain policies and populations. Ideally, a member of the network will be in a position to explain what the numbers mean or who can provide an explanation. 

If members can not explain substantial changes in the data from one period to 

another, some members may be in a position to access information from key 

informants. For example, if the treatment data show that there was a significant increase in primary marijuana users admitted into drug abuse treatment 

programs during the prior 6 months, it might be useful to contact treatment 

providers to get their views. If one or more network members volunteered to 

get this information, they could prepare a brief supplementary report and 

communicate the information to the other members. 

The question of why indicator data change over time may be partially answered when additional information about the data sources is obtained. For 

example, an increase in heroin arrests may reflect special efforts made by the 

police department to “crack down” on heroin dealers during a particular time 

period. Future research is needed to explain the extent to which increased focus by the police or an increase in heroin use has resulted in more arrests. 

Surveillance networks generally do not have the time or resources to conduct 

studies to determine how and why patterns of drug use are changing. That 

does not mean that insights into plausible explanations cannot be obtained. 

Network members may already know or suspect some of the reasons for the 

changes, especially members who come into direct contact with drug abuse 

clients. Anecdotal information can be valuable in helping to guide interpretations and future research. 

Another method is to investigate the reason for changes by exploring the who, 

what, when, where, why, and how. One or more network members might assume a lead role. If time and resources permit, members could go into the 

community and talk to people close to or directly involved with the drug 

scene. In gathering this type of information, it might be possible to identify 

some of the possible causes for the changes. 

112 Assessing Drug Abuse Within and Across Communities: Second Edition 
7. Qualitative Research 

...establish a list of 

such people... 

Key Informants: Monitoring Local Drug Trends 

Another reason for using key informants is to address the question: How can 

network members broaden their perspective and identify new drug abuse patterns and trends before they emerge through indicator data? 

Network members can never be sure (especially when beginning a local 

group) who might be in a position to contribute new information. Therefore, it 

is useful for a network to establish a list of such people over time. The people 

on this list may be able to serve as key informants. 

To be helpful to a network, key informants should be... 

 Interested in assisting the network in assessing drug abuse problems 

 Invested in their community or neighborhood 

 Reliable (i.e., proven credible over time) 

 Reachable 

 Capable 

The following types of individuals may prove to be valuable key informants: 

 Current or ex-drug abusers 

 Non-drug-using peers or associates of drug abusers 

 School counselors 

 Representatives of different racial/ethnic populations 

 Community leaders 

 Outreach workers 

 Treatment personnel (e.g., program directors, clinicians) 

 Local police “on the beat” in selected neighborhoods 

 Police narcotics unit staff 

 Recreational workers (e.g., coaches) 

 Other community services workers (e.g., bartenders, beauticians) 

There can be several types of key informants who can be contacted in person, 

by telephone, by e-mail, or by other means... 

 Those contacted by one or more network members on a regular basis 

 Specific types of informants who have unique knowledge of or experience 

with a drug-abusing population 

 Informants selected only for a specific purpose at a specific time 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 113 
Part II. Accessing and Analyzing Data from Different Sources 

...alert the network 

directly... 

...seek confirmation 

of the information... 

Key informants who prove credible and knowledgeable over time can be requested and should feel free to alert the network directly at any time when 

something new or unique appears to be happening in the community or a particular neighborhood. Different network members may elect to have working 

ties with specific types of key informants. What is most important is to constantly tap the “pulse” of the community so the network can be alerted to new 

or escalating drug abuse problems in their area. 

Key informants may have biases and may not always be objective. When what 

appears to be important information is provided by one or more key informants, the network needs to seek confirmation of the information, e.g., by expanding the informant sample to gather additional information or by seeking 

confirmation through existing record data or more indepth qualitative research. Ethnographic research provides one option for gathering more indepth 

qualitative data on a specific population or issue. 

Ethnographic Research 

Ethnographic methods can be used... 

At some point, a network might decide that more detailed information is 

needed about some pattern of drug use or what seems to be an emerging trend, 

something more systematic than current knowledge, telephone calls, or conversations with knowledgeable people can provide. 

Ethnographic methods can be used to learn more about particular drugs of 

abuse and the people who use these drugs. These methods can be used to... 

 Learn more about an emerging drug abuse problem when little is known 

about the use of a drug 

 Gain insight about user groups and populations 

 Answer questions that emerge from quantitative research studies 

 Help researchers plan quantitative studies 

Questions may focus on... 

 Why are particular drugs being used? 

 How are they being used? 

 What are the consequences of using the drug(s)? 

...talking with drug 

abusers in their 

natural settings... 

Ethnography goes beyond objective analytic description to include analysis of 

the knowledge and beliefs that underlie behavior. Ethnographic methods include observation and formal and informal interviews. Information is often 

gathered by talking with drug abusers in their natural settings, getting to know 

them and their language and culture, gaining their trust, and engaging them in 

114 Assessing Drug Abuse Within and Across Communities: Second Edition 
7. Qualitative Research 

conversation. Interviews are often taped with the prior consent of the interviewees, so the researchers have a good record of the interview and can conduct content analysis of the transcripts. 

Ethnographers in their studies of drug abusers generally collect the following 

routine information: 

 Demographic information 

 Drugs used 

 Combinations of substances used 

 Frequency of use 

 Modes of administration 

 Social setting in which drugs are used 

 Ages and circumstances for initiation to drugs 

 Reasons for using drugs 

 Drug effects 

 Adverse reactions to drugs 

 Consequences of drug use over time 

...assess the constant and variable 

patterns... 

...guide members 

in interpreting 

findings... 

Ethnographers can obtain data from a variety of sources and systematically 

assess the constant and variable patterns that range across the data collected. 

In addition to observation and interviews, archives, memoranda, newsletters, 

and other documents can be used for analysis. 

Network members should optimize existing data where possible, including 

findings from local ethnographic studies. Ethnographic research can provide 

contextual and behavioral data/information to guide members in interpreting 

findings from quantitative data and drug abuse indicators. Network members 

should check with local colleges, universities, and other agencies and organizations to determine whether ethnographic studies involving drugs or drugabusing populations have been or are being conducted, including quantitative 

studies that may have qualitative components. Network members might also 

check studies funded through grants by NIH to determine whether any studies 

are underway or have been recently completed in their area(s) (see the CRISP 

link <http://crisp.cit.nih.gov/> on the NIDA Web site). 

Network members may also find it beneficial to collaborate with local ethnographers in planning local studies. In selecting an ethnographer, it is important 

to review the person's training, type of degree, publications, professional organization, and affiliation. Also, obtain and review the individual's recently 

published ethnographic research, especially if it involves drug abuse. Ethnographers often work as faculty in university anthropology or sociology departments, two disciplines with strong traditions in cultural and behavioral patterns in different populations and in qualitative research. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 115 
Part II. Accessing and Analyzing Data from Different Sources 

Examples of how qualitative research methods can be used to monitor drug 

abuse trends and explore emerging problems are briefly described below. 

Los Angeles 

CEWG representative Beth Finnerty (2005b), together with colleagues, used 

key informants to verify and supplement information obtained from focus 

groups on the use and abuse of phencyclidine in the Los Angeles area. This 

effort was initiated in 2003 in response to concern that indicator data pointed 

to a rise in PCP arrests and treatment admissions, suggesting an increasing 

problem of PCP abuse in the population. In this small study, treatment data 

were used to identify geographic areas in Los Angeles where the majority of 

PCP treatment admissions were concentrated. Key informants were drawn 

from a pool of existing professional colleagues and referrals and were selected 

to represent a range of perspectives, including law enforcement and treatment 

counselors. Study findings helped to clarify patterns of use and effects of PCP 

and factors influencing manufacture and distribution. 

Colorado 

In an exploratory study of clonazepam abuse among treatment admissions in 

Colorado, Bruce Mendelson used treatment data to identify the geographic areas in the State where clonazepam clients were admitted to treatment. Thirteen 

clinicians served as key informants and provided information on the primary 

reasons clients were using clonazepam; the desired effects of the drug; how 

the drug is obtained; and the street cost of the drug (Mendelson 2005). 

New York City 

The Street Studies Unit (SSU), Division of the Ethnography and Trends 

Analysis Section of the Treatment Services Bureau, New York State Office of 

Alcoholism and Substance Abuse Services, has been using ethnographic 

methods for more than 20 years. 

The Field Researchers in the SSU are former substance abusers who have 

been trained in ethnographic techniques to observe and record information 

about drug dealing and abuse on the streets of New York City. Information 

from the SSU studies is regularly reported to the CEWG by Rozeanne Marel, 

Ph.D., and appears in CEWG reports (see, e.g., Marel et al. 2005). 

Ohio 

Ohio’s Substance Abuse Monitoring System (OSAM) Network uses archival 

data, ethnographic methods, and other qualitative methods (e.g., focus groups) 

to monitor drug abuse patterns and trends. Informants are located throughout 

the State and provide information for the semiannual monitoring of substance 

abuse trends. Findings are disseminated through reports and through the 1-

page OSAM-O-GRAM (see Addendum A for an example). 

116 Assessing Drug Abuse Within and Across Communities: Second Edition 
7. Qualitative Research 

Maryland 

Researchers at CESAR, University of Maryland, used ethnographic and other 

qualitative methods to obtain up-to-data information on how and why PCP 

was being used in Prince George’s County, Maryland, where PCP indicators 

had shown increases in abuse of the drug (see Addendum B). 

Connecticut 

Researchers at the Institute for Community Research (ICR), in partnership 

with the Hispanic Health Council, conducted a study of drug use among youth 

and young adults in 1999–2002 through a NIDA grant (RO1DA11421). In a 

second NIDA-funded grant (R01DA4863), ICR is focusing on use of club 

drugs. In both studies, the researchers have used a combination of ethnographic field observations, key informant interviews, semistructured interviews, and survey methods. Data from the first study were presented at the 

CEWG PCP Panel in December 2003, providing insights into why and how 

PCP was being used and the consequences of its use (Schensul 2004). 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 117
Part II. Accessing and Analyzing Data from Different Sources 

Addendum A. Ohio Substance Abuse Monitoring (OSAM) 

Network 

118 Assessing Drug Abuse Within and Across Communities: Second Edition 
7. Qualitative Research 

Addendum B. The Center For Substance Abuse Research 

(CESAR) 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 119 
 

 

 

Part II. Accessing and Analyzing Data from Different Sources 

8. OTHER USEFUL DATA SOURCES 

Several other data sources can provide useful information for epidemiologic 

networks: the U.S. Census Bureau, university researchers, and communitylevel sources. These are briefly covered in this chapter. 

Census Data 

Census data can 

be useful to 

networks in a 

number of ways... 

Census data are collected and reported by the U.S. Census Bureau every 10 

years, and estimated changes in populations are projected between each 

decennial census. Census data can be useful to networks in a number of ways, 

including the following: 

 To describe the population living in the network’s geographic area, 

including the population’s... 

3⁄4 Demographic characteristics (e.g., gender, age, race/ethnicity) 

3⁄4 Socioeconomic status (e.g., median family income, percentage of 

families living below the poverty level) 

3⁄4 Marital status 

3⁄4 School enrollment and educational attainment 

3⁄4 Housing (e.g., value of home or monthly rent paid, number of rooms 

and bedrooms, plumbing and kitchen facilities) 

 To learn more about populations in areas where particular types of drug 

use are prevalent or drug use and trafficking are high 

 To determine whether a particular population group is underrepresented or 

overrepresented in a specific drug-abuser group documented in indicator 

data1 

 As the basis for determining rates, e.g., per 100,000 population of a 

specific subpopulation (e.g., among female methamphetamine abusers in 

treatment) 

The Census Bureau 

data are available 

for many types of 

geographic areas. 

The Census Bureau data are available for many types of geographic areas.

Detailed results of the Census 2000 are contained in a series of five files that 

can be accessed through the Internet and on CD-ROM or DVD. Profiles are 

1

For example, treatment indicator data may show that White primary methamphetamine abusers represent 55 percent of 

the total treatment admissions in a given year, but that Whites represent 73 percent of the area population. Conversely, 

African-American primary heroin admissions may represent 25 percent of all treatment admissions, but only 16 percent 

of the area population. In the former case, the White admissions group would be underrepresented in treatment, while in 

the latter case, the African-American admissions group would be overrepresented. 

120 Assessing Drug Abuse Within and Across Communities: Second Edition 
8. Other Useful Data Sources 

The Census Bureau 

has established 

“census tracts” as 

units for the study 

of small statistical 

subdivisions... 

provided for most geographic areas; Quick Tables allow users to choose from 

approximately 50 table shells and then specify the geographic area and the 

universe or population subgroup (e.g., the African-American population). 

There are also approximately 30 Geographic Comparison Tables that allow 

users to compare key data items across geographic areas. A series of three 

reports are available in Portable Document Format (PDF) on the Internet. For 

easy access to all Census 2000 information, click on American FactFinderTM 

on the Census Bureau’s Home Page <www.census.gov>. 

The Census Bureau has established “census tracts” as units for the study of 

small statistical subdivisions (averaging about 4,000 people) of counties, as 

well as “counties and equivalent areas” (the primary divisions of most States). 

These two types of census areas may be of most interest to networks that are 

not focused on “metropolitan areas” with large populations. 

In intervening years between the censuses, your State Census Data Center can 

provide information on updated census estimates by county. In some 

instances, the State center makes the estimate, while in other instances, 

another State agency makes the official State and county population estimates 

for these years. 

University Researchers 

...faculty members... 

may be conducting 

very relevant 

research...[and] 

often have students 

who want to 

become engaged in 

projects. 

Often there are local university or college faculty, especially in health, social 

science, and science departments, who are interested in alcohol and drug 

abuse issues or have expertise in research methods that can be used by 

epidemiologic networks. The network and these faculty members, who may 

be conducting very relevant research, may be unaware of each other’s efforts. 

In addition to their research interests, faculty often have students who want to 

become engaged in projects. These students can be useful in collecting 

information and analyzing data, especially since they have access to 

computers and statistical software programs that can be used in data searches 

and data analysis. 

To find interested faculty, contact academic departments in public health, 

pharmacy, sociology, anthropology, social work, psychology, criminal justice, 

nursing, health sciences, and education. Research centers for special ethnic 

studies also may house researchers who are interested in substance abuse 

issues. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 121 
Part II. Accessing and Analyzing Data from Different Sources 

Community-Level Sources 

...there are two 

ways to start the 

process of identifying sources... 

122 Assessing Drug Abuse Within and Across Communities: Second Edition 

It is sometimes difficult to identify sources of information at the community 

level. Find out what types of information are available from these sources, and 

establish procedures to obtain relevant information initially, and perhaps on a 

regularly scheduled basis. It must be kept in mind that information about drug 

abuse is likely to be confidential. The people responsible for collecting and 

reporting information about drugs are usually very busy and are likely to have 

reservations about sharing information. 

If a network does not already have connections with community data sources 

through its members, there are two ways to start the process of identifying

sources that can be done concurrently. The first way is to get local telephone

numbers of criminal justice, health, and treatment agencies so that calls can be 

made to identify potential data sources. The mayor’s office, chamber of 

commerce, or a similar source may have a directory of human resource 

organizations. Community or local telephone books generally specify in the 

front pages telephone numbers of local police and sheriff departments. The 

regular telephone directories may list police and sheriff departments under 

Government Listings and hospital and treatment programs in yellow pages or 

the business section (by name). Support staff at network-backed agencies may 

be helpful in this task. In many towns and cities, such information is likely to 

be found on the Internet. 

The second way to start to identify potential information sources at the 

community level is to start at the top and work down. In attempting to identify 

sources of treatment data, begin by calling individuals at your State Substance 

Abuse Agency who can identify and provide a list of the substance abuse 

treatment programs that are located within or serve particular communities. 

For arrest data, call the State Police Department and the UCR office to find 

out who their contacts are at the local level. In trying to identify individuals 

and departments within hospitals, contact representatives of the State health 

department to find out what and whom they know. 
9. Establishing and Developing Relationships with Information Sources 

PART III. NETWORKING AND REPORTING 

9. ESTABLISHING AND DEVELOPING 

RELATIONSHIPS WITH INFORMATION 

SOURCES 

Public Versus Private Information Sources 

...data may not be 

readily available, 

and potential data 

providers will be 

most responsive 

to polite inquiries 

rather than 

demands. 

In establishing a network and in accessing data, it should be kept in mind that 

most public organizations are obligated to release data/information. For 

example, arrest data collected by police departments fall under the category of 

public information as long as individuals cannot be identified. These data are 

generally reported to another level of authority, e.g., the city and county police 

departments report to regional Drug Enforcement Administration offices, the 

Federal Bureau of Investigation (Uniform Crime Report), and to their State 

Police Department. On the other hand, private hospitals are not obligated to 

give information to outside sources other than those to which they are 

accountable for documenting services provided and costs associated with 

providing services. That said, data may not be readily available, and potential 

data providers will be most responsive to polite inquiries rather than demands.

They may give you the minimum dataset they have, which may be of no 

value, while a more politic approach may yield much richer data and vital

context.

Private facilities, while not obligated to provide data, may still be willing to 

share information. Given that there are often numerous private agencies, it is 

important to prioritize those that serve populations of particular interest. It 

may also prove useful to select those large agencies or those that are part of a 

multisite agency that maintains data from all affiliated sites. 

Preparation/Making Contact 

Prior to contacting..., be well 

prepared... 

Prior to contacting representatives of agencies and departments about the

availability of data/information, it is important to be well prepared by...

 Specifying whom you represent, the reason for pursing the information, 

and how the information will be used and reported 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 123 
Part III. Networking and Reporting 

 Specifying clearly that the network is involved in a public health project 

and that you do not want the names and identities of individuals who used 

drugs, but only data that have been aggregated and do not contain such 

personal identifiers 

 Inviting individuals who have access to data/information to attend or 

participate in a network meeting 

 Following up a telephone contact with a letter or e-mail reiterating whom 

you represent, confirming your understanding about the availability of 

data and how it might be obtained, and perhaps formally inviting the 

individual to the next network meeting 

 Sending each individual information about the network, and, if available, a 

copy of a network meeting report or summary, or an outline of a project 

being planned 

Developing Relationships 

...continued twoway information 

sharing can lead to 

long-term data 

access. 

It is important to maintain good relationships with representatives of 

community agencies, schools, and organizations that have access to current 

and potential data sources. As indicated earlier, it is difficult to identify 

sources of information at the community level; however, once relationships 

are established, continued two-way information sharing can lead to long-term

data access.

Several steps can be taken to develop working relationships with data sources, 

including the following: 

 Inviting representatives to network meetings 

 Meeting with representatives so they get to know you personally (e.g., 

invite them to your office or visit them) 

 Visiting a contact; this can provide unanticipated benefits by allowing 

network members to see the facility and the computer applications with 

which staff work, as well as meet other people at the agency who may be 

interested in the network 

 Sending them information, including any documents developed by the 

network. If they are willing to review reports prior to dissemination and 

make any corrections or provide important context, this will be of great 

benefit to the network. 

124 Assessing Drug Abuse Within and Across Communities: Second Edition 
10. Reporting 

10. REPORTING 

...a standardized 

format will make it 

easier to review 

data... 

Networks will find it useful to have a standardized format for reporting 

findings. This can be useful, as in the following ways: 

 As the network evolves over time and produces several reports, a 

standardized format will make it easier to review data from different 

reporting periods to develop and access trends across different time 

periods. 

 For networks that cover more than one geographic area, a standardized 

format will make it easier to summarize data across different areas, and 

also make it easier for readers to make their own comparisons across 

reporting areas. 

 For networks that plan to distribute reports to policymakers, practitioners, 

and other interested parties, it is advisable to have a standard format with a 

concise table of contents to guide readers and facilitate their review of the 

report; over time, readers will become accustomed to the format and find 

the reports easier to review. 

It is important to recognize that your network is not likely to have all the 

sources of data described in earlier chapters of this guide as it begins its 

surveillance work. Yet, much can be learned in initial efforts. For example, 

when the Louisiana State Epidemiology Work Group (SEWG) began in 

September 1997, only seven parishes reported indicator data from their 

jurisdictions. A year later, 11 parishes reported the type of indicator data. By 

2002, this work group was reporting data by administrative region, with data 

on some or all of the parishes included in the 10 regions. These SEWG 

reports have been prepared in a standard format, with each regional or parish 

paper containing an Abstract of key findings and section on Drug Abuse 

Patterns and Trends by drug or data source. Tabular and graphic data appear 

at the conclusion of each paper. 

The Community Epidemiology Work Group has used a similar format over 

the years, always reporting patterns and trends by drug of abuse. The CEWG 

area reports are published semiannually in a series entitled Epidemiologic 

Trends in Drug Abuse, Volume II, and can be viewed on the NIDA Web site 

<http://www.nida.nih.gov> (see Appendix B). 

Once a network has become established, members may opt to disseminate 

findings in a brief one-page fax or e-mail, such as the examples provided in 

the addenda to Chapter 7. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 125 
Part III. Networking and Reporting 

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(SMA) 04-3964, NSDUH Series H-25. Rockville, MD: SAMHSA, OAS 2004a. 

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. DAWN, 

2003: Interim National Estimates of Drug-Related Emergency Department Visits. DAWN Series 

D-26, DHHS Publication No. (SMA) 04-3927. Rockville, MD: SAMHSA, OAS, 2004b. 

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Drug 

Abuse Warning Network: Development of a New Design (Methodology Report). DAWN Series 

M-4, DHHS Publication No. (SMA) 02-3754. Rockville, MD: SAMHSA, OAS, 2002. 

Sullivan, J. Special drug courts: Female drug abusers and dually diagnosed mental health arrestees 

in St. Louis. In Epidemiologic Trends in Drug Abuse: Volume II. Proceedings of the 

Community Epidemiology Work Group, June 2003. NIH Publication No.04-5365A Rockville, 

MD: National Institute on Drug Abuse, 2004, pp. 331–333. 

Thorton-Collins, G. Drug abuse indicators in New Orleans. In Epidemiologic Trends in Drug 

Abuse: Volume II. Proceedings of the Community Epidemiology Work Group, June 2005. 

Rockville, MD: National Institute on Drug Abuse, 2006, pp. 171–179. 

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 References 

Vermeer, B., Lt. Drug abuse patterns and trends in Phoenix: A law enforcement perspective. In 

Epidemiologic Trends in Drug Abuse: Volume II. Proceedings of the Community Epidemiology 

Work Group, January 2006. Rockville, MD: National Institute on Drug Abuse (in publication). 

Wright State University, Substance Abuse Treatment Admissions and Methamphetamine Abuse, 

OSAM-O-Gram: January 2005. Dayton, Ohio: Wright State University, 2005. 

Zugor, B.A. Panel on criminal justice indicator data in Phoenix and Arizona. In Epidemiologic 

Trends in Drug Abuse: Volume II. Proceedings of the Community Epidemiology Work Group, 

January 2006. Rockville, MD: National Institute on Drug Abuse (in publication). 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 129 
 

 

Appendix A. 

APPENDIX A. CURRENT CEWG 

REPRESENTATIVES, 

BY LOCATION 

Atlanta 

Brian J. Dew, Ph.D., L.P.C. 

Assistant Professor 

Department of Counseling and Psychological 

Services 

Georgia State University 

P.O. Box 3980 

Atlanta, GA 30308 

Phone: 404-808-5436 

Fax: 404-651-1160 

E-mail: bdew@gsu.edu 

Baltimore 

Leigh A. Henderson, Ph.D. 

Project Director 

Synectics for Management Decisions, Inc. 

3001 Guilford Avenue 

Baltimore, MD 21218-3926 

Phone: 410-235-3096 

Fax: 703-528-6421 

E-mail: leighh@smdi.com 

Boston 

Daniel P. Dooley 

Boston Public Health Commission 

1010 Massachusetts Avenue 

Boston, MA 02118 

Phone: 617-534-2360 

Fax: 617-534-2422 

E-mail: ddooley@bphc.org 

Chicago 

Larry Ouellet, Ph.D. 

Community Outreach and Intervention Projects 

2121 West Taylor Street, Room 552 

Chicago, IL 60612-7260 

Phone: 312-996-5523 

Fax: 312-996-1450 

E-mail: ljo@uic.edu 

Denver 

Tamara Hoxworth 

Research Analyst 

Colorado Alcohol and Drug Abuse Division 

4055 S. Lowell Boulevard 

Denver, CO 80236 

Phone: 303-866-7497 

E-mail: Tamara.hoxworth@state.co.us 

Detroit 

Cynthia L. Arfken, Ph.D. 

Associate Professor 

Psychiatry and Behavioral Neurosciences 

Wayne State University 

2761 East Jefferson 

Detroit, MI 48207 

Phone: 313-993-3490 

Fax: 313-993-1372 

E-mail: carfken@med.wayne.edu 

Honolulu 

D. William Wood, Ph.D. 

Department of Sociology 

University of Hawaii at Manoa 

265 North Kalaheo Avenue 

Honolulu, HI 96822 

Phone: 250-384-3748 

Fax: 808-9565-3707 

E-mail: dwwood@shaw.ca 

Los Angeles 

Beth A. Rutkowski, M.P.H. 

Associate Director of Training/Epidemiologist 

ATTC/NIDA Liaison 

Integrated Substance Abuse Programs 

University of California, Los Angeles 

Suite 200 

1640 South Sepulveda Boulevard 

Los Angeles, CA 90025 

Phone: 310-445-0874, ext. 376 

Fax: 310-312-0538 

E-mail: finnerty@ucla.edu 

Miami 

James N. Hall 

Director 

Center for the Study and Prevention of 

Substance Abuse 

Up Front Drug Information Center 

Nova Southeastern University 

Suite 215 

12360 Southwest 132nd Court 

Miami, FL 33186 

Phone: 786-242-8222 

Fax: 786-242-8759 

E-mail: upfrontin@aol.com 

130 Assessing Drug Abuse Within and Across Communities: Second Edition 
Current CEWG Representatives, by Location 

Minneapolis 

Carol L. Falkowski 

Director 

Research Communications 

Hazelden Foundation 

Butler Center for Research 

15245 Pleasant Valley Road, Box 11 

Center City, MN 55012-0011 

Phone: 651-213-4566 

Fax: 651-213-4344 

E-mail: cfalkowski@hazelden.org 

New York City 

Rozanne Marel, Ph.D. 

Head, Epidemiology and Needs Assessment 

New York State Office of Alcoholism and 

Substance Abuse Services 

501 7th Avenue, 9th Floor 

New York, NY 10018 

Phone: 646-728-4605 

Fax: 646-728-4685 

E-mail: rozannemarel@oasas.state.ny.us 

Newark 

Allison S. Gertel-Rosenberg, M.S. 

Program Manager 

Division of Addiction Services 

Office of Policy Development 

New Jersey Department of Human Services 

120 South Stockton Street, 3rd Floor 

P.O. Box 362 

Trenton, NJ 08625 

Phone: 609-984-4050 

Fax: 609-292-1045 

E-mail: allison.gertel@dhs.state.nj.us 

Philadelphia 

Samuel J. Cutler 

Program Manager 

Coordinating Office for Drug and Alcohol 

Abuse Programs 

City of Philadelphia, Office of Behavioral Health 

Suite 800 

1101 Market Street 

Philadelphia, PA 19107-2908 

Phone: 215-685-5414 

Fax: 215-685-5427 

E-mail: sam.cutler@phila.gov 

Phoenix 

Ilene L. Dode, Ph.D. 

EMPACT-Suicide Prevention Center, Inc. 

2528 East Geneva Drive 

Tempe, AZ 85282 

Phone: 480-784-1514, ext. 1116 

Fax: 480-967-3528 

E-mail: idode@aol.com 

St. Louis 

Heidi Israel, Ph.D. 

Division of Infectious Diseases 

St. Louis University 

School of Medicine 

1200 South Grand Avenue 

St. Louis, MO 63104-1017 

Phone: 314-268-5448 

Fax: 314-268-5196 

E-mail: israelha@slu.edu 

San Diego 

Steffanie Strathdee, Ph.D. 

Professor and Harold Simon Chair 

Chief, Division of International Health and 

Cross Cultural Medicine 

Department of Family and Preventive 

Medicine 

Adjunct Professor 

Department of Epidemiology 

Johns Hopkins Bloomberg School of Public 

Health 

University of California San Diego 

School of Medicine, 

9500 Gilman Drive, Mailstop 0622 

San Diego, CA 92093 

Phone: 858-822-1952 

Fax: 858-534-4642 

E-mail: sstrathdee@ucsd.edu 

San Francisco 

John A. Newmeyer, Ph.D. 

Epidemiologist 

Haight-Ashbury Free Clinics, Inc. 

612 Clayton Street, 2nd Floor 

San Francisco, CA 94117 

Phone: 415-931-5420 

Fax: 415-864-6162 

E-mail: jnewmeyer@aol.com 

Seattle 

Caleb Banta-Green, M.P.H., M.S.W. 

Research Scientist 

Alcohol and Drug Abuse Institute 

University of Washington 

Suite 120 

1107 N.E. 45th Street 

Seattle, WA 98105 

Phone: 206-685-3919 

Fax: 206-543-5473 

E-mail: calebbg@u.washington.edu 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 131 
Appendix A. 

Texas 

Jane C. Maxwell, Ph.D. 

Research Professor 

Center for Social Work Research 

University of Texas at Austin 

Suite 335 

1717 West 6th Street 

Austin, TX 78703 

Phone: 512-232-0610 

Fax: 512-232-0616 

E-mail: jcmaxwell@sbcglobal.net 

Washington, DC 

Eric Wish, Ph.D. 

Director 

Center for Substance Abuse Research 

4321 Hartwick Road 

Suite 501 

College Park, MD 20740 

Phone: 301-403-8329 

Fax: 301-403-8342 

E-mail: ewish@cesar.umd.edu 

132 Assessing Drug Abuse Within and Across Communities: Second Edition 
 

Web Sites Containing Data and Information Discussed in this Publication 

APPENDIX B. WEB SITES1 CONTAINING DATA 

AND INFORMATION DISCUSSED 

IN THIS PUBLICATION 

1. National Institute on Drug Abuse
 

(NIDA)
 

2. The Office of National Drug Control
 

Policy (ONDCP)
 

3. Office of Applied Studies (OAS), 

Substance Abuse and Mental Health

Services Administration (SAMHSA)
 

4. Drug Enforcement Administration 

Intelligence Division 

Diversion Control Division 

3⁄4

3⁄4

5. National Drug Intelligence Center
 

(NDIC)
 

6. Federal Bureau of Investigation, 

Uniform Crime Reports 

3⁄4

3⁄4

3⁄4

3⁄4

3⁄4

7. Centers for Disease Control and 

Prevention (CDC) 

National Center for Chronic Disease 

Prevention and Health Promotion 

National Center for HIV, STD, 

and TB Prevention 

8. American Association of Poison 

Control Centers (AAPCC) 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 133 

9. Other Web Sites: 

USACops 

U.S. Customs and Border Protection

U.S. Census Bureau 

U.S. Census Bureau U.S. Census Bureau U.S. Census Bureau

1

All Web addresses given in this appendix are current as of November 2005. 
 

Appendix B. 

NationalInstituteonDrugAbuse(NIDA)

Web address: http://www.nida.nih.gov 

NIDA supports intramural and extramural research on all aspects of drug abuse and addiction. The extramural 

program supports scientists in universities and research centers around the country and abroad in conducting a wide 

range of basic, clinical, and epidemiologic studies to increase understanding of drug addiction and improve methods 

of preventing and treating it. 

Soon after its inception in 1974, NIDA launched the Community Epidemiology Work Group (CEWG) and the 

Monitoring the Future (MTF) surveys to assess drug abuse patterns and track nationwide trends. 

This Web site provides access to data/information produced by five ongoing NIDA drug abuse data sources (CEWG 

and MTF) and links to data sources supported by other agencies and institutions. These other data sources include 

Computer Retrieval of Information on Science Projects (CRISP), a searchable database of federally funded 

biomedical research projects being conducted at universities, hospitals, and other research institutions. This 

database includes NIDA grantees who are conducting drug abuse research. 

Monitoring the Future (MTF) Survey is conducted

and funded by NIDA. MTF has tracked 12th grader

8th and 10th graders were added to the study. The

 by the University of Michigan’s Institute for Social Research (ISR) 

s’ illicit drug use and attitudes towards drugs since 1975. In 1991, 

 2004 study surveyed 49,500 students in 406 schools across the 

Nation about their lifetime use, past-year use, past-month use, and daily use of drugs, alcohol, and cigarettes and 

smokeless tobacco. 

Additional information about the MTF survey, related publications, and press releases, as well as links to other ISR 

research projects can be found at www.monitoringthefuture.org. 

NIDA sponsors and conducts epidemiologic research to monitor and assess the complex and constantly changing 

phenomenon of drug abuse. The Community Epidemiology Work Group, established by NIDA in 1976, provides 

ongoing community-level surveillance of drug abuse through the collection and analysis of epidemiologic and 

ethnographic data. The CEWG meets semiannually to review epidemiologic and ethnographic data from 20 U.S. 

metropolitan areas and the State of Texas. 

134 Assessing Drug Abuse Within and Across Communities: Second Edition 
•

•

•

•

•

•

•

•

•

•

•

•

•

•

Web Sites Containing Data and Information Discussed in this Publication 

CEWG members representing the areas rely on multiple sources of information, including the types listed below: 

Survey findings 

Drug abuse treatment admissions and discharges 

Drug-related deaths 

Emergency department drug abuse episodes 

Public health data 

AIDS cases associated with injection drug use 

Drug-related arrests 

Forensic laboratory analyses 

Price and purity levels (of illicit drugs) 

Ethnographic research 

Qualitative information 

Each data source is a potential drug abuse indicator. By comparing and assessing data from different sources 

concurrently, members obtain a more comprehensive view of drug abuse patterns and trends. One source can 

complement and support another. Each data source may also represent different populations of users and the 

agencies that serve their needs. Interpretation of indicator data, therefore, requires an understanding of the strengths 

and weaknesses of each data source and variables within each database. 

CEWG Meeting Reports are based on data/information reported at biannual meetings. At the meetings, CEWG 

members present data on drug abuse from a variety of city, State, Federal, and other sources. These data are 

enhanced with information gathered through qualitative methods. From each meeting stem the following 

publications: 

Epidemiologic Trends in Drug Abuse – Advance Report 

Volume I: Highlights and Executive Summary 

Volume II: Proceedings of the Epidemiology Work Group on Drug Abuse 

These reports are available online at www.nida.nih.gov/about/organization/cewg/Reports.html. 

The Computer Retrieval of Information on Scientific Projects (CRISP) is a searchable database of federally 

funded biomedical research projects conducted at universities, hospitals, and other research institutions. The 

database, maintained by the Office of Extramural Research at the National Institutes of Health, includes projects 

funded not only by NIDA but also by the National Institutes of Health (NIH), Substance Abuse and Mental Health 

Services Administration (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug 

Administration (FDA), Centers for Disease Control and Prevention (CDC), Agency for Health Care Research and 

Quality (AHRQ), and Office of Assistant Secretary of Health (OASH). Users, including the public, can use the CRISP 

interface to search for emerging trends and techniques or to identify specific projects and/or investigators. CRISP 

can be viewed at http://crisp.cit.nih.gov. 

Related Links with other NIDA constituent organizations, grantees, and government sites of interest are also 

available. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 135 
Appendix B. 

136 Assessing Drug Abuse Within and Across Communities: Second Edition 

TheOfficeofNationalDrugControlPolicy(ONDCP)

Web address: http://www.whitehousedrugpolicy.gov 

ONDCP is a component of the White House resources under the Office of the President. Initiated in 1988 by the 

Anti-Drug Abuse Act, ONDCP establishes policies, priorities, and objectives to reduce the illicit use, manufacturing, 

trafficking, crime, and health consequences directly related to the abuse of drugs. The ONDCP Web site provides 

the public with an array of data/information on substance abuse. 

Drug Facts provides data and information on specific drugs and drug-abusing populations, and the subcategories of 

specific drugs. 

Information is also provided on a wide range of topics, including the extent of drug use, health effects, treatment, 

arrest and sentencing, production and trafficking, legislation, street terms, and other links. 

ONDCP Major Cities Initiative 

The Major Cities Initiative develops and supports the leadership in 25 targeted cities—particularly in the areas of 

drug prevention, drug treatment, and public safety—to enhance cooperation and accomplish significant improvement 

in key measures of drug use in each city. A State-of-the-City Profile for each targeted city can be accessed by 

selecting a city from the map or the drop down menu. 

High-Intensity Drug-Trafficking Areas (HIDTA) 

The HIDTA program provides Federal resources to areas within the United States that exhibit serious drug trafficking 

problems. The HIDTA link directs one to a map showing HIDTA sites and to individual HIDTA summaries for each 

site. 

State and Local Profiles, Contacts, and Resources 

The State and Local link on the Home Page allows the user to access each State’s profile, contact information, and 

various other resources with respect to drug policy information. The drop box (like the HIDTA page’s drop box) 

transfers the user to the specific State information page, which consists of links to the information. 

Science and Technology is a link to Research, which is a link to the comprehensive list of Research, Science, and 

Technology resources. 

Related Links to other sites offers a listing of other Web pages that provides drug abuse data/information. These 

links take the user to completely different Web pages that are not created or maintained by the Office of National 

Drug Control Policy. 
Web Sites Containing Data and Information Discussed in this Publication 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 137 

OfficeofAppliedStudies(OAS),
 

SubstanceAbuseandMentalHealthServices
 

Administration(SAMHSA)
 

Web site: http://www.oas.samhsa.gov 

SAMHSA is the lead Federal agency within the Department of Health and Human Services for improving access to 

quality substance abuse prevention, addiction treatment, and mental health services in the United States. OAS, an 

office within SAMHSA, is the primary source of national data on the prevalence, treatment, and consequences of 

substance abuse. Data are collected on the Nation’s treatment systems and outcomes. These data are intended to 

serve as statistical indicators of progress in the field and to provide a better understanding of the nature and extent of 

substance abuse in order to improve prevention and treatment services and reduce substance abuse in this country. 

Data from the OAS data systems are available to the public, researchers, and other interested persons through 

published and Web site reports. OAS produces several publication series that provide national and State data on 

alcohol, tobacco, and illegal drug use and their correlates and consequences. In addition, persons may do their own 

data analysis using the Substance Abuse and Mental Health Data Archives (SAMHDA) system that provides for 

data analysis either online or by downloading public use tapes. Additional information about SAMHDA and how it can 

be used is provided in a section below. 

Data/information can be obtained from the following OAS sources on the Web site: 

Latest Data This link provides access to recently released reports, by data system and time period (e.g., year). 

National Survey on Drug Use and Health (NSDUH) Previously called the National Household Survey on Drug 

Abuse, NSDUH reports on the prevalence patterns and consequences of drug and alcohol use and abuse in the 

general U.S. civilian noninstitutionalized population age 12 and older. Data are collected on the use of illicit drugs, 

nonmedical use of licit drugs, and use of alcohol and tobacco products. The survey is conducted annually and is 

designed to produce drug and alcohol use incidence and prevalence estimates. Data are also collected periodically 

on special topics, such as criminal behavior, treatment, mental health, and attitudes about drugs. Incidence data 

describe emerging patterns of substance abuse, particularly among young people. Incidence estimates are based on 

retrospective reports of age of first use of particular substances by respondents interviewed. Incidence rates are 

reported as the number of new users per 1,000 potential (persons who have not yet used the substance) users. Data 

are reported nationally, and findings on selected variables are reported by State and periodically by substate areas. 

Drug and Alcohol Services Information System (DASIS), the primary source of national data on substance abuse 

treatment, has three components: 

• Substance Abuse Treatment Facility Locator provides names/addresses of local providers and of Single 

State Agencies. Facility Locator information is available at http://findtreatment.samhsa.gov. 

• National Survey of Substance Abuse Treatment Services (N-SSATS) Treatment data are collected on 

location, patient characteristics, services offered, and numbers of clients in public and private alcohol and 

drug abuse treatment in the 50 States, the District of Columbia, and other U.S. jurisdictions. N-SSATS is a 

point-prevalence survey collecting data collected on and for a particular (reference) date. See also 

http://www.drugabusestatistics.samhsa.gov. 

• Treatment Episode Data Set (TEDS) is minimum data set that includes demographic and substance abuse 

characteristics of admissions to substance abuse treatment. These data are routinely collected by State 

administrative systems and submitted to SAMHSA in a standard format. Some States also report discharge 

status data. The most recent data reported by States, the District of Columbia, and Puerto Rico are 

presented by primary substance of abuse, according to gender, age, and race/ethnicity. See 

http://www.drugabusestatistics.samhsa.gov. 
Drug Abuse Warning Network (DAWN) is a public health surveillance system that collects and reports data on: 

• Drug-related hospital emergency department cases 

• Drug-related deaths reported by medical examiners 

DAWN data are both local (metropolitan area) and national in scope. A scientific sample of hospitals, by geographic 

area, participates in DAWN. Eligible hospitals include non-Federal, short-term, general hospitals that operate 24-

hour emergency departments. Types of drugs covered in DAWN include illegal drugs, prescription and over-thecounter medications, dietary supplements, non-pharmaceutical inhalants, and alcohol. Data are collected through a 

retrospective review of patient medical records and decedent case files. OAS publishes national and metropolitan 

area estimates of drug-related emergency department visits each year. Mortality data are published annually for 

each participating jurisdiction. SAMHSA is required to collect DAWN data under Section 505 of the Public Health 

Service Act (42 U.S.C. 290aa-4). Both DAWN systems were redesigned in 2003, and data from 2002 and before 

cannot be compared with those from 2003 and subsequent years. See http://DAWNinfo.samhsa.gov. 

Substance Abuse and Mental Health Data Archive (SAMHDA) provides ready access to substance abuse and 

mental health research data and promotes the sharing of these data among researchers, academics, policymakers, 

service providers, and others. The online analysis system allows one to run both simple and complex analyses, 

recode and compute new variables, subset variables, or cases for downloading, and run Quick Tables. One objective 

is to increase the use of the data in understanding and assessing substance abuse and mental health problems and 

the impact of related treatment systems. The data archive is also intended to expand the variety of media on which 

data are available and to make the data available in a user-friendly format. The Web site features a data analysis 

system (DAS) that allows users to conduct analyses on selected datasets within the archive. SAMHDA also provides 

user support through e-mail and a toll-free helpline. 

Appendix B. 

138 Assessing Drug Abuse Within and Across Communities: Second Edition 

DrugEnforcementAdministration(DEA)

IntelligenceDivision

Web address: http://www.usdoj.gov/dea/programs/intelligence.htm 

In coordination with Federal, State, local, and foreign law enforcement organizations, the DEA collects, analyzes, and 

disseminates drug-related intelligence. The DEA Intelligence Program gathers information that leads to drug seizures 

and arrests and provides policymakers with drug and drug trend information upon which program decisions can be 

made. The DEA’s intelligence missions are to: 

• Collect and produce intelligence in support of the Administrator and other Federal, State, and local agencies 

• Establish and maintain close working relationships with all agencies that produce or use narcotics intelligence 

• Increase the efficiency in the reporting, analysis, storage, retrieval, and exchange of such information 

• Continue review of the narcotics intelligence effort to identify and correct deficiencies 

The DEA Intelligence System includes domestic field divisions; district, resident, and foreign officers; the El Paso 

Intelligence Center; and the Intelligence Division at DEA Headquarters. 

Stats and Facts is the link to State Fact Sheets for the 50 States and Washington, DC. Fact Sheets include the most 

recent information about the general drug situation (e.g., trafficking, availability, and abuse of particular drugs) and 

more detailed information about specific drugs (e.g., seizures) in each area. 

Drug Information provides descriptions and up-to-date information (including reports) on more than 50 drugs. 
Web Sites Containing Data and Information Discussed in this Publication 

DiversionControlProgram(DEA)
 

Web address: http://www.deadiversion.usdoj/gov 

The DEA Office of Diversion Control (ODC) is responsible for assessing and addressing the diversion of controlled 

pharmaceuticals and controlled chemicals. ODC staff include diversion investigators, special agents, chemists, 

pharmacologists, and program analysts. The activities of this office include field management oversight; coordination 

of major investigations; drafting and promulgating of regulations; legal control of drugs and chemicals not previously 

under Federal control; control of imports and exports of drugs and chemicals; computerized monitoring and tracking; 

the distribution of certain controlled substances; and providing distribution intelligence to the States. Data/information 

on drugs and drug distribution are collected and reported on the Web site. 

Publications through which diversion data/information are reported include Informational Brochures, Manuals, 

Newsletters, Press Releases, and Program Reports. 

Drugs/Chemicals of Concern provides data/information on a variety of prescription and over-the-counter drugs 

including fentanyl, hydrocodone, hydromorphone, ketamine, oxycodone, salvia divinorum, and tramadol. 

ARCOS is the link for the Automation of Reports and Consolidated Orders System that monitors the flow of DEA 

controlled substances from their point of manufacture, through commercial distribution channels, to point of sale or 

distribution at the dispensing/retail levels. The information is used to identify the diversion of controlled substances 

into illicit channels of distribution. ARCOS retail drug distribution data are reported (PDF format) by Zip Code and 

State. These data can be accessed directly at retail drug summary. 

NFLIS is the link for the National Forensic Laboratory Information System that systematically collects results from 

solid dosage drug analyses conducted by State and local forensic laboratories across the country. These data are 

used to monitor and assess drug abuse and trafficking in the U.S., including the diversion of legally manufactured 

drugs into illegal markets. NFLIS laboratory results, validated by chemical analysis, have a degree of validity. 

Approximately 300 State and local forensic laboratories perform nearly 2 million drug analyses each year. 

DEA Field Offices 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 

To obtain drug intelligence data for your area, first contact the appropriate DEA division office. You will then be 

directed to an agent covering your community. 

139 
Atlanta Division 

(404) 893-7000 

Offices 

Augusta, GA 

Columbus, GA 

Macon, GA 

Rome, GA 

Savannah, GA 

Asheville, NC 

Charlotte, NC 

Greensboro, NC 

Raleigh, NC 

Wilmington, NC 

Beaufort, SC 

Charleston, SC 

Columbia, SC 

Florence, SC 

Greenville, SC 

Chattanooga, TN 

Jackson, TN 

Johnson City, TN 

Knoxville, TN 

Memphis, TN 

Nashville, TN 

Denver Division 

(303) 705-7300 

Offices 

Colorado Springs, CO 

Glenwood Springs, CO 

Grand Junction, CO 

Steamboat Springs, CO 

Billings, MT 

Missoula, MT 

Salt Lake City, UT 

St. George, UT 

Casper, WY 

Cheyenne, WY 

Miami Division 

(305) 994-4870 

Offices 

Freeport, Bahamas 

Nassau, Bahamas 

Ft. Lauderdale, FL 

Ft. Myers, FL 

Gainesville, FL 

Jacksonville, FL 

Key Largo, FL 

Key West, FL 

Orlando, FL 

Panama City, FL 

Pensacola, FL 

Port St. Lucie, FL 

Tallahassee, FL 

Tampa, FL 

Titusville, FL 

W. Palm Beach, FL 

Boston Division 

(617) 557-2100 

Offices 

Bridgeport, CT 

Hartford, CT 

New Haven, CT 

New Bedford, MA 

Springfield, MA 

Bangor, ME 

Portland, ME 

Manchester, NH 

Portsmouth, NH 

Providence, RI 

Burlington, VT 

Detroit Division 

(313) 234-4000 

Offices 

Kalamazoo, MI 

Lexington, KY 

London, KY 

Louisville, KY 

Madisonville, KY 

Lansing, MI 

Grand Rapids, MI 

Saginaw, MI 

Cincinnati, OH 

Cleveland, OH 

Columbus, OH 

Dayton, OH 

Toledo, OH 

Youngstown, OH 

New Jersey Division 

(973) 776-1100 

Offices 

Atlantic City, NJ 

Camden, NJ 

Paterson, NJ 

Caribbean Division 

(787) 775-1815 

Offices 

Bridgetown, Barbados 

Santo-Domingo, D.R. 

Port-au-Prince, Haiti 

Kingston, Jamaica 

Curacao, Neth. Ant. 

Ponce, Puerto Rico 

Port of Spain, Trinadad &

Tobago 

St. Thomas, VI 

St. Croix, VI 

El Paso Division 

(915) 832-6000 

Offices 

Albuquerque, NM 

Las Cruces, NM 

Alpine, TX 

Midland, TX 

New Orleans Division 

(504) 840-1100 

Offices 

Birmingham, AL 

Huntsville, AL 

Mobile, AL 

Montgomery, AL 

Fayetteville, AR 

Ft. Smith, AR 

Little Rock, AR 

Baton Rouge, LA 

Lafayette, LA 

Monroe, LA 

Shreveport, LA 

Gulfport, MS 

Jackson, MS 

Oxford, MS 

Chicago Division 

(312) 353-7875 

Offices 

Rockford, IL 

Springfield, IL 

Evansville, IN 

Ft. Wayne, IN 

Indianapolis, IN 

Merrillville, IN 

Minneapolis/St. Paul, 

MN 

Bismarck, ND 

Fargo, ND 

Green Bay, WI 

Madison, WI 

Milwaukee, WI 

Houston Division 

(713) 693-3000 

Offices 

Austin, TX 

Beaumont, TX 

Brownsville, TX 

Corpus Christi, TX 

Del Rio, TX 

Eagle Pass, TX 

Galveston, TX 

Laredo, TX 

McAllen, TX 

San Antonio, TX 

Waco, TX 

New York Division 

(212) 337-3900 

Offices 

Albany, NY 

Buffalo, NY 

Long Island, NY 

Plattsburgh, NY 

Rochester, NY 

Syracuse, NY 

Westchester Cty, NY 

Dallas Division 

(214) 366-6900 

Offices 

McAlester, OK 

Oklahoma City, OK 

Tulsa, OK 

Amarillo, TX 

Ft. Worth, TX 

Lubbock, TX 

Tyler, TX 

Los Angeles Division 

(213) 621-6700 

Offices 

Riverside, CA 

Santa Ana, CA 

Ventura, CA 

Guam 

Hilo, HI 

Honolulu, HI 

Maui, HI 

Lake Tahoe, NV 

Las Vegas, NV 

Reno, NV 

Philadelphia Division 

(215) 861-3474 

Offices 

Dover, DE 

Wilmington, DE 

Allentown, PA 

Harrisburg, PA 

Pittsburgh, PA 

Scranton, PA 

Appendix B. 

140 Assessing Drug Abuse Within and Across Communities: Second Edition 
 

Web Sites Containing Data and Information Discussed in this Publication 

Phoenix Division 

(602) 664-5600 

Offices 

Flagstaff, AZ 

Lake Havasu City, AZ 

Nogales, AZ 

Sierra Vista, AZ 

Tucson, AZ 

Yuma, AZ 

San Diego Division 

(858) 616-4100 

Offices 

Carlsbad, CA 

Imperial County, CA 

San Ysidro, CA 

San Francisco 

Division 

(415) 436-7900 

Offices 

Bakersfield, CA 

Fresno, CA 

Modesto, CA 

Oakland, CA 

Redding, CA 

Sacramento, CA 

San Jose, CA 

Santa Rosa, CA 

Seattle Division 

(206) 553-5443 

Offices 

Anchorage, AK 

Fairbanks, AK 

Boise, ID 

Bend, OR 

Eugene, OR 

Medford, OR 

Portland, OR 

Salem, OR 

Blaine, WA 

Spokane, WA 

Tacoma, WA 

Tri-Cities, WA 

Yakima, WA 

St. Louis Division 

(314) 538-4600 

Offices 

Cedar Rapids, IA 

Des Moines, IA 

Sioux City, IA 

Carbondale, IL 

Fairview Hts., IL 

Quad Cities, IL 

Garden City, KS 

Kansas City, KS 

Topeka, KS 

Wichita, KS 

Cape Giradeau, MO 

Jefferson City, MO 

Springfield, MO 

North Platte, NE 

Omaha, NE 

Rapid City, SD 

Sioux Falls, SD 

Washington, DC 

Division 

(202) 305-8500 

Offices 

Baltimore, MD 

Hagerstown, MD 

Salisbury, MD 

Bristol, VA 

Hampton, VA 

Norfolk, VA 

Richmond, VA 

Roanoke, VA 

Winchester, VA 

Charleston, WV 

Clarksburg, WV 

Wheeling, WV 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 

NationalDrugIntelligenceCenter(NDIC)

141 

Web address: http://www.usdoj.gov/ndic/index.htm 

NDIC was established in 1993 as a component of the U.S. Department of Justice (DOJ) to be a focal point for 

counter-drug intelligence. It gathers intelligence on drug production and drug use and assesses the threat of illicit 

substances by geographic area. 

National and State threat assessment reports can be found under Publications. 

The National Drug Threat Assessment is an annual NDIC report on national drug trafficking and abuse trends 

within the United States. The report identifies “drug threats,” monitors fluctuations in drug consumption levels, and 

tracks drug availability by geographic market. It includes current quantitative and qualitative information on 

availability, demand, production, cultivation, transportation, and distribution, as well as the effects of particular drugs. 

State Drug Threat Assessment reports provide detailed threat assessments of drug patterns and trends in a 

particular State. Each report identifies the primary drug threats in the State and gives a detailed overview of the most 

current trends by drug type. State reports are periodically updated. 

Bulletins and Briefs are responses to new trends or high-priority drug issues. They are quickly transmitted to law 

enforcement and intelligence officials to warn them of emerging drug, drug patterns, and trends. 
Appendix B. 

FederalBureauofInvestigation(FBI)

UniformCrimeReports(UCR)

Web address: http://www.fbi.gov/ucr/ucr.htm/ 

The FBI compiles crime data collected from more than 17,000 law enforcement agencies annually to form the data 

set known as the Uniform Crime Report (UCR). 

These data include arrests for drug abuse violations by State and county and also the demographics for arrestees 

(i.e., age, sex, and race). 

Data pertaining to drug abuse violation arrests are collected in specific drug categories by type of arrest (i.e., Sales 

and Manufacturing or Possession). The drug categories include Opium or Cocaine and Derivatives, Marijuana, 

Synthetic Narcotics, and Other Dangerous Narcotic Drugs. 

UCR Reports available on the FBI Web site include data by State but not by county. To obtain the most recent 

reports that include county data, one should contact the State law enforcement agency responsible for reporting UCR 

data to the FBI. Generally, hard copies of the most recent State UCR report can be obtained from the State agency. 

CentersforDiseaseControlandPrevention(CDC)

NationalCenterforChronicDiseasePrevention

andHealthPromotion

Web address: http://www.cdc.gov/HealthyYouth/YRBS/ 

CDC, a component of the Department of Health and Human Services, is the lead Federal agency for protecting the 

health and safety of people, providing credible information to enhance health decisions, and promoting health through 

partnerships. It carries out this role through disease prevention and control, environmental health, and health 

promotion and education activities. 

Youth Risk Behavior Surveillance System (YRBSS) 

The YRBSS, developed in 1990, monitors health risk behaviors that contribute markedly to the leading causes of 

death, disability, and social problems among youth and young adults in the United States. These behaviors include 

tobacco use, alcohol use, and other drug use. 

142 Assessing Drug Abuse Within and Across Communities: Second Edition 
Web Sites Containing Data and Information Discussed in this Publication 

The YRBSS is designed to: 

• Determine the prevalence of health risk behaviors 

• Assess whether health risk behaviors increase, decrease, or stay the same over time 

• Examine the co-occurrence of health risk behaviors 

• Provide comparable national, State, and local data 

• Provide comparable data among subpopulations of youth 

• Monitor progress toward achieving the Healthy People 2010 objectives and other program indicators 

The YRBSS includes national, State, and local school-based surveys of representative samples of 9th through 12th 

grade students. The Youth Risk Behavior Survey (YRBS) is conducted every 2 years, usually during the spring 

semester. The national survey, conducted by CDC, provides data representative of high school students in public 

and private schools in the United States. The State and local surveys, conducted by departments of health and 

education, provide data representative of the State or local school district. 

At-A-Glance Report: Assessing Health Risk Behaviors Among Young People: Youth Risk Behavior 

Surveillance System, 2004 

NationalCenterforHIV,STD,andTBPrevention

Web address: http://www.cdc.gov/hiv/stats/hasrlink.htm/ 

http://www.cdc.gov/hiv/stats/hasr1402/website.htm 

The CDC Web sites include HIV/AIDS data by region but not by State, county, or city. State and territorial health 

departments use local HIV/AIDS surveillance programs to report surveillance data to CDC. These are the best 

sources of local HIV/AIDS, hepatitis B, and hepatitis C data. 

The Morbidity and Mortality Weekly Report (MMWR) series includes provisional weekly data based on reports to 

CDC by State health departments. Data are provisional because of delayed reporting and the ongoing revision of 

information. 

The HIV/AIDS Surveillance Supplemental Report is an annual report on persons with diagnoses of HIV infection 

and AIDS, persons living with a diagnosis of HIV infection or AIDS, reported cases of HIV/AIDS and AIDS, and 

deaths among persons with AIDS, by race/ethnicity, in the United States 

http://www.cdc.gov/hiv/stats/hasrlink.htm. 

Estimated Numbers of Persons Living with HIV infection (not AIDS) by exposure category and year and by 

race/ethnicity and age. 

HIV/AIDS exposure categories by gender include: 

• Injection drug use 

• Male-to-male sexual contact and injection drug use 

• Heterosexual contact 

Acute Hepatitis http://www.cdc.gov/ncidod/diseases/hepatitis/resource/index.htm (Hepatitis Surveillance 

Report). This recent report is largely national data, however, Figure 12 shows the Incidence of Acute Hepatitis B by 

Region (Northwest, Northeast, etc.) and Figure 13 shows the same by county. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 143 
 

 

Appendix B. 

AmericanAssociationofPoisonControlCenters

(AAPCC)

Web site: http://www.aapcc.org/ 

AAPCC is a nationwide association of Poison Control Centers in the United States. It collects, analyzes, and reports 

on poisoning data submitted by centers. 

Find Your Poison Center Local centers can be identified by clicking on a map of States, by entering a zip code or 

by directory. 

Poisoning Data can be accessed directly. 

Poison Center Survey Results are through annual reports. 

OtherWebSites
 

USACOPS

Web address: http://www.usacops.com/ 

USACOPS, a national directory of law enforcement agencies in the United States, is supported by donations. 

Contact information (person in charge, address, and telephone numbers) can be accessed for local (county/city) 

police departments and sheriffs’ offices. 

It is possible to obtain information on drug arrests (cases) for particular drugs (trafficking, production, availability, and 

cost). 

144 Assessing Drug Abuse Within and Across Communities: Second Edition 
U.S. Census Bureau U.S. Census Bureau

Web Sites Containing Data and Information Discussed in this Publication 

U.S.CustomsandBorderProtection(CBP)

U.S.DepartmentofHomelandSecurity

Web address: http://www.cbp.gov/ (Formerly, U.S. Customs site); click on News Releases. 

This Web site contains CBP news releases by date. 

U.S. Census Bureau U.S. Census Bureau

U.S.CensusBureau

Web address: http://www.census.gov; click on American FactFinderTM 

This Web site contains census data by geographic area on population size and sociodemographic population 

characteristics. 

A Guide for Community Epidemiology Surveillance Networks on Drug Abuse 145 
NIH Publication No. 06-3614
 

Printed September 2006