Heroin use cannot be measured adequately with a general population survey
Heroin use cannot be measured adequately with a general population survey
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DOI：
10.1111/add.15458
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发表时间：
2021-03-27
期刊：
影响因子：
6
通讯作者：
Midgette, Greg
中科院分区：
文献类型：
--
作者：
Reuter, Peter;Caulkins, Jonathan P.;Midgette, Greg
背景 在全球范围内，海洛因和其他阿片类药物造成一半以上因吸毒导致的死亡和减寿，并构成非法毒品的四大市场之一。对有问题的海洛因使用者的数量进行合理的估计对于制定健全的健康和刑事司法政策至关重要。研究人员和政策制定者严重依赖一般人口调查 (GPS)，例如美国国家药物使用和健康调查 (NSDUH) 来估计海洛因使用情况，而没有面对其局限性。基于 GPS 的估计对于可卡因和甲基苯丙胺也很普遍，因此与 GPS 估计海洛因使用情况相关的见解也与这些毒品市场相关。 分析 对 NSDUH 中潜在错误的四个来源进行了评估：选择性不答复、样本量小、抽样框遗漏和报告不足。提出并解释了利用各种来源（包括对成年男性被捕者的调查）得出的另一种估计。讨论了流行率估计的其他方法。结果 NSDUH 中的少报和选择性不答复可能会导致严重低估。样本量小会导致估计不精确和逐年波动不稳定。另一种估计提供了可靠的证据，表明 NSDUH 低估了频繁使用海洛因的人数至少四分之三，甚至可能更多。 影响 GPS，即使像 NSDUH 一样强大，也注定无法对集中在难以追踪的人群中的罕见且污名化的行为做出糟糕的估计。尽管许多欧洲国家避免依赖这些调查，但许多其他国家却效仿美国模式。更好的估计需要利用包括 GPS 在内的各种数据源的模型来提供可靠的估计。选定国家最近的方法发展可以提供指导。期刊应要求研究人员严格评估 GPS 对任何低流行率的污名化毒品相关行为的估计的合理性。
Background Globally, heroin and other opioids account for more than half of deaths and years-of-life-lost due to drug use and comprise one of the four major markets for illegal drugs. Having sound estimates of the number of problematic heroin users is fundamental to formulating sound health and criminal justice policies. Researchers and policymakers rely heavily upon general population surveys (GPS), such as the US National Survey on Drug Use and Health (NSDUH), to estimate heroin use, without confronting their limitations. GPS-based estimates are also ubiquitous for cocaine and methamphetamine, so insights pertaining to GPS for estimating heroin use are also relevant for those drug markets.Analysis Four sources of potential errors in NSDUH are assessed: selective non-response, small sample size, sampling frame omissions and under-reporting. An alternative estimate drawing on a variety of sources including a survey of adult male arrestees is presented and explained. Other approaches to prevalence estimation are discussed.Findings Under-reporting and selective non-response in NSDUH are likely to lead to substantial underestimation. Small sample size leads to imprecise estimates and erratic year-to-year fluctuations. The alternative estimate provides credible evidence that NSDUH underestimates the number of frequent heroin users by at least three-quarters and perhaps much more.Implications GPS, even those as strong as NSDUH, are doomed by their nature to estimate poorly a rare and stigmatized behavior concentrated in a hard-to-track population. Although many European nations avoid reliance upon these surveys, many others follow the US model. Better estimation requires models that draw upon a variety of data sources, including GPS, to provide credible estimates. Recent methodological developments in selected countries can provide guidance. Journals should require researchers to critically assess the soundness of GPS estimates for any stigmatized drug-related behaviors with low prevalence rates.