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In tracking drug trends, can't afford to play catch-up

October 31, 2017
by Gary A. Enos, Editor
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Letter from the Editor

In the analysis of drug trends, the most pressing question might not be, “What will be the next drug crisis?” The field arguably should focus more on, “Why do we always seem to be running behind the problem?”

An undercurrent of concern about the timeliness of the surveillance systems on which policy leaders, law enforcement and public health rely has characterized many recent discussions with researchers. Those interviewed for our article on emerging trends in stimulant use pointed out gaps in the tracking and reporting of actionable data, both nationally and in the states.

Jim Hall, whose career as an epidemiologist in Florida spans multiple drug crises, looks in several directions in tracking trends at the state and local level. Crime lab data and medical examiner toxicology screen results capture most of his attention, but he adds that social media also can be fertile ground for terms that signal new activity afoot.

Stephanie Nichols, PharmD, of the School of Pharmacy at Husson University in Maine, has been involved as a research partner with the state's Diversion Alert system that collects timely information on the substances involved in drug arrests. Yet she laments that Diversion Alert remains severely underutilized.

Data show that while 44% of the system's users are physicians, only one-third of all physicians in Maine are registered to use it, Nichols reports. Involvement from other practitioners is even more disappointing, with only a 16% registration rate among pharmacists.

Nichols says that even when someone is plugged into a source such as the state's prescription drug monitoring program, the ability to extract specific data to inform research can be limited. She has found on occasion that a report cannot be run in time for a project's deadline.

The researchers I've recently spoken with generally agree that government bears the primary responsibility for improving the speed with which drug trends are tracked and communicated. There has been some progress in this area, such as the National Institute on Drug Abuse's (NIDA's) funding of the National Drug Early Warning System at the University of Maryland's Center for Substance Abuse Research.

Additional inroads would come as welcome news to researchers such as Theodore J. Cicero, PhD, professor of psychiatry at Washington University in St. Louis. He led a study, published in the November issue of Addictive Behaviors, that found heroin is now the most commonly initiated opioid. Given the public health implications of a greater number of opioid-naïve individuals starting with heroin rather than a prescription opioid, Cicero's paper included some pointed advice.

It stated that public health agencies must address this trend now, “so that, as a country, we are much better prepared to deal with this aspect of the opioid problem than we were in recognizing the initial emergence of prescription opioid abuse in the 1990s and the recent transition to heroin.”