Duck and Cover: How the Obama Administration Mishandled the 2014 National Household Survey on Drug Use and Health

A man smokes a joint during a march for the legalization of marijuana towards the Legislative Palace in Montevideo, on December 10, 2013. (PABLO PORCIUNCULA/AFP/Getty Images)
A man smokes a joint during a march for the legalization of marijuana towards the Legislative Palace in Montevideo, on December 10, 2013. (PABLO PORCIUNCULA/AFP/Getty Images)

It felt a bit like being invited to a christening, but: no baby. Thursday morning (September 4) saw the annual release of the 2014 National Survey on Drug Use and Health (NSDUH), produced by the Substance Abuse and Mental Health Administration (SAMHSA) and used as one basis for the strategic goal of drug use by the President’s Office of National Drug Control Policy. (The report is always a retrospective on the previous year, such that the data represent the situation in 2013.)

The official data from this national survey is eagerly awaited by researchers and drug policy experts, and is one of the official “report cards” on the President’s National Drug Control Strategy. Media coverage is typically widespread, and often front-page, especially when there is either strikingly good or negative news in the results.

Given that this Administration has declared an “end to the drug war” and facilitated, beginning in January of 2014, the legalization of recreational marijuana in Colorado and now Washington, and amid reports of a heroin outbreak and a stunning rise in seizures of methamphetamine at the border, one would have thought that the topic of drug use trends would be significant.

This year, the results are not good. Drug use is up, again, as it has been every year since the Obama Administration took over drug policy in 2009. But you would be hard-pressed to find that information, as this year, as SAMHSA Administrator Pam Hyde noted at the Press Club, there would be a “change” in plans. The NSDUH data would not be released yet; there was no report.

I asked the Edelman Public Affairs personnel at the front desk, “Where’s the NSDUH report?” Don’t have it. “Is it online?” Nope. “When do you expect it?” Oh, probably a couple of weeks.” At which point, one suspects that it will be “old news.” No further press event has been announced.

For an Administration that claims transparency and science as hallmarks, the actual practice certainly fell short.

If the political goal was to avoid negative press coverage, it worked very well. Though the Washington Post had room this morning for a report on the spread of obesity in America, and had recently run two stories (one a front-page personal account about the new ONDCP Acting Director, the other an A-2 musing about the drug budget which included data from last year’s survey), this time they ran not a word. Even watchdogs need sleep.

The annual NSDUH is a large and comprehensive document costing taxpayers roughly $70 million per year, running to hundreds of pages with tables, charts, calculations of statistical significance, detailed methodologies, and numerous breakdowns and cross-tabs by such variables as age cohorts, gender, pregnancy status, and periods of drug use for multiple drugs. For a policy expert, it is a fundamental menu of data and evaluation.

Hence it was a shock to learn that the only data available at the event was a short press booklet with one page devoted to illicit drug use, and but a single table. It showed past month drug use for Americans 12 and older, ages 12-17, and curiously, 18 and older (the more consequential category is the group 18-25, always the category with the highest drug prevalence rates; but this was not available.)

There was no comparison with any earlier year, so any trend lines were not presented, even in comparison to last year. There was just the SAMHSA story line.

What did that one table provide? Illicit drug use for those 12 and older in 2013 was 9.4 percent of the population, with marijuana use standing at 7.5 percent. So? Is that up, down, or flat? How does it compare to the previous Administration’s performance? Are any changes statistically significant, or just the random fluctuation found in any large survey?

There is no way from this document to answer those questions. But through a little digging it is possible to find this: For all Americans 12 and over, past-month illicit drug use in the most recent NSDUH report is 9.4 percent. That figure is up from 2012, when it came in at 9.2 percent. Moreover, since 2008, the upward change is 16 percent.

The Obama Administration set for itself the goal of a 15 percent reduction in the current use of any illicit drug. Instead, they have delivered an increase of 16 percent measured since the end of the George W. Bush Administration, when they took command of drug policy.

And marijuana? The most recent low point for past-month marijuana use, 12 and older, was 2007, when it stood at 5.8 percent. In 2013, marijuana use had climbed to 7.5 percent (7.6 percent for the population 18 and older). That is an upward change of 29 percent, in six years, or nearly 5 percent increase per year. And we have yet to see the full effects of the January 2014 initiation of legal marijuana on the rest of the nation.

There was one additional discussion about drugs in the press kit, with a somewhat self-serving implication involving the Affordable Care Act (ACA). Fully 37.3 percent of people, we read, who needed drug treatment, sought it, but did not get it cited “no health coverage/could not afford” as the reason that they weren’t treated for a diagnoseable substance problem. Could the new “parity” requirement for insurance coverage in the ACA be the answer?

But here’s the real math. There were 20.2 million aged 12 and older who met the criteria for “needing treatment but did not receive it” for an illicit drug or alcohol use problem. Of those, only 4.5 percent “felt that they needed treatment.” So, of the 20.2 million who needed treatment, only 908,000 felt they needed it and sought it, equaling 4.5 percent.

It is only that last 4.5 percent of whom it is true that, of them, 34.8 percent made an effort but couldn’t get treatment for insurance or cost reasons. That figure, however, represents only 1.6 percent of the total number that stand in need of substance use treatment.

That’s not where the treatment policy problem is; it lies with those who don’t feel that they need treatment and aren’t even seeking it, expanded coverage or no.

Here, only available from last year’s NSDUH, is a chart showing the 2002-2012 data for “past month use, all Americans 12 and older”: