Debunking the Debunking: The Meth Problem Is Real

I was in my office at UCLA this afternoon, reading the latest press-release-dressed-up-as-a-research-report from the Sentencing Project, in which Ryan S. King "proves" that methamphetamine isn't really much of a problem. While I was wondering how long it would take Jack Shafer of Slate to jump on it, and betting myself 10-to-1 against Shafer, or any other reporter except Steve Suo, noticing how spectacularly the report abused the data -- its primary data source, the National Survey on Drug Use and Health, notoriously misses about three-quarters of the nation's population of serious drug abusers -- there was a knock on my door.

My caller was a woman of about twenty, dressed, coiffed, and made up in the expensively casual fashion characteristic of Westside Los Angeles, though not in general of UCLA. She had in her hand the green form students use to drop a course; since this is Exam Week, it wasn't hard to guess her mission. She was there to drop my drug policy class. As I signed the form, I asked her, as I always do, why she was dropping. She explained that she'd run into a drug problem, and had spent most of the quarter at a very expensive and well-known rehab center. Naturally, I asked what drug had been her problem. "Methamphetamine," she said.

(No, I'm not making this up. That sort of coincidence is too weird for fiction, and only occurs in real life.)

Whenever a new or resurgent problem drug appears, or appears to appear, Congress raises the penalties for dealing that particular drug. No one expects the higher penalties to have any particular result: it's just Washington's version of a rain dance (or prayers for rain). That is, it expresses a communal desire that some result happen, without actually doing anything to bring that result about.

So it's natural for those who think that making insanely long drug sentences even longer is a bad idea to want to deny the appearance of new or resurgent problem drugs. Since law enforcement, Congressional and journalistic accounts of drug problems tend to float free of mundane reality, it's never hard to prove that the people most loudly trumpeting the new problem don't know their posterior from second base. Then people like Jack Shafer can denounce the whole thing as a hoax, and we all can go back to sleep.

Shafer has been denouncing what he sees as the methamphetamine hoax for almost a year now. And of course he's all over King's report like a cheap suit, demanding that any reporter who covers the meth issue from now on "perform the simple due diligence of ringing up King at the Sentencing Project for a skeptical take before filing." In the same essay, Shafer denounces reporters for accepting cops as authorities on drug abuse and dentists (as opposed to dental researchers) as authorities on the effects of meth on the teeth.

Presumably, then, Shafer regards Ryan S. King as an authority on drug problems. But he never says why. The report identifies King as a "Policy Analyst" for the Sentencing Project. King's profile at Niemanwatch says of King, "His research specialization is the American correctional system." But somehow it never mentions either where King got his research training or what scholarly articles he has published in peer-reviewed journals.

Instead we learn:

Mr. King has written for the New York Times and The Washington Post and has appeared on a broad range of local and national talk radio programs to discuss sentencing and corrections issues, including NPR's The Tavis Smiley Show and Talk of the Nation. In addition, Mr. King is frequently invited to speak at conferences and other events to discuss the work of The Sentencing Project.

In other words, King has no more qualification for judging the extent of a drug abuse problem than the typical cop or dentist. King is a pseudo-scholar, working for a pseudo-think-tank. There's nothing wrong with writing briefing papers releases against excessive sentencing, which is after all what the Sentencing Project is about, but it's not the same as being an actual expert.

If reporters working on meth have an obligation to call King for his skeptical take on the question, presumably reporters working on the latest advance in evolutionary biology have an obligation to call the Discovery Institute for a "skeptical take" on Darwin, and reporters covering global warming need to talk to Sterling Burnett of the National Center for Policy Analysis for his -- that is to say, Exxon Mobil's -- "skeptical take" on climate change.

(Shafer, with the parody of objectivity that helps make American journalism the wonderful thing that it is, also quotes Richard Rawson, one of the leading researchers on drug treatment, specializing in methamphetamine, who points out that the myth of the methamphetamine myth is believed only by residents of the Boston-Washington corridor, and that "west of Ohio and south of Chicago" knows full well that the problem is only too real. Rawson has a Ph.D., a faculty appointment at UCLA, and 125 journal papers to his credit. Shafer, generously says "I find wisdom in both King and Rawson," and concludes that reporters, after calling King, "should talk to Rawson too," as if the two sources had equivalent credibility.)

Now of course nothing says that uncredentialed researchers publishing advocacy documents rather than scholarly papers can't get the right answers. But King spectacularly fails to do so; he clearly doesn't understand his data sources, and is evidently more interested in "proving" a predetermined conclusion than carefully weighing the scattered bits of evidence.

King triumphantly reports that only 583,000 Americans are regular users of methamphetamine, putting it on a par with crack cocaine. Neither King nor Shafer seems to notice that crack is a rather substantial problem, and that, therefore, if a drug as dangerous as crack has become as widely used as crack, it's more than a mythical problem. If heavy meth use is really as widespread as heavy crack use, it's time to sit up and take notice. And neither King nor Shafer seems to notice that an estimate of the number of regular crack users that small is wildly implausible, and that there might therefore be something wrong with the data source.

In fact there is, and the problem is well known to those in the field. King is using the National Survey on Drug Use and Health (NS-DUH, pronounced by some of us "En-Ess-Duhhhhhhhhh"). NS-DUH is a survey of the household population; it excludes those in prisons, jails, residential treatment facilities, and dormitories, as well as the homeless. Even among its target population, NS-DUH has a sample non-response rate (respondent refused or couldn't be located) of about 20%. It's not hard to guess that heavy drug users might be less inclined than average to open the door when the nice man from the government knocks and says he'd like to ask a few questions.

It's possible to estimate the number of regular crack users from other sources; the right number is something like 2 million, not 600,000. (As far as drug quantities go, an estimate of the total volume of crack and powder cocaine used in the U.S. based on NS-DUH responses gets about 10% of the actual number.) If there were really 2 million regular meth users, that would be a disaster. But the real number might be higher or lower, since there's no reason to think that NS-DUH misses a constant fraction of heavy drug users.

King notes that NS-DUH has been criticized (citing a post on this weblog) and therefore turns his attention to ADAM, which used to measure drug use among big-city arrestees.

But ADAM wasn't any better-placed to catch the meth phenomenon than the NS-DUH. The meth-using population tends to be exurban or rural, and is typically less criminally active before getting involved with the drug than, say, the crack-using population. So looking for meth use among big-city arrestees isn't likely to catch anything like the total extent of the problem. (There's a quite different meth problem around the dance scene, especially in the gay community, but so far that seems to be much smaller, and again among people not likely to be arrested.) Worse, ADAM stopped collecting data in 2003, so it tells us nothing about current events.

King does note that treatment admissions for meth have quintupled, as has the number of meth labs seized, while the self-reported number of new meth users each year has doubled over the past decade. But since those observations don't fit his story, he explains them away.

Meth is a truly nasty drug: strongly reinforcing and highly toxic, with marked cognitive deficits among long-term users even after they stop. Its use has been growing, and spreading geographically. It hits a population not very likely to use other illicit drugs (other than cannabis): rural and small-town working-class and lower-middle-class whites. That means the meth problem is mostly happening where we don't collect the much data, where the social fabric is already badly frayed, and where neither enforcement nor treatment has much spare capacity. (King correctly notes that meth is treatable; he fails to note that the dropout rates for almost all forms of drug treatment other than opiate substitution therapy are high, and that treatment doesn't work for people who don't attend it.)

How big a problem methamphetamine is right now, and how big it's likely to get, are matters mostly of guesswork. We don't have the right data to make convincing current estimates or adequate models to make strong predictions. But in overall social impact, I'd rate it third among the illicit drugs, behind cocaine (including crack) and heroin, and way ahead of cannabis, "club drugs" including MDMA, and diverted licit pharmaceuticals including opioids such as Oxycontin and benzodiazepines such as Valium and Xanax. (Alcohol, of course, swamps them all.) And meth is still rising, while the heroin population continues to age and cocaine is on the way (slowly) down.

Offhand, I'm not sure what to do about meth. It's a hard enforcement target because, unlike crack, it's typically bought in large multiples of the dose size, so transactions are relatively infrequent. Making pseudoephedrine harder to acquire might have helped slow the geographic spread of the problem, since sudafed is the precursor used in the home "meth labs" that are often the first sources of the drug in a new community. Even today, denying sudafed to the home cookers would have some environmental benefits. But it's hard to imagine that the Mexican drug gangs won't figure out a way to fill any gap in supply created by putting the home labs out of business. Expanding treatment supply where it's scarce compared to treatment demand is certainly worthwhile, but lots of people who need meth treatment aren't actually demanding it. Once meth users hit the criminal justice system, we can try to coerce them into treatment, but in fact probation departments aren't very effective in getting their clients to comply with treatment orders.

Judge Steven Alm in Honolulu, where meth has been problem for a long time, is apparently getting good results by requiring frequent tests and imposing quick and reliable sanctions every time a probationer tests positive. However, I"ve been pushing that sort of program (invented, independently as far as I can tell, by J.J. Gallegher of Project Sentry, by the late John Kaplan, and by Eric Wish) for twenty years now, and in most places the organizational barriers to making it work seem to be insuperable.

So it's possible that the meth wave is less a problem we ought to be trying to fix than a situation we need to ty to adjust to as best we can. But that's no excuse for pretending it's not happening. Media criticism is good clean fun, but it's no substitute for studying the actual phenomena.