The
(F)Utility
of
DAWN:
Experts
Look
at
the
Drug
Abuse
Warning
Network
8/30/02
In a Week Online newsbrief last week (http://www.drcnet.org/wol/251.html#dawnstats), DRCNet quickly surveyed the federal Substance Abuse and Mental Health Services Administration's (SAMHSA) report on the latest statistics from DAWN (the Drug Abuse Warning Network) and promised a deeper look this week. Here we deliver. Last week, SAMHSA's news release announcing the numbers emphasized an increase in marijuana-related emergency room visits, raising eyebrows and causing consternation to drug reformers while providing ammunition for drug czar John Walters to fire another salvo in his crusade. "Marijuana-related medical emergencies are increasing at an alarming rate, exceeding even those for heroin. This report helps dispel the pervasive myth that marijuana is harmless," Walters railed. "In reality, marijuana is a dangerous drug, and adults and youth alike should be aware of the serious consequences that can come from smoking it." Provoked by Walters' propaganda move, DRCNet asked Dr. David Duncan, a clinical associate professor at the Brown University School of Medicine and private research consultant, just what the marijuana figures indicated. "They tell us very little," he replied. "Does a marijuana 'mention' mean that marijuana played a vital role or was it ancillary? No one knows because DAWN was not set up to collect that data," he said. "Mr. Walters and many, many others have used this data in the wrong way," Duncan continued. "DAWN was never set up to collect enough information to tell you useful things about problems coming into the emergency room. When someone uses DAWN numbers to try to tell you how dangerous a drug is, it's just not set up for that." Duncan also questioned DAWN's 30,000 marijuana-only "unexpected reaction or overdose" reports. He scoffed at the very notion of a marijuana overdose. "Marijuana overdose just doesn't happen, as the term is normally used in medicine," he said. "What I expect is being labeled an overdose is really an unexpected reaction. You can get very stoned or paranoid or have psychedelic effects with very large doses, but that is not an overdose in the normal sense of the term." A cannabis overdose is theoretically possible, Duncan conceded, but a practical impossibility. "The estimate is that a 150-pound man would have to eat five pounds of hashish," he said. "What that means is that you can't eat enough to produce a life-threatening overdose." If the marijuana numbers are misleading in that they can over-dramatize the weed's ill effects, the methamphetamine numbers may be misleading in the opposite way, according to Duncan and E. Michael Gorman, a professor of social policy and drug abuse policy at San Jose State University. According to DAWN, "there were no significant changes in the number of mentions" of either amphetamines or methamphetamines nationwide, with 33,000 mentions for 2001. Gorman was skeptical, but conceded that the wave of methamphetamine abuse may have plateaued. Still, he told DRCNet, "DAWN is a very limited data set, and you have to look at other numbers as well. I think we are seeing an increase in treatment admissions; I know that in Santa Clara county meth admissions are now exceeding alcohol admissions," he said. Gorman seconded Duncan's opinion of DAWN's limited utility and added another complaint: regional bias. "DAWN does not reflect regional variations very well," he said. "It was an ongoing battle between us and SAMHSA, because we felt they were not paying enough attention to the West Coast. What you get is a skewed, East Coast perspective and a disinclination to address real regional issues. As a result, the meth epidemic is the elephant sitting in the living room," Gorman said. "This is a policy issue. Not only is there a regional bias, there is an urban bias," Gorman continued. "As a result, meth is the redheaded stepchild of drug research. Too many New York-based researchers dismiss attempts to get funding for meth studies because they don't see it as a big problem." DAWN may also understate the extent of meth use because of the drug's characteristics, added Duncan. "You don't see a significant number of true meth overdoses," he said, "because in classic terms, amphetamine overdose is possible but very rare. You may get unexpected effects, paranoia, but those guys are more likely to end up in jail than the emergency room." Rick Doblin heads the Multidisciplinary Association for Psychedelic Studies (http://www.maps.org) and is in the process of prodding the DEA to approve studies of ecstasy as a therapeutic agent in treating Post Traumatic Stress Disorder. Doblin was also skeptical of the DAWN figures' significance. DAWN reported "no significant changes from 2000 to 2002" in ecstasy-related emergency room mentions. But Doblin told DRCNet, "As far as I can tell, according to other survey data, use rates are still climbing for ecstasy, so I'm not sure what these numbers mean." The stability in ecstasy mentions could mean that harm reduction measures are taking hold, Doblin suggested. "Perhaps people are learning to minimize harm, developing a certain collective wisdom and creating informal social controls," he mused. "The other possibility is that pill testing is having an impact. Programs like those on Erowid (http://www.erowid.org) are getting a lot of use and are finding a lot of fakes. When people are informed they will be less likely to take pills that could send them to the hospital." But Doblin is less concerned about DAWN's utility than the RAVE Act now pending in Congress. "The RAVE Act could transform current harm reduction practices into 'signs of drug use,'" Doblin said. "If the RAVE act passes, I would predict there would be an increase in ecstasy emergency room mentions." So where does that leave DAWN? Primarily as a resource for propagandists, said Duncan. "DAWN tells us very little about a particular drug. It was set up to provide an early warning of new drugs showing up or new trends. It was not intended to function as a means of monitoring detailed statistics about a particular drug. DAWN's conclusions are too often used for political purposes, and it is mostly a matter of distorting DAWN's own conclusions."
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