	Background

The rapid and widespread increase in the use of crack—a smokable form of cocaine—in the 1980s has frequently been referred to as a drug epidemic. The Alcohol, Drug Abuse, and Mental Health Services (ADMS) block grant program was also created in 1981 to provide funds to states for planning, establishing, and evaluating programs for the development of more effective prevention, treatment, and rehabilitation services. SAMHSA also assumed responsibility for overseeing state administration of the block grant programs. A description of the drug detection mechanisms NIDA sponsored follows. Three other metropolitan areas were later added. The National Prevalence of Crack Use in the General Population Was Not Known Until the Late 1980s

Although NIDA was aware of the rapid spread of crack use from CEWG reports starting in the mid-1980s, the national prevalence of crack use in the general household population was not measured until the late 1980s. Limitations in Data Sources Raised Concerns About the Adequacy of Information on the Crack Cocaine Crisis

In two congressional hearings held in July 1986, a number of concerns were raised about the data that had been collected through the NIDA-sponsored drug detection mechanisms. Federal Public Health Response to Crack Focused on Cocaine Research and Education, Funding, and Reestablishing a Service Focus

The federal public health response to crack in the 1980s primarily focused on cocaine in general instead of on crack specifically. The creation of ONDCP and organizational changes to HHS’ drug abuse agencies since the late 1980s were intended to strengthen the federal response to drug abuse problems. To coordinate the federal drug control effort, ONDCP was charged with developing an annual national drug control strategy. SAMHSA Was Created to Strengthen Drug Prevention and Treatment Services

SAMHSA was created to address concerns related to the availability and quality of drug prevention and treatment services. Despite Changes, Concerns Remain About Our Nation’s Ability to Detect and Respond to Emerging Drug Crises

Despite changes to federal drug detection mechanisms and congressional efforts to better position federal public health agencies to respond to emerging drug crises, concerns remain. Since ONDCP is responsible for developing and coordinating a national drug control strategy, it could take the lead in improving the nation’s drug data collection system and coordinating the development of a strategy to address future emerging drug use problems. Recommendations

To improve the nation’s drug use detection and response capability, we recommend that the Director of ONDCP implement any additional changes that would improve the completeness, accuracy, and overall usefulness of data generated by the nation’s drug data collection mechanisms; take action to further improve the federal drug data collection system by determining what data should be collected and developing a systematic approach for gathering, analyzing, and disseminating information; and develop a defined strategy for determining the timing, magnitude, and nature of actions needed to appropriately respond to potential drug crises or epidemics, taking into consideration that emerging drug problems surface as local phenomena. Executive Vice President and Medical Director Center on Addiction and Substance Abuse,     Columbia University, and Professor of Psychiatry,     Columbia University College of Physicians and Surgeons A. Thomas McLellan, Ph.D., Scientific Director DeltaMetrics in Association With Treatment Research Institute University of Pennsylvania Before convening the panel, we sent each panelist a discussion paper containing a brief description of the current array of detection mechanisms used by the public health service agencies and the Office of National Drug Control Policy (ONDCP); the legislative responsibilities of the National Institute on Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and ONDCP to address illicit drug use problems; and information these agencies gave us about how they implement their responsibilities and respond to changes in drug use patterns.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed the efforts of the federal public health agencies to detect the spread of drug use in the United States and their ability to respond to potential drug crises, focusing on: (1) how the public health service agencies have detected and responded to the crack cocaine epidemic; (2) any changes made to improve the nation's drug detection and response capability; and (3) any remaining issues that could compromise the nation's ability to detect and respond to emerging drug problems.

What GAO Found

GAO noted that: (1) despite certain limitations in its sources of information, the National Institute on Drug Abuse (NIDA) was able to track the use of a number of illicit drugs, including cocaine, during the late 1970s and early 1980s; (2) two drug detection mechanisms NIDA used as a part of that effort helped detect the emergence of crack--a smokable form of cocaine; (3) NIDA had become aware of the rapid spread of crack in 17 metropolitan areas by 1986, but the prevalence of crack use in the national household population was not known until the late 1980s; (4) federal public health agencies primarily directed their response efforts to the problem of cocaine and drug abuse in general, rather than to crack specifically; (5) the response, orchestrated largely by NIDA, focused primarily on drug abuse research and education; (6) the Alcohol, Drug Abuse, and Mental Health Administration provided funding to state and local entities for substance abuse prevention and treatment services through the federal block grant program during the 1980s; (7) following the height of the crack epidemic around 1985, concerns were raised in Congress about efforts to detect and respond to the problem--in particular about the timeliness and accuracy of drug use data, lack of data on certain populations and geographic areas, limited availability of certain treatment programs, limited monitoring of the block grant program, and lack of a coordinated national drug control strategy; (8) in response, the responsible federal agencies made changes to improve drug detection capability--changes that included adding new detection mechanisms; (9) also, to help strengthen the federal response to drug problems, Congress legislated changes in the organization of the Department of Health and Human Services' major drug control agencies: the Substance Abuse and Mental Health Services Administration was created as a separate agency to focus on prevention and treatment services, and, to emphasize its research focus, NIDA was moved to the National Institutes of Health; (10) in addition, Congress created the Office of National Drug Control Policy (ONDCP) to develop a national drug control strategy and coordinate the national drug control effort; (11) despite these changes, concerns remain about the nation's ability to detect and respond to emerging drug problems; (12) ONDCP established a group to study the use of drug data that has recommended ways to improve the nation's drug data collection system; and (13) in addition, experts agree on the need for an overall strategy among key drug control agencies for managing emerging drug problems.