Another Fine Meth Survey

Over at Slate, Jack Shafer pokes holes in a National Association of Counties (NACo) survey that is being cited as evidence of a nationwide "meth epidemic." As Shafer notes, the survey of emergency rooms, which received respectful coverage in The New York Times, USA Today, and elsewhere, suffers from an inadequate, nonrepresentative sample and questions that asked for impressions instead of hard data.

NACo (whose previous, equally flawed survey of law enforcement officials was dissected by Nick Gillespie) started out with a nonrepresentative sample by focusing on hospitals run by counties, hospitals of last resort that disportionately treat poor, uninsured patients. (Somehow NACo still finds it worth reporting that the survey indicates meth users treated at these hospitals tend to be uninsured.) The results probably were further skewed by response bias, since it's plausible that hospitals seeing a lot of meth users would be more likely to participate. But NACo does not consider that issue in its report or give enough data for an independent assessment. The report says NACo "contacted county public hospital or regional hospital emergency rooms in 48 states" and got 200 responses from E.R. officials in 39 states. It does not say what percentage of county hospitals those 200 responses represent. But as Shafer notes, the respondents account for about 5 percent of all the emergency rooms in the U.S.

Tables in the NACo report indicate that the responses came overwhelmingly from Midwestern states (72 percent) and from counties with populations below 50,000 (80 percent). As Shafer notes, "58 percent of all emergency departments are in metropolitan areas and account for 82 percent of all annual use." It would be extremely misleading to portray the results of this survey as evidence of a nationwide "meth epidemic," even if there were no other problems with the study.

But there are. "Have hospital presentations where methamphetamine was involved increased at your hospital's emergency room?" the survey asked. In response to this leading question, about three-quarters of the participants said "yes, in the last five years." As Shafer notes, no data were required to back up this impression. (Even if they were, decisions to classify admissions as methamphetamine-related are often open to question and may be influenced by the sort of meth panic NACo is pushing. For example, NACo mentions that injuries from a fight would be considered meth-related if someone at the hospital decided the patient got into the fight because meth made him aggressive.)

Clearly, though, the respondents had the impression that their hospitals were seeing more meth-related E.R. presentations than they did five years ago. How many more? Oddly, NACo did not ask. But 71 percent of the respondents said meth accounted for "0 to 10 percent" of presentations. Is the typical experience (of this highly skewed sample) closer to 0 or to 10? NACo doesn't know, or at least it isn't saying.

So even with a sample that overrepresents rural, Midwestern counties where meth use is especially common and with questions that invite confirmation of the "meth epidemic" to which NACo repeatedly refers in its report, the results are unimpressive, hardly rising above the level of anecdote. At best, they suggest that meth use has been rising in certain parts of the country. Nationally representative surveys find no indication of a nationwide increase in meth use. Yet the press treated the NACo survey as proof of a national problem. "A sharp increase in the number of people arriving in emergency rooms with methamphetamine-related problems is straining local hospital budgets and treatment facilities across the country," said the Times (emphasis added). USA Today said the survey indicated that "methamphetamine accounts for more emergency room visits than any other drug." Yes, if you're talking about this particular sample, which is not nationally representative. And if you exclude legal drugs. And if you assume the respondents' impressions were accurate.

The news media's eagerness to believe in the latest drug "epidemic" is hardly surprising. But since NACo is plainly pushing an agenda that clashes with that of other drug warriors–demanding a shift in focus at the national level from marijuana to meth, and in particular seeking more federal funding for the counties it represents–you'd think even journalists who routinely parrot anti-drug propaganda would be a little more skeptical of a crappy study like this one.