CICAD: Inter-American Observatory on Drugs (OID)

Community-Based Surveillance of Drug Use


Illustration showing divergent trendsCommunity-Based Surveillance of Drug Use Provides Adds Valuable Perspectives on Trends

By James N. Hall*

Within nations, patterns of substance abuse may vary between different regions and communities. A system for tracking national drug trends across communities helps identify similarities and differences among diverse geographical areas and populations while also providing information for local strategies. In the United States, the National Institute on Drug Abuse (NIDA) established the Community Correspondence Group in 1976 to track patterns of heroin abuse in major urban centers. The group’s name was soon changed to the Community Epidemiology Work Group (CEWG) as it expanded to 20 communities and its surveillance to include most illicit drugs and the non-medical use of pharmaceuticals. It has met semi-annually since 1976.

 Taping into existing data sources

The mission of the CEWG is to monitor drug abuse trends by tracking existing data sources within and across 20 local areas in the United States. Those data sources include public health, criminal justice, and education organizations whose information is assembled in a community report by CEWG members. The communities and states currently represented on the CEWG are: Atlanta, Boston, Chicago, Cincinnati, Denver, Detroit, Honolulu, Los Angeles, Miami/Ft. Lauderdale, Minneapolis/St. Paul, New York City, Philadelphia, Phoenix, St. Louis, San Diego, San Francisco, Seattle, Washington, DC, and the states of Maine and Texas. The goals of the CEWG are to:

  1. Characterize changes in drug use patterns and
  2. Provide early identification of new patterns and emerging drug abuse issues.
Graphic: Changes in Race among Primary Meth Treatment Admissions

The CEWG meets for three days in January and June of each year, rotating the meeting site among the 20 community locations. Each member prepares a 15-20 page written report organized by drug categories addressing multiple local indicators including drug-related:

  • Deaths,
  • Emergency department reports,
  • Addiction treatment admissions,
  • Price and purity of illicit drugs,
  • Crime lab cases,
  • Prevalence surveys, and
  • Infectious diseases.

At the meeting, each member reports key findings in a 20-minute presentation. The meeting includes group discussions on regional patterns, specific drugs and special topics. A panel is invited to explore an emerging issue from the previous CEWG meeting while another panel features local researchers from the host community. Updates on Federal data sets and reports from other nations complete the agenda. All the meeting reports are available online.

Latest findings

Graphic: LA Country Treatment Admissions by Substance of Abuse - 200-2006A key emerging trend from the June 2007 CEWG meeting in Philadelphia is that consequences of polysubstance abuse are rising, fueled by the non-medical use of prescription opiates and benzodiazepines in combination with alcohol and other drugs. The Work Group also identified that the escalation of methamphetamine abuse in the Western and Midwestern portions of the United States had abated since early 2006, yet its use was increasing among Latinos in some areas.

While prevalence of cocaine use remains relatively low, its consequences are very high, including deaths, medical emergencies, and addiction treatment admissions. Declines in heroin-related deaths in some areas have been replaced by increasing deaths related to abuse of prescription opiates. As marijuana is the most prevalent illicit drug used, it ranks second in the number of emergency department reports, addiction treatment admissions, and crime lab cases.

Indicators for the club drug, ecstasy, that had been steadily declining since 2001, started to increase in 2006 with reports that many tablets sold as ecstasy may contain MDMA (ecstasy’s chemical compound) but are also contaminated with some methamphetamine.

National CEWG information is disseminated by the Division of Epidemiology, Services and Prevention Research at NIDA, through its biannual report series entitled Epidemiologic Trends in Drug Abuse. Information on the national CEWG, its reports, and contact information for CEWG members can be accessed from the NIDA Web site.

An example to be followed

Graphic: polysubstance use among deaths in Florida, 2001-2006Based on the NIDA CEWG model, state epidemiology work groups (SEWGs) have been organized in many of the United States. Similar work groups have been organized or are under development in other nations and continents including Asia, Australia, Canada, Central America, Europe, Mexico, and South Africa. Local drug-abuse epidemiology work groups from multiple sites provide rich insight to the nature of a nation’s drug problem and vital information for action for their host communities.

The CEWG has often been the first to report emerging drugs trends in the United States including:

  • MDMA use in 1984
  • Crack cocaine in 1985
  • The return of methamphetamine in 1988
  • Abuse of the sedative-hypnotic, Flunitrazepam (Rohypnol) in 1992
  • GHB (Gamma Hydroxybutyrate) and drug-facilitated rape in 1994
  • The rise of ecstasy and club drugs in 1996
  • The decline of ecstasy and club drugs in 2001
  • Increasing non-medical prescription drug abuse in 2002
  • Fentanyl-contaminated heroin in 2006
  • The return of ecstasy in 2006

Cover of NIDA/CEWG publicationHow to start a local drug monitoring network

To establish a local drug surveillance network, it is best to start with a small work group so that all participants have an opportunity to contribute to the process. Members should be from different organizations and with different perspectives. Include the medical examiner, treatment program personnel, HIV street outreach workers, health planners, university researchers and local police officers. If the local network is to be part of a national or regional work group, the reporting process should be standardized so that comparisons can be more easily made across different jurisdictions. A complete manual and guide on local drug epidemiology work groups entitled Assessing Drug Abuse Within and Across Communities [155 pages, 5.6 MB] is available free from NIDA online.


Photo of James HallJames N. Hall is director of the Center for the Study and Prevention of Substance Abuse at Nova Southeastern University. The Center is a community partnership with the United Way of Broward County Commission on Substance Abuse.  For the past 24 years, he has tracked patterns and trends of substance abuse in South Florida as a member of the National Institute on Drug Abuse’s Community Epidemiology Work Group. Jim’s work has focused on converting research about emerging drug abuse problems into community-based solutions. He serves as chair of the Miami-Dade County (Florida) Addiction Services Board.


updated on 8/14/2012 3:54:35 PM