Castle Medical Solutions for Prescription Drug Abuse
By Ashley Collman and Reuters Published: 17:36, 1 November 2013 | Updated: 16:06, 2 November 2013 61View commentsThe parents of three children were arrested in Daytona Beach, Florida yesterday after police discovered the family living in a dead woman's house - all while the woman's body was decomposing in a bedroom.Police conducted a well-being check at the home in Holly Hill after being contacted by the Department of Children and Families who hadn't been able to contact the home's owner since early September. When officers forced their way into the home, they discovered the body of a woman - believed to be 33-year-old Tiffany Kain - in the late states of decomposition lying in a bedroom. Kain had spina bfida and was wheelchair-bound. Scroll Down for VideoGrim living: Todd Christopher La Duke, 38 (left), and Nicole Scalise, 32 (right), were arrested yesterday and their three children put in protective custody after police found them living in a house with a decomposing body 'It was like a house of horrors for Halloween,' said Holly Hill Police Chief Mark Barker. 'It was awful. You could smell the body from 150 feet away.' But it was the presence of living bodies in the home that unsettled police the most. Across the hall in another bedroom, they found Todd Christopher La Duke, 38, and Nicole Louise Scalise, 32, with their 4-year-old child. La Duke and Scalise had been living with Kain on and off for years. Apparently they had been living in the house with the decomposing body. Two of their other children, ages 6 and 11, lived there as well but were at school at the time.Making themselves at home: La Duke, Scalise and their three children were discovered living at this house in Holly Hill. The woman's body is believed to be that of 33-year-old Tiffany Krain who the family lived with on and off Gruesome: In addition to the decomposing body, police found the house littered with dog feces and urine and evidence of drug abuse In addition to the awful odors from the decomposing bodies, police also found dog feces and urine in the home and evidence of drug abuse in the form of bath salts. 'This is one of the worst cases of child neglect and child endangerment that I've seen in my 31 years here,' Barker said. Both La Duke and Scalise admitted that they had been cashing in the dead woman's food stamps and Social Security benefits. However, they say they didn't know that Kain had died and assumed she left the home. Both were arrested on charges of child neglect and failure to report a death to the medical examiner. La Duke is also being charged with theft of utility services since he illegally connected electrical and water service on the residence when it had been cut off. Their three children are now in protective custody. Kain's death has been deemed suspicious by the police and an autopsy and toxicology report were ordered today. Share what you think The comments below have not been moderated. The views expressed in the contents above are those of our users and do not necessarily reflect the views of MailOnline. We are no longer accepting comments on this article.Published by Associated Newspapers LtdPart of the Daily Mail, The Mail on Sunday & Metro Media Group
II. Americas Drug Use Profile Youth Drug Use Trends Marijuana Cocaine Heroin Methamphetamine MDMA Inhalants Other Illicit Substances The Link Between Drugs and Crime The Consequences of Illegal Drug Use Performance Measures of Effectivenessn 1999, an estimated 14.8 million Americans twelve years of age and older were current illicit drug users,* meaning they had used an illicit drug during the month prior to interview.1 This number represents 6.7 percent of the population twelve and older. Drug use reached peak levels in 1979 when 14.1 percent of the population (25 million) age twelve and over were current users. This figure declined significantly between 1979 and 1992, from 23 million to twelve million. Since 1992 the number of current users has gradually increased, with statistically insignificant changes occurring each year. An estimated 3.6 million people met diagnostic criteria for dependence on illegal drugs in 1999, including 800,000 youths between the ages of twelve and seventeen.2Drug use affects all Americans. More than half of our citizens (53 percent) say their concern about drug use has increased over the past five years; alarm is growing most in minority and low-income communities.3 In 1999, a study by the National League of Cities cited use of illegal drugs, alcohol, and tobacco among youth as one of the top threats to America in the new millennium.4 Even citizens who do not come into contact with illegal drug users share the burden of drug abuse. All of us pay the toll in the form of higher health-care costs, dangerous neighborhoods, and an overcrowded criminal justice system.YOUTH DRUG USE TRENDSYoung Americans are especially vulnerable to drug abuse. Their immature physical and psychological development makes them highly susceptible to the ill effects of drugs for years to come. Moreover, behavior patterns that result from teen and preteen drug use often produce tragic consequences. Self-degradation, loss of control, disruptive conduct, and antisocial attitudes can cause untold harm to themselves and their families.Trends of drug-use ratesAccording to the Department of Health and Human Services Substance Abuse and Mental Health Services Administrations (SAMHSA) 1999 National Household Survey on Drug Abuse (NHSDA), 9.0 percent of youth age twelve to seventeen reported current use of an illegal drug in 1999a 21 percent decrease from 11.4 percent in 1997. For the age group between eighteen to twenty-five years of age, current use of any illegal drug has been rising since 1994 and currently stands at 18.8 percent. This increase of 28 percent over the last two years (rising from 14.7 percent in 1997 and 16.1 percent in 1998) reflects the maturing of youth that experienced greater drug-use rates between 1992 and 1996. General changes in drug use are often linked to marijuanathe most frequently used illegal drug.5Marijuana use is linked to crime and antisocial behaviorMarijuana use by young people has been associated with a wide range of dangerous behavior. Children who begin smoking pot at an early age are less likely to finish school and more apt to engage in acts of theft, violence, vandalism, and other high-risk behavior than children who do not smoke marijuana.6 In 1996, nearly one million adolescents, age sixteen to eighteen, reported at least one incident of driving within two hours of using an illegal drug (most often marijuana) in the past year.7 An ysis of Maryland juvenile detainees found that 40 percent were in need of substance-abuse treatment. Among this group, 91 percent needed treatment for marijuana dependence.8 The link between early marijuana use and long-term substance abuse is demonstrated by an almost four-fold increase in the likelihood of problems with cigarettes and a more than doubling of the odds of alcohol and marijuana problems.9 Additionally, the 1999 NHSDA reports that the younger a person starts using marijuana, the higher the rate of adult illicit drug dependence. For example, 8.9 percent of adults who began smoking marijuana at age 14 or younger are drug dependent. In contrast, only 1.7 percent of adults who started using marijuana when they were 18 or older is drug dependent.10Changing teen attitudesThe Partnership for a Drug-Free Americas 2000 Partnership Attitude Tracking Study (PATS) indicates that disapproval of drugs among 7th through 12th graders reflected their knowledge of drug-related risks. The survey found teen attitudes and perceptions about marijuana trending in a positive direction, with more teens rejecting the drug. This year, more teens believe marijuana will make them lazy (48 percent, up from 44 percent in 1997), boring (32 percent, up from 29), or act stupidly or foolishly (54 percent, up from 51). Fewer see marijuana all around them (47 percent, compared to 59 percent in 1997), and fewer believe most people will use the drug (36 percent, down from 41).11 Similarly, teens continue to view cocaine and crack as dangerous drugs, with 82 percent of teens agreeing that there is great risk associated with regular use of cocaine, and close to half (47 percent) saying the same about trial use of these drugs. Additionally, three out of four teens (78 percent) continue to recognize the deadly consequences of using inhalants. This measure remained stable over the last year. Earlier PDFA research indicated that while teens associated high risk with regular use of inhalants, the same did not hold true for occasional use. Emerging drug-use trends among youthThe increase in 3,4-methylenedioxymethamphetamine (MDMA) usage rates among 10th and 12th graders, according to the 2000 Monitoring the Future Survey, is of concern. The documented increase in use of this so-called club drug corroborates other recent indicators, including ONDCP Pulse Check, and underscores the importance of NIDAs new research initiative on club drugs announced in October 2000. Among 10th graders, annual use of MDMA increased 33 percent (from 3.3 percent to 4.4 percent). Use of MDMA increased in all three use categories for 12th graders: 38 percent for lifetime use (from 5.8 percent to 8 percent); 56 percent for annual use (from 3.6 percent to 5.6 percent); and 67 percent for past 30-day use (from 1.5 percent to 2.5 percent). The 2000 Monitoring the Future study supports the NHSDA MDMA findings. Specifically, the MTF study reports that past-year use of ecstasy by 8thgraders increased 82 percent (from 1.7 percent to 3.1 percent) between 1999 and 2000; past-month use increased 75 percent (from 0.8 percent to 1.4 percent). Past-month use of MDMA by 10th graders increased 44 percent (from 1.8 percent to 2.6 percent).Increases in the use of steroids highlights the need for the international sports community to educate youth about the dangers of steroids and other performance-enhancing drugs. Among 10th graders, past year steroid use increased 29 percent between 1999 and 2000, from 1.7 percent to 2.2 percent.12Underage use of alcoholYoung people use alcohol more than illegal drugs. The younger a person is when alcohol use begins, the greater the risk of developing alcohol abuse or dependence problems later in life. Over 40 percent of youth who begin drinking before age fifteen become dependent on alcohol compared with just 10 percent of those who begin drinking at age twenty-one.13 Alcohol use among the young strongly correlates with adult drug use. For example, adults who start drinking at early ages are nearly eight times more likely to use cocaine than adults who did not drink as children.14The United States had 10.4 million underage current drinkers of alcohol in 1999. In this group, 6.8 million engaged in binge drinking, and 2.1 million were classified as heavy drinkers.15 The 2000 MTF reports that daily alcohol use by eighth graders declined twenty percent from one percent to 0.8 percent. Other changes in alcohol use, between 1999 and 2000, by 8th, 10th, and 12th graders were statistically insignificant. In 1999, past-month alcohol use for eighth graders in metropolitan areas was lower than for eighth graders in rural areas (21.7 percent versus 28.1 percent).16Underage use of tobaccoThe younger a person is when smoking begins, the greater the risk of contracting a disease attributable to smoking. The NHSDA estimates that every day more than six thousand people aged eighteen or younger try their first cigarette, and about three thousand people eighteen or younger become daily smokers.17 If these trends continue, approximately five million individuals now under eighteen will die early from a preventable disease associated with smoking. Widely available and legal for those of required age, tobacco is one of the easiest illicit substances of abuse for children to obtain.Smoking tobacco and use of illegal drugs appear to be linked. The 1999 NHSDA indicates that youths age twelve to seventeen that currently smoked cigarettes were 7.3 times more likely to use illegal drugs and fifteen times more likely to drink heavily than youths that did not smoke were.18 An estimated 15.9 percent of people in this age group were current cigarette smokers in 1999.19 This rate has declined since 1997, when the rate was 19.9 percent. In 1997, 39.7 percent of white high school students currently smoked cigarettes, compared with 34 percent for Hispanics and 22.7 percent for African-Americans.20 According to the 1999 National Youth Tobacco Survey, these numbers decreased to 32.8 percent, 25.8 percent, and 15.8 percent, respectively.21 This survey also reports that about one in ten (9.2 percent) middle school students and more than a quarter (28.4 percent) of high school students are current cigarette smokers; 12.8 percent of middle school students and 34.8 percent of high school students use any type of tobacco.22 In rural America, eighth graders are twice as likely to have smoked cigarettes in the past month than their peers in large metropolitan areas (26.1 percent versus 12.7 percent) and almost five times more likely to have used smokeless tobacco (8.9 percent versus 1.8 percent).23The recent entry of Indian bidis* into the American market poses a new tobacco-related health problem, especially in relation to youth. This type of cigarette is available at gas stations, liquor stores, ethnic food shops, selected health stores, and through the Internet. Bidis must be puffed more frequently than regular cigarettes, and inhaling a bidi requires great pulmonary effort due to its shape and poor combustibility. Consequently, bidi smokers breathe in greater quantities of tar and other toxins than smokers of regular cigarettes.24 In addition, bidis contain in excess of three times the amount of nicotine and five times the tar than regular cigarettes.25 Bidi smokers have twice the risk of contracting lung cancer compared to people who smoke filtered cigarettes; five times the risk of suffering heart disease; and a considerably greater risk for cancer of the oral cavity, pharynx, larynx, lungs, esophagus, stomach, and liver.26 Clubs and RavesThe use of synthetic drugs has become a popular method of enhancing the dance club and rave experience.* While these events were not originally intended to serve as a nexus for illicit drug sales, the culture surrounding the events has created a favorable environment for illegal drug trafficking. Club Drugs is a general term for a number of illicit drugs (primarily synthetic; i.e. MDMA, Ketamine, GHB, GBL, Rohypnol, LSD, PCP, methamphetamine, and inhalants) that are most commonly encountered at nightclubs and raves. The drugs have gained popularity due to the false perception that they are not as harmful, nor as addictive, as mainstream drugs such as heroin. In fact, rave party attendees who ingest such substances are at risk of dehydration, hyperthermia, and heart or kidney failure. These risks are due to a combination of these drugs stimulant effect that allows the user to dance for long periods of time and the hot, crowded atmosphere of rave parties. The combination of crowded all-night dance parties and synthetic drug use has caused fatalities.An additional danger associated with this emerging drug market is that drug composition may vary significantly and substitute drugs often are sold when suppliers are unable to provide the drug currently in demand. Club drug users risk taking dangerous combinations of drugs. Not only can this lead to a greater risk of drug overdose, the lack of knowledge regarding what drug was ingested can complicate the task of emergency response personnel.27Drug abuse and sexual activityJuvenile abuse of alcohol and other drugs is strongly associated with risk-taking behavior, including promiscuity. According to the 1999 National Center on Addiction and Substance Abuse (CASA) study Dangerous Liaisons, increased promiscuity leads to a greater risk for sexually transmitted diseases and unplanned teenage pregnancy.28 Adolescents aged fourteen and younger who use alcohol are twice as likely to engage in sexual behaviors than non-drinkers; drug users are five times more likely to be sexually active than youth who are drug-free. Teens between the age of fifteen and nineteen who drink are seven times more likely to have sex and twice as likely to have four or more partners than those who refrain from alcohol. Furthermore, more than 50 percent of teenagers say that sex while drinking or on drugs often produces unplanned pregnancies.29 An Ohio study of high school girls who tried cocaine indicated that these adolescents were five times more likely to have experienced an unintended pregnancy than peers who avoided cocaine.30MARIJUANA Overall usageIn 1999, 11.2 million of Americans aged twelve and older were current (past-month) marijuana usersthis number is not statistically different from the 11 million (5 percent) reported in 1998 and the 11.1 million (5.1 percent) reported in 1997. An estimated 75 percent of current illicit drug users use marijuana.31 An estimated 2.3 million Americans tried marijuana for the first time in 1998.32 This number translates to about 6,400 new marijuana users per day and has increased from approximately 1.4 million in 1990 to 2.6 million in 1996, remained level in 1997, then dropped between 1997 and 1998. There has been an increasing trend toward marijuana use since 1997 among young adults, age 18-25 years (12.8 percent in 1997, 13.8 percent in 1998, and 16.4 percent in 1999) and a decreasing trend since 1997 for youths age 12-17 years (9.4 percent in 1997, 8.3 percent in 1998 and 7.0 percent in 1999).33Use among youthMarijuana is the major illicit drug used by youths, age 12-17; 7.7 percent of youths were current users of marijuana in 1999.34 More than two-thirds of the 2.3 million new users reported in 1999 were under the age of 18. According to the 2000 MTF, use of marijuana was stable between 1999 and 2000. Past-year use of marijuana among 8th graders declined 15 percent (from 18.3 percent to 15.6 percent) between 1996 and 2000; past-year marijuana use among 10th graders declined ten percent between 1997 and 1998 and has remained stable since then.35 However, the rates of marijuana initiation for youth during 1995 through 1998 are at their highest levels since the peak levels in the late 1970s.36 The rate had increased between 1991 and 1995 from 46 per thousand potential new users* in 1991 to 80 per thousand potential new users in 1995. Use of marijuana by youths who had never previously used the substance doubled during that time period. However, the 1998 rate for youth (81.0 ) was significantly lower than the 1997 rate (90.8).37 The 2000 MTF reports that disapproval of trying marijuana once or twice increased three percent (from 70.7 percent to 72.5 percent) among 8th graders, a continuation of a trend started in 1997 when 67.6 percent of 8th graders expressed disapproval. Among 12th graders, disapproval of trying marijuana increased eight percent from 48.8 percent to 52.5 percent), reversing the trend observed through the previous nine years.AvailabilityMarijuana is the most readily available illegal drug in the United States. Further, the NDIC reports an upswing in the number of investigations, arrests, and seizures in and around high schools, indicative of the ease with which youth can access this dangerous drug.38 The majority of the marijuana in the U.S. was foreign-grown. Mexico, Colombia, and Jamaica are primary source nations; Canada, Thailand, and Cambodia are secondary sources.39 Although the full scope of domestic marijuana cultivation is unknown, the National Drug Intelligence Center indicates that every state in the nation reports some level of indoor and outdoor cultivation.40 The DEAs Domestic Cannabis Eradication/Suppression Program show that authorities eradicated 2.2 million outdoor marijuana plants in 1998 and 3.2 million in 1999. Further, preliminary DEA reporting indicates that 1.4 million plants had been eradicated in just 30 states between January and September 2000. In 1999,the leading states for outdoor cannabis growthCalifornia, Hawaii, Kentucky, and Tennesseeaccounted for nearly 2.49 million cultivated outdoor plants. This represents roughly 75 percent of the total number of plants eradicated last year.41 In the past year, the Department of Agriculture and the U.S. Forest Service report an escalation of in the amount of marijuana cultivation on federal public land632,310 plants destroyed in 2000 up from 490,300 in 1999.42Indoor cultivation of marijuana provides a controlled environment conducive to year-round production of high-potency sinsemilla* and can be accomplished in a variety of settings from closets to elaborate greenhouses. Indoor cannabis cultivators frequently employ advanced agronomic practices such as cloning; hydroponics; and automatic light metering, irrigation, fertilizing, and insecticides to enhance the rate of growth. Nationally, drug law-enforcement authorities seized 208,027 indoor-grown marijuana plants in 1999, a slight decrease from the 232,839 seized in 1998.43 Law enforcement speculates that this decrease may be indicative of the increased sophistication in clandestine cultivation methods employed by growers.Prices for commercial-grade marijuana have remained relatively stable over the past decade, ranging from approximately $400 to $1,000 per pound in U.S. Southwest border areas to between $700 and $2,000 per pound in the Midwest and Northeast United States. According to data from the Potency Monitoring Project at the University of Mississippi, the tetrahydrocannabinol (THC) content of commercial-grade marijuana rose from under 2 percent in the early 1980s to 4.43 percent in 1998 and to 4.87 percent in 1999.44 THC levels in sinsemilla increased from 12.41 percent in 1998 to 13.55 percent in 1999. As of June 2000, the average TCH potency level for commercial grade domestic marijuana increased to 5.58 percent. The highest concentration of THC found in a marijuana sample submitted for ysis was 33.12 percent in a seizure submitted by the Oregon State Police to the University of Mississippi.45Cocaine Overall usageCocaine use stabilized in the United States between 1992 and 1999. Past-month cocaine use declined from 3 percent of the population in 1985 to 0.7 percent in 1992 and did not change significantly through 1999, in which 0.8 percent of the population reported past-month use.46 Despite the stabilization of use, the number of new users has increased. In 1998, there were 934,000 new users of cocaine. This number represents a 37 percent increase from 1990, when there were 683,000 new users.47 This level is still lower than during the 1980s when the new initiate figures were between one and 1.6 million per year.Use among youthIn 1999, 0.7 percent of youths, age 12-17 reported past-month use of cocaine. This number is not significantly different from the 0.8 percent reported for 1998 and the 1 percent reported in 1997; it is however, significantly higher than the 0.3 percent reported in 1994.48 The 2000 MTF reports that use of cocaine showed significant declines in 2000 in several categories among 12th graders. Specifically, past-year use of any type of cocaine declined from 6.2 percent in 1999 to 5.0 percent in 2000; past-year crack use decreased from 2.7 percent to 2.3 percent and past-year use of powder cocaine declined 24 percent, from 5.8 percent to 4.5 percent. The rate of initiation among youths age 12-17 increased from 5.1 in 1992 to 13.1 in 1996, and has remained level since then.49AvailabilityCocaine continues to be readily available in nearly all major metropolitan areas.50 The Mid-Year 2000 report of the Interagency Assessment of Cocaine Movement estimated that 242 metric tons of cocaine arrived in the United States in the first six months of 2000, an almost 40 percent increase over the 174 metric tons estimated to have arrived over the same period in 1999.51 A significant amount of the cocaine smuggled into the U.S. traveled through the Mexico-Central America Corridor.52 In recent years, domestic cocaine availability has been estimated at 288 pure metric tons for 1996, 312 metric tons for 1997, 291 metric tons for 1998 and 276 metric tons for 1999.53 According to most recent data, the average wholesale purity of cocaine remained relatively stable since 1990between 65 and 80 percent (with retail purity varying widely according to local supply and demand).54 Law-enforcement agencies throughout the nation continue to report serious problems with cocaine, crack, and related criminal activity. The National Drug Intelligence Center (NDIC) observes that the production and availability of crack is directly linked to the availability of cocaine powder.* Despite the stabilization of domestic cocaine use between 1992 and 1999, improvements in the criminal distribution and production of cocaine and crack have increased their availability in suburban and rural communities.55HEROIN Overall usageHeroin use in the United States has stabilized since 1992. Approximately, 0.1 percent of the household population reported past-month use of heroin in 1999, which is the same as the 0.1 percent that reported in 1994,1995,1996, and 1998 (0.2 percent of the population reported past-month use in 1997).56 An estimated 149,000 new users were reported in 1998, which is not statistically different than the 189,000 new users in 1997 or the 132,000 new users in 1996.57 Injection remains the most prevalent method of ingestion, particularly for low purity heroin. The increased availability of high purity heroin and the fear of injection from the Human Immunodeficiency Virus (HIV), sometimes transmitted through shared needles, has made snorting and smoking the drug more common. In addition to avoiding the negative stigma of intravenous drug use, some teenager heroin users smoke or snort heroin under the false impression that such routes of admission are less addictive.Use among youthIn 1999, past-month use of heroin among youth age 12-17, was 0.1 percent, not statistically different from the 0.2 percent reported in 1995-1998.58 The rate of heroin initiation for youth increased from less than one per 1,000 potential new users during the 1980s to nearly two per 1,000 potential new users between 1996 through 1998.59 Among the estimated 471,000 persons who used heroin for the first time during 1996 through 1998, a quarter (125,000) were under age 18. The 2000 MTF60 reports that past-year use among 8th graders peaked in 1995 and 1996 and has declined 21 percent, from 1.4 percent to 1.1 percent in 2000. Past-year use among 10th graders peaked in 1997 and has remained at that level each year through 2000. The peak year for past-year and past-month use among 12th graders, however, was 2000 at 1.5 percent. This number represents an increase of 275 percent from the 10-year low of 0.4 percent in 1991. AvailabilityHeroin purity is a reflection of the drugs availability. Unprecedented retail purity and low prices in the United States indicate that heroin is readily accessible.61 When the drug is hard to find, it is cut with other substances. High purity levels may also reflect changes in trafficking patterns. A decrease in the number of middlemen involved in getting South American and Mexican heroin to customers bypasses mid-level individuals and minimizes cutting and adulteration that historically has reduced heroin purity. For example, the Central Florida High Intensity Drug Trafficking Area reports heroin sampled from 1999 seizures with purity levels up to 97 percent.62 Consumption-based modeling estimates that U.S. heroin availability in 2000 will remain unchanged from the 1999 level of 12.9 metric tons; meanwhile, the average price per gram remained constant at just over $1,000.63 A supply-based approach has also been used to estimate heroin availability, applying data from DEAs Heroin Signature Program and potential production estimates. This methodology has resulted in an estimate of 16 metric tons of domestically available heroin in 1999an uncertain figure due to the lack of information on Latin American poppy cultivation.METHAMPHETAMINE General Methamphetamine is a highly addictive stimulant that can be manufactured using products commercially available anywhere in the United States. The stimulant effects from methamphetamine can last for hours, instead of minutes as with crack cocaine. Many methamphetamine users try to alleviate the effect of a methamphetamine crash by buffering the drug with other substances like alcohol or heroin. As is the case with heroin and cocaine, methamphetamine can be snorted, smoked, or injected. The chemicals used in producing methamphetamine are extremely volatile, and the amateur chemists running makeshift laboratories can cause deadly explosions and fires. The by-products of methamphetamine production are extremely toxic and present a threat to the environment. The El Paso Intelligence Center estimates that clandestine methamphetamine laboratories, each of which costs between $3,100 and $150,000 to clean up (depending on size), produce as much as twenty metric tons of toxic waste each year.64 Methamphetamine traffickers display no concern over environmental hazards when manufacturing the drug and disposing of its chemical by-products.Overall usageIn 1998, there were an estimated 378,000 new methamphetamine users, up from 149,000 in 1990. For young adults age 18-25, there was an increase in the rate of first use between 1990 and 1998 (from 3.0 to 6.1 per 1,000 potential new users).65 While use of this drug is spreading east, methamphetamine continues to be more common in the western U.S. The number of hardcore methamphetamine users in 1998 was estimated to be 356,000 compared with 310,000 in 1997.66Use among youthThe rate of first use among youths age 12-17 rose significantly from 1990 to 1998, from 2.2 to 7.4 per 1,000 potential new users.67 The 2000 MTF reports slight declines, among 8th, 10th, and 12th graders, in annual use of methamphetamine between 1998 and 2000. However, these declines are not statistically significant. CASA reports that past-month methamphetamine use for eighth graders in rural areas is 5.1 percent versus 2.5 percent for their peers in larger cities.68AvailabilityMethamphetamine is the most prevalent synthetic drug clandestinely manufactured in the United States.69 Historically, the methamphetamine problem has been concentrated in the west and southwestern United States. It is now in most major metropolitan areas (except in the northeast) and is emerging in small towns and rural communities.70 Methamphetamine manufacturing is experiencing unprecedented growth. The total number of clandestine laboratories seized by federal, state, and local law-enforcement agencies in CY 1999 totaled 7,544. Between January and October 2000, these agencies seized 4,600.71 Clandestine laboratory seizures by the DEA alone increased over 41 percent from 1,502 in CY 1998 to 2,122 in CY 1999. Between January and October 2000, DEA had seized 1,741 labs.72 In the Midwest, lab seizures made by state and local authorities, working in Midwest HIDTA, more than tripled between CY 1997 to 1999.73 This increase in seizures may reflect efforts by individuals operating small clandestine laboratories on the periphery of the methamphetamine market to exploit demand for the drug and satisfy personal use.74 According to consumption-based modeling estimates, U.S. methamphetamine availability at the retail level increased from 11.9 metric tons in 1997 to 15.9 metric tons in 1998. For 1999 and 2000, methamphetamine availability is estimated at 15.5 metric tons. The average retail price per pure gram remained constant at approximately $140.75MDMA GeneralMDMA (3,4-methylenedioxymethamphetamine), commonly called ecstasy or XTC, is a synthetic, psychoactive drug possessing stimulant and mild hallucinogenic properties. The substance gained popularity in the late 1980s and early 1990s as an alternative to heroin and cocaine. MDMA customarily is sold and consumed at raves, which are all-night parties and concerts. Use appears to be widespread within virtually every major U.S. city with indications of trafficking and abuse in smaller towns. MDMA is considered a designer drug, which is a substance on the illegal market that is a chemical ogue or variation of another psychoactive drug. MDMA is similar in stimulant properties to amphetamine or methamphetamine, and it resembles mescaline in terms of hallucinogen qualities. Illicitly marketed as a feel good drug, it has been dubbed the hug drug. Risks associated with MDMA include severe dehydration and death from heat stroke or heart failure.76 A review of several studies by the National Institute on Drug Abuse (NIDA) concludes that heavy MDMA users have significant impairments in visual and verbal memory compared to non-users.77 Further findings by Johns Hopkins University and the National Institute of Mental Health (NIMH) suggest that MDMA use may lead to impairment in other cognitive functions, such as the ability to reason verbally or sustain attention.78Overall usageEcstasy is often used in conjunction with other drugs and is extremely popular among some teenagers and young professionals. Furthermore, growing numbers of usersprimarily in the Miami and Orlando areascombine MDMA with heroin, a practice known as rolling. If this trend continues, MDMA may become a gateway drug that leads to the consumption of a variety of other substances. Emergency room mentions increased from sixty-eight in 1993 to 2,200 in 2000.79 MDMA also suppresses the need to eat, drink, or sleep and subsequently allows people to stay up all night, dancing at raves.80Use among youthMDMA use is widespread, particularly among white adolescents in the Northeast. The Partnership for a Drug-Free Americas Attitude Tracking Survey reports that teen trial use of ecstasy has doubled since 1995. Trial use of MDMA is now on par with teens trial use of cocaine, crack, and LSD; more teens in the United States have now tried ecstasy than heroin. Trial use of ecstasy has increased from five percent in 1995 to seven percent last year to ten percent this year. Nearly one-third (32 percent) of teens in 2000 reported they had close friends who used ecstasy, up significantly from 24 percent in 1998 and 26 percent in 1999. The 2000 MTF study reports that past-year use of ecstasy by 8th graders increased 82 percent (from 1.7 percent to 3.1 percent) between 1999 and 2000; past-month use increased 75 percent (from 0.8 percent to 1.4 percent). Past-month use of MDMA by 10th graders increased 44 percent (from 1.8 percent to 2.6 percent) and past-year use by 12th graders increased 46 percent, from 5.6 percent to 8.2 percent. Among 12th graders, the perceived availability of ecstasy rose sharplyan increase of 28 percent (11.3 percentage points, from 40.1 percent to 51.4 percent). This is the largest one-year percentage point increase in the availability measure among 12th graders for any drug class in the 26-year history of the MTF study. AvailabilityNumerous data reflect the increasing availability of MDMA in the United Statesin metropolitan centers and suburban communities alike.81 Law-enforcement agencies consider MDMA to be among the most immediate threats to youth and to law enforcement.82 Law-enforcement agencies report a surge in MDMA seizures between 1998 and 2000. Domestically, the DEA seized 174,278 MDMA tablets in 1998, over a million in 1999, and more than 949,000 between January and October 2000.83 Similarly, the United States Customs Service (USCS) reports that its MDMA seizures surged 165 percent between FY 1999 and 2000. USCS officers seized approximately 9.3 million ecstasy tablets in FY 2000, compared to 3.5 million in FY 1999 and 750,000 in FY 1998.84 Further signaling increased availability, U.S. Customs reports that individual shipments of MDMA are increasing in size and weight, from under ten pounds several years ago to some in excess of 1,100 pounds in July 2000.85 Production of MDMA is centered in Europe (predominately Belgium, the Netherlands, and Luxembourg).86 Further encouraging the importation of MDMA to the United States is the drugs high profit marginproduction costs are as low as two to twenty-five cents per dose while retail prices in the U.S. are between twenty dollars and forty-five dollars per dose.87 Increasing involvement of organized criminal groupsparticularly Western European, Russian, and Israeli crime syndicatesindicates a move toward professionalization of MDMA markets.88 More recently, law-enforcement agencies report that drug organizations based in the Dominican Republic may be spearheading an effort to step-up MDMA trafficking in the Caribbean.89 Law-enforcement reports indicates criminal groups that have proven capable of producing and smuggling significant quantities of MDMA into the United States are expanding distribution networks from coast to coast.90 Finally, MDMA has spread into branches of the military. The Air Force reports that the number of its internal investigations involving MDMA nearly doubled from 35 in 1998 to 66 in 1999. Between January and November 2000, this number skyrocketed to 337 cases.91INHALANTS GeneralThe term inhalants refers to more than a thousand different household and commercial products that can be intentionally abused by sniffing or huffing (inhaling through ones mouth) for an intoxicating effect. These products are composed of volatile solvents and substances commonly found in commercial adhesives, lighter fluids, cleaning solutions, and paint products. Their easy accessibility, low cost, and ease of concealment make inhalants one of the first substances abused by many young Americans. Overall usageIn 1999, approximately 0.3 percent of the population age 12 or older reported past-month use of inhalants. This number has been unchanged since 1998. There were an estimated 991,000 new inhalant users in 1998, up from 390,000 in 1990.92 Inhalants can be deadly, even with first-time use. Use among youthIn 1999, 0.9 percent of youths age 12-17, reported past-month use of inhalants. This number represents a statistically significant decline from the two percent reported in 1997 and the 1.6 percent reported in 1994.93 The rate of first use among youths age 12-17 rose significantly from 1990 to 1998, from 11.6 to 28.1 per 1,000 potential new users.AvailabilityInhalant abuse typically involves substances readily available in any home or school. Examples include: adhesives (airplane glue, rubber cement), aerosols (spray paint, hair spray, air freshener), cleaning agents (spot remover, degreaser), food products (vegetable cooking spray, canned dessert topping), gases (butane, propane), solvents and gases (nail polish remover, paint thinner, typing correction fluid, lighter fluid, gasoline).OTHER ILLICIT SUBSTANCES Overall usageThe 1999 NHSDA reports that past-month use of hallucinogens among persons age 12 or older has remained relatively stable since 1995. However, the 0.7 percent who used hallucinogens in 1999 represents a statistically significant increase over the 0.5 percent in 1994.94 The rate of current hallucinogens use did not change significantly between 1997 and 1999 (0.8 percent versus 0.7 percent, respectively). Data are not available to describe emerging threats from other illicit substances like ketamine, gamma-hydroxybutyrate (GHB), gamma-butyrolactone (GBL), and rohypnol. Nevertheless, ethnographers continue to report cafeteria use* of hallucinogenic or psycho-sedative drugs like ketamine, LSD, and GHB. The increasing popularity of raves within the dance culture has sparked a resurgence of designer drugs. Steroid use is becoming more prevalent among adolescents. The repercussions of steroid use are enormous. Among teens, steroid use can lead to an untimely halting of growth due to premature skeletal maturation and accelerated puberty changes. All steroid users risk liver tumors, high blood pressure, severe acne, and trembling.95Use among youthThe 1999 NHSDA reports that past-month use of hallucinogens has remained relatively stable since 1994; the current percentage for 1999 is 1.6 percent, down slightly (not statistically significant) from 2.0 percent in 1996.96 The incidence rate of using prescription-type pain relievers non-medically has increased from 6.3 per 1,000 potential new users in 1990 to 32.4 per 1,000 potential new users in 1998.97 The MTF reports that despite a sharp rise in the use of MDMAwhich the MTF classifies as an hallucinogenpast-year and past-month use of hallucinogens, in general, showed declines among 10th and 12th graders. Specifically, past-year and past-month use among 12th graders was down 14 percent (from 9.4 percent to 8.1 percent) and 26 percent (from 3.5 percent to 2.6 percent), respectively. Past-month use among 10th graders was down 21 percent (from 2.9 percent to 2.3 percent). Past-year use of LSD among 12th graders declined ten percent (from 8.1 percent to 6.6 percent) and past-month use declined 44 percent (from 2.7 percent to 1.6 percent).AvailabilityThe Community Epidemiology Working Group reports that designer drugs in most parts of the country are easily obtainable and used primarily by adolescents and young adults at clubs, raves, and concerts.98 GBL and 1,4-butanediol (both chemical precursors to GHB) are easily obtainable over the Internet. Individuals seeking illicit substances can also exploit Internet sites specializing in the sale of veterinary pharmaceuticals and prescription medications. Controlled Substances DiversionAttention must be paid to the misuse of a great variety of pharmaceuticals, narcotics, depressants, and stimulants. Manufactured in the United States and overseas to meet legitimate medical needs, these drugs are subject to diversion into the illicit trade.99 Of the 2.8 billion prescriptions written in 1999, approximately 457million were for controlled substances; this is up from 254 million in 1998. An unknown quantity is diverted into illicit traffic, but legally controlled substances account for over 30 percent of all reported deaths and injuries associated with drug abuse.100 In 1999, the United States Customs Service seized 9,275 packages containing prescription drugsabout 4.5 times as many as in 1998. The number of pills and tablets impounded by the Customs Service jumped to 1.9 million from 760,720 in 1998.101 DEA had 723 arrests for pharmaceutical diversion during the first three-quarters of FY 2000.102 The availability of prescription-free pharmaceuticals via the Internet and overseas pharmacies represents an emerging challenge for the United States.103 This challenge has been exacerbated by Internet pharmacies shipping medications via express consignment operators (ECO; i.e. FedEx, UPS, DHL, etc.) rather than the US Postal Service. USCS prescription drug seizures from ECOs jumped from 294 in fiscal year 1998 to 518 in fiscal year 1999.Precursor ChemicalsOf all the major drugs of abuse, only marijuana is available as a natural, harvested product. The others must be manufactured using various chemicals and techniques. Illegal drug trafficking is heavily dependent on the availability of commodities from legitimate sources in order to obtain the substances required for criminal production or synthesis.104 Traffickers are able to obtain chemicals in large quantities at relatively low cost as a result of ignorance, indifference, or collusion by pharmaceutical distributors and international brokers.105 The problem of chemical diversion continues to be pursued through various legislative measures, cooperative law-enforcement programs, and participation in multilateral agreements, and operational chemical control, and enforcement initiatives. Aggressive action by federal law-enforcement agencies continues in order to prevent the diversion of pseudoephedrine cold tablets to methamphetamine manufacturing laboratories.THE LINK BETWEEN DRUGS AND CRIME The problem of drug-related crime in the United States is not going away. More than 1.5 million Americans were arrested for drug-law violations in 1999, and drug abuse violations and alcohol-related arrests combined accounted for an estimated 31 percent of the overall arrests in 1999. However, a comparison of data for drug abuse violations indicates that in 1999 the total number of arrests for these offenses were 2 percent lower than in 1998. In 1999, 19.5 percent of drug law violations were for the sale or manufacturing of illegal drugs and 80.5 percent were for possession of illegal substances.106 Over 80 percent of all jail and state prison inmates said they had previously used drugs, and over 60 percent reported having regularly used drugs, i.e., and at least once a week for at least a month. BJS surveys have revealed that, among inmates reporting past regular drug use, approximately 1 in 7 jail inmates and 1 in 3 state inmates had participated in substance abuse programs or treatment since admission.107 In order to break the link between drugs and crime, the criminal justice system must work with treatment agencies to decrease the demand for illegal drugs by providing substance abusers with the skills to become clean and sober.Arrestees frequently test positive for recent drug useThe National Institute of Justices (NIJs) Arrestee Drug Abuse Monitoring (ADAM) drug-testing program collected data from adult male arrestees in 34 sites. All 34 sites reported that at least 50 percent of adult males arrested tested positive for at least one drug.108 This cohort tested positive most frequently for marijuana in 24 of the 34 reporting sites, and cocaine was detected most frequently in the other 10 sites. Therefore it appears that despite the popularity of other drugs such as methamphetamine and PCP in certain parts of the country, marijuana is still the drug of choice for most male arrestees. This trend was particularly apparent among young males. In 8 of the 34 sites, more than 70 percent of the 15- to 20- year-old male arrestees tested positive for marijuana.109 Additionally, the average rate for multiple drug use by adult males remained constant from 1998 to 1999.110ADAM collected data from adult female arrestees in 32 sites. Among female adult arrestees, the average rate of drug use was three percent higher in 1999 than in 1998. For women, cocaine, not marijuana, was detected most often in 25 of the 32 sites.111 It also appears that multiple drug use is growing in popularity among female offenders. In 1999, the median rate of multiple drug use for female adults was up three percent from 1998. Multiple drug use seems to be more common among particular types of drug users which may help explain why multiple drug use has increased among women but not among men. Proportionally, female arrestees tested positive for opiates more than male arrestees, and in the entire adult ADAM sample, more than three-fourths of the arrestees who tested positive for opiates also tested positive for some other drug.112Information on juvenile male detainees was obtained in nine sites, and six sites reported data for juvenile female detainees.113 All nine sites reported similar drug use trends. Marijuana was the most commonly used drug for both juvenile male and female detainees, with cocaine use a distant second. None of the nine sites reported any significant opiate use for male or female juveniles.114ADAM data suggests that methamphetamine use is much more prevalent in the western part of the United States. In Atlanta, both male and female results were less than one percent positive for methamphetamine115 and in New York City both male and female arrests had rates of zero percent.116 These rates are drastically different from the adult female methamphetamine-positive rate of 36 percent in San Diego and 28 percent for males in Sacramento.117 Actually, in most sites where methamphetamine use was substantial, females tested positive for its use at higher rates than males.118State and federal prison authorities had 1,284,894 people physically in their custody at year-end 1999.119 In addition to state and federal prisons, there were 1,621 inmates in 69 Indian country jails and detention centers, and 105,790 juveniles were held in 1,121 public and 2,310 private residential placement facilities. The U.S. Immigration and Naturalization Service (INS) reported 7,675 detainees were held in INS-operated facilities or other confinement facilities, and at year-end 1999, U.S. military authorities held 2,279 prisoners in 65 facilities and 18,394 inmates held in U.S. territorial prisons.120 Thus, [overall,] the U.S. incarcerated 2,026,596 persons at year-end 1999the equivalent of 1 in every 137 residents in the U.S. and its territories.121 There are still significant racial disparities among these prison populations. In 1999 the rate among black males in their late twenties reached 9,392 prisoners per 100,000 residents compared to 3,126 among Hispanic males and 990 among white males.122Prison incarceration rates have increased drastically over the last decade. Since 1990 the number of sentenced prisoners per 100,000 residents has risen from 292 to 476, even though in 1999 the prison population grew at the lowest rate since 1979.123 During 1999 the number of female prisoners rose by 4.4%, totaling 90,668 at year-end, which was greater than the increase in male prisoners (3.3%). The number of males prisoners was 1,276,053 at the end of 1999.124 State prison population growth rates in the last ten years can be partly explained by declining rates of release of inmates and increases in the amount of time served. The rise of federal prison populations can be explained by increases in number of convictions in U.S. District Courts, increases in the number of those sentenced to a period of incarceration, and an increase in the average length of custodial sentences.125Drug offenders accounted for the largest source of the total growth among female inmates (36%), compared to 18% among male inmates.126 Nonetheless, drug offenders account for only 19% of state prison population growth while large numbers of violent offenders are responsible for 51% of the growth.127 However, the number of parole violators who are returned to prison for drug offenses has doubled since 1990. Drug offenders also account for more than half (52 percent) of the total rise in the number parolees who have their parole revoked and are returned to State prison. The number of drug offending parolees returned to prison increased from 30,900 in1990 to 68,600 in 1998.128Another group of inmates recently studied is military veterans who are serving time in state prisons and local jails. In 1998, 225,700 of the nations veterans were incarcerated. While data appears to show that veterans are more likely to be violent offenders than other inmates are, they are not as likely as other inmates to be convicted of drug offenses are. In fact, they report lower levels of recent drug abuse and were less likely than other inmates to report having used drugs in the month before the offense for which they were incarcerated. They were, however, more likely than other inmates to report a history of alcohol abuse.129 As for veterans held in military correctional facilities at year-end 1997, sex offenders accounted for 1 in 3 prisoners. That same year, 20 percent of veterans incarcerated in military facilities were serving time for drug offenses.130In 1998 an estimated 7 in 10 local jail inmates (or 417,000 inmates) had used drugs regularly or had committed a drug offense. This number compares to 261,000 jail inmates in 1989 who regularly used drugs or had committed a drug offense. In addition, more than half of both jail (55 percent) and state prison (57 percent) inmates reported they had used drugs in the month before the offense.131 It is estimated that 61,000 (16 percent) convicted jail inmates committed the current offense in order to obtain money to buy drugs, and approximately 138,000 convicted jail inmates were under the influence of drugs at the time they perpetrated their crimes. At the time of their offense, about 72,000 convicted jail inmates had used marijuana or hashish and 59,000 had used crack cocaine. Therefore, the link between drugs and crime is undeniable and to decrease crime rates, drug use must also be decreased.THE CONSEQUENCES OF ILLEGAL DRUG USE Increased crime, domestic violence, accidents, illness, lost job opportunities, and reduced productivity can be linked to illegal drug use. Every year Americans of all ages engage in unhealthy, unproductive behavior as a result of substance abuse.Economic lossIllegal drugs exact a staggering cost on American society. In 1995, they accounted for an estimated $110 billion in expenses and lost revenue.132 This public-health burden is shared by all of society, directly or indirectly. Tax dollars pay for increased law enforcement, incarceration, and treatment to stem the flow of illegal drugs and counter associated negative social repercussions. NIDA estimated that health-care expenditures due to drug abuse cost America $9.9 billion in 1992 and nearly twelve billion dollars in 1995.133Drug-related deathsIllegal drug use is responsible for the deaths of thousands of Americans annually. In 1997, the latest year for which death certificate data are published, there were 15,973 drug-induced deaths in America.134 Drug-induced deaths result directly from drug consumption, primarily overdose.* In addition, other causes of death, such as HIV/AIDS, are partially due to drug abuse. Using a methodology that incorporates deaths from other drug-related causes, ONDCP estimates that in 1995 there were 52,624 drug-related deaths. This figure includes 14,218 drug-induced deaths for that year, plus mortalities from drug-related causes.** SAMHSAs Drug Abuse Warning Network (DAWN) collects data on drug-related deaths from medical examiners in forty-one major metropolitan areas. DAWN found that drug-related deaths have steadily climbed throughout the 1990s.135Drug-related medical emergenciesMore than two thirds of people suffering from addiction see a primary-care or urgent-care physician every six months, and many others are seen regularly by medical specialists.136 The Drug-Abuse Warning Network (DAWN) survey provides information on the health consequences of drug use by capturing data on emergency department (ED) episodes that are related to the use of an illegal drug or the nonmedical use of a legal drug.* It is important to remember that DAWN data show only one dimension of the total consequences of drug use. It does not measure the prevalence of drug use in the population, the untreated health consequences of drug use, or the impact of drug use on health-care settings other than hospital EDs.The number of emergency department drug episodes has been increasing over the 1990s. In 1999, there were an estimated 554,932 drug-related ED episodes in the United States, compared to 371,208 in 1990a 49 percent increase.137 Alcohol in combination with drugs continued to be the most frequently mentioned (196,277) in ED reports.138 Cocaine continued to be the most frequently mentioned illicit drug, comprising 30 percent of episodes (168,763 mentions) in 1999. Cocaine was followed in frequency by marijuana/hashish (16 percent, 87,150 mentions) and heroin/morphine (15 percent, 84,409) In 1999, marijuana/hashish mentions exceeded heroin/morphine mentions, changing a rank ordering of illicit drug mentions that had been constant since 1990.139Spreading of infectious diseasesAmong the serious health and social issues related to drug abuse is the spread of infectious diseases. Drug abuse is a major vector for the transmission of HIV and other sexually transmitted diseases, hepatitis, and tuberculosisand for the infliction of violence.140 Chronic users are particularly susceptible to infectious illnesses and are considered core transmitters. Of the 17,537 cases of tuberculosis reported to CDC in 1999, 2.6 percent were drug-related, down from 2.9 percent in 1999.141 There was a decline in injection drug-related AIDS cases between 1998 and 1999 among men from 26 percent in 1998 to 25 percent in 1999; among women, this number declined from 29 percent in 1998 to 27 percent in 1999.142 No new data for Hepatitis B have been yzed for this report, although in the past the number of Hepatitis B cases has been declining.143HomelessnessDrug abuse is a contributing factor in the problem of homelessness. Although only a minority (thirty-one percent) of the homeless suffer from drug abuse or alcoholism exclusively, inappropriate use of these substances compounds other diseases for many homeless people with mental illness who are dually diagnosed.144 Substance abusers with other illnesses experience homelessness of a longer duration and are more likely to be chronically without a residence.145 Homelessness generates tremendous social and human costs. The general public is poorly served by having people with serious and chronic illnesses, such as addiction, living on the street. Further, addiction treatment tends to be less effective when recipients lack stable housing.146 Of those who are currently homeless, twenty-five percent have ever been treated for drug abusethirty-six percent have received inpatient treatment and twenty-seven percent have received outpatient care.147 Thirty-eight percent of those who are currently homeless have received inpatient treatment three or more times.148 Homeless persons may be able to obtain residential treatment but with no recovery venue other than a shelter, such treatment is often ineffective.Drug use in the workplaceAccording to the 1999 NHSDA, current employment status is highly correlated with rates of illicit drug use. An estimated 16.4 percent of unemployed adults (age 18 and older) were current illicit drug users in 1999, compared with 6.5 percent of full-time employed adults and 8.6 percent among part-time employed adults. More than 77 percent of current illicit drug users aged 18 and older are employed full or part-timenumbering approximately 9.42 million workers.Other significant workforce data from the1999 NHSDA indicate illicit drug use is also highly correlated with age and educational status. Among youth aged 12 to 17 years, 10.9 percent had used an illicit drug within the 30 days prior to interview. Among persons aged 18-25 years, 17.1 percent reported current use. The rates of use generally decline in each successively older age group, with only 1.7 percent of those aged 50-65 reporting current illicit use. An exception to this pattern is the 8.6 percent rate reported by the 40-44 year old age group, somewhat higher than the 6.6 percent rate for persons aged 35-39 years and the 4.1 percent for those aged 45-49. Members of the cohort of 40-44 year olds were teenagers during the 1970s, a period when drug use incidence and prevalence rates rose dramatically.Performance Measures of Effectiveness (PME) The stated intent of the National Drug Control Strategy is to reduce drug use and availability by 50 percent and decrease health and social consequences a minimum of 25 percent by 2007 (compared to 1996 baseline levels). The Strategy charts the course for accomplishing this end. Progress toward the Strategys five goals and thirty-one objectives must be continuously assessed in order to gauge success or failure and adjust the Strategy accordingly. ONDCP has consulted with Congress, federal drug-control agencies, state and local officials, private citizens, and organizations with experience in demand and supply reduction to develop a Performance Measurement of Effectiveness (PME) system to gauge national drug-control efforts.The PME system: (1) assesses the effectiveness of the Strategy and its supporting programs, (2) provides information to the entire drug-control community on what needs to be done to refine policy and programmatic directions, and (3) assists with drug-control budget management. The PME system fulfills congressional guidelines that the National Drug Control Strategy contain measurable objectives and specific targets to accomplish long-term quantifiable goals. These targets and annual reports are intended to inform congressional appropriations and authorizing committees as they restructure appropriations in support of the Strategy to ensure that resources necessary to attain ambitious long-term performance goals are provided.The nucleus of the PME system consists of twelve impact targets that define measurable results to be achieved by the Strategys five goals. There are five impact targets for demand reduction, five for supply reduction, and two for reducing the adverse health and criminal consequences associated with drug use and trafficking. Eighty-five additional targets further delineate mid- (2002) and long-term (2007) targets for the Strategys thirty-one objectives. They are stretch targets in that they require progress above that attained in previous years. This system is in accordance with recommendations from the National Academy of Public Administration, the General Accounting Office, and other organizations advocating good government practices. The performance system is described in detail within a companion volume to this StrategyPerformance Measures of Effectiveness 2001. Click to see its PDF versionProgress toward each goal and objective is assessed using new and existing data sources. The Monitoring The Future (MTF) and the National Household Survey on Drug Abuse (NHSDA), for example, both estimate risk perception, rates of current use, age of initiation, and lifetime use for alcohol, tobacco, and most illegal drugs. The State Departments annual International Narcotics Control Strategy Report (INCSR) provides country-by-country assessments of initiatives and accomplishments. INCSR reviews statistics on drug cultivation, eradication, production, trafficking patterns, and seizure along with law-enforcement efforts including arrests and the destruction of drug laboratories. The Drug Control Research, Data, and Evaluation Committee (an advisory committee to the ONDCP Director), Subcommittee on Data, Research, and Interagency Coordination is developing additional instruments and measurement processes required to address the demographics of chronic users, domestic cannabis cultivation, drug availability, and other data shortfalls.149The measurement part of the PME System is now in place although there is more work to be done to streamline the data collection process and fill the data gaps. Refinement of the targets and measures is an ongoing process with more dramatic changes likely in a new Administration. Nonetheless, ONDCP designed the PME System to be flexible so that it could accommodate such changes, by incorporating the key elements of any drug control strategyprevention, law enforcement, treatment, interdiction, and source country efforts. The weighting, especially for resource allocation, may change but these components are likely to be included in any new strategy.Recognizing that measuring the success of the national drug control community does not automatically mean achievement of these ambitious, long-term PME targets, ONDCP embarked upon a deliberate process of developing small groups of stakeholders committed to meeting these targets. Using tools of Performance Management, we have brought together interagency working groups to focus on identifying what needs to be done between now and 2007 in order to meet the targets, which agencies are responsible, and how to monitor this process. These groups have developed logic models and action plans for the PME targets: these are staff working documents that will be calibrated regularly to reflect budget realities and evaluation findings. We have begun the process of linking these action plans to the budget. We have just started the process of nationalizing the process by involving key participants from state, local, and private sectors. For the Strategy to be most effective, other levels of government must share the sense of community and joint vision at the federal level. By partnering with state and local governments, we gain a better understanding of the trends and obstacles communities, and neighborhoods. Click to see its PDF versionONDCP has pioneered formal performance partnerships between the federal government and state or municipal governments to coordinate policy actions and share lessons-learned to enhance national efforts toward reducing illicit drug use and drug-related crime and violence. Performance partnerships operate on the principle of mutual need for cooperation to achieve common goals and a belief that target-focused collaboration will improve the effectiveness of drug control activities at all levels of government. ONDCP has initiated three Performance Partnerships, two with the states of Oregon and Maryland and a third with the City of Houston, Texas.Finally, it is extremely rare to find interagency action plans, based on target-focused logic models, in a mission area that cuts across several agencies. The nationalizing process, although time-consuming and iterative, will widen the debates on policies and institutions. But the dialogue will focus on how best to achieve the PME targets, that is, it will be target-focused. ONDCP will continue to use these logic models and action plans to develop cohesive national communities committed to developing agendas and resource allocation decisions around the targets of the national Strategy.