Illicit Drug Use Significantly Underreported

Survey methods may lead to varying responses to questions related to drug use.

Hundreds of illicit, psychoactive drugs have been created in recent years. Understanding the prevalence of these drugs is key to developing widespread prevention efforts, but identification of use has become difficult, according to a study published by the American Journal of Drug and Alcohol Abuse.

For example, synthetic cathinones—commonly known as bath salts—are stimulants that are similar to amphetamines. These drugs have largely been a mystery to researchers. Alpha-PVP—known as Flakka—is a synthetic cathinone that has been linked to numerous incidences involving crimes, especially in Florida.

Currently, monitoring the use of illicit drugs relies on data from drug-related seizures and overdoses. In addition to limited data, known drugs are commonly combined with 1 or more substances, thus creating a new drug. These factors add a layer of difficulty in determining the use of new drugs from traditional survey methods, according to the study.

"Research was needed to determine how to ask about use of these new drugs on health surveys," said Joseph Palamar, PhD, MPH. "There are hundreds of new drugs, and many go by multiple street names, so it is difficult to accurately ask about use on surveys."

To fill the limitations of current methods, the authors explored the impact of gate questions to reduce the burden on individuals when given lists of substances. Gate questions are simple yes or no questions about whether an individual has ever used a particular substance in a drug class.

If the individual answered “yes” to a question, the investigator then asked follow-up questions, while a “no” answer skipped the follow-up questions and moved on to another drug category, according to the study.

"We know that gate question methods work well on national surveys, but these studies don't ask about hundreds of new drugs, so it was unknown how survey participants would respond," Dr Palamar said. "In addition, it is likely that most participants on major drug surveys have at least heard of the majority of drugs queried. Lists of potentially unfamiliar drugs can confuse participants."

Included in the study were 1048 individuals who attended electric dance music (EDM) parties in New York City during the summer of 2016. Participants were asked about drug usage and were randomized to receive surveys with or without gate questions.

Since the authors were interested in determining the use of synthetic cathinones among this population, all participants were asked about the drugs regardless of their answer to the gate question. The authors reported that nearly 1 of 10 individuals who initially reported they never used synthetic cathinones had used at least 1 drug in the class, according to the study. These findings suggest that there is significant underreporting when it comes to synthetic cathinones use.

"There are a lot of people using drugs such as methylone in the EDM scene, but many users are unaware that methylone is a 'bath salt'," Dr Palamar said. "It seems that some people didn't pay attention to the list of drugs that are considered 'bath salts' and simply checked off 'no' to use. 'Bath salts' are now highly stigmatized drugs by a lot of partiers, yet many don't even know some of the drugs they use are in fact 'bath salts.’"

Of the 8 drug classes queried, the authors found that reported use of Dox, other stimulants, and other psychedelics, was higher without a gate question. There were differences in drug use as high as 5%, according to the study.

These results suggest that showing participants an actual list of drugs could lead to higher attention paid to the list and increase the accuracy of the results.

"As NPS [new psychoactive substances] continue to emerge at a fast pace, there is an urgent call for research focusing on use of these compounds, as it is essential in order to inform prevention," Dr Palamar concluded.