A New Survey Suggests Illicit Opioid Use Is Much More Common Than the Government’s Numbers Indicate
A new survey of American adults suggests that illicit opioid use in the United States is much more common than the government’s numbers indicate. In the survey, conducted via the online platform Respondi in June 2024, 7.5 percent of respondents reported they had used (or might have used) illicitly manufactured fentanyl (IMF) in the previous 12 months, 25 times the rate suggested by the government-sponsored National Survey on Drug Use and Health (NSDUH).
RAND Corporation economist David Powell and University of Southern California economist Mireille Jacobson, who published their results in JAMA Health Forum on Friday, say the reasons for that huge disparity are unclear. “A number of previous studies also have reported higher rates of illicit opioid use, challenging the accuracy of the federal estimate,” a RAND press release notes. A 2014 report by Beau Kilmer and eight other drug policy analysts at RAND, for example, estimated that something like 1.5 million Americans were “chronic heroin users” in 2010, when the NSDUH suggested a total of about 620,000 Americans used heroin.
RAND suggests such disparities “may relate to the way the federal survey asks participants about illicit opioid use.” Powell and Jacobson note that “about half of NSDUH surveys are conducted in-person,” which may inhibit respondents’ candor. The Respondi survey, by contrast, was conducted entirely online, which may have encouraged honesty by enhancing the participants’ sense of privacy and making them less likely to shape their answers based on social expectations.
The phrasing of the questions may also help explain the dramatic divergence in estimates. The NSDUH asks, “Have you ever, even once, used illegally made fentanyl?” If the respondent says yes, he is asked, “How long has it been since you last used illegally made fentanyl?”
In the Respondi survey, by contrast, “participants were asked about use of nonprescription opioids within the past 12 months, with heroin and IMF given as examples.” They “could respond in 1 of 3 ways: (1) yes, I intentionally used illicit opioids; (2) yes, I may have unintentionally used illicit opioids; or (3)
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