The New Math of Addiction

How do authorities arrive at heroin addiction figures? They count known habitual users, of course, such as those who are arrested and those who sign up for treatment programs. But such figures account for only a fraction of the addict population. To arrive at an overall estimate, officials in many cities project from the number of overdose deaths, one commonly used criterion being 200 addicts for each fatality. A new study in Washington, D.C., indicates that because some overdose deaths have gone undetected, the number of active users may be even higher than previously estimated.

Dr. Robert DuPont of Washington's Narcotics Treatment Administration reports this new math of addiction in a New England Journal of Medicine article. Like most major U.S. cities, Washington is experiencing an alarming heroin epidemic. The number of narcotic arrests in the city rose by 462% between 1967 and 1970; drug-related crimes, such as robbery, theft and prostitution, also increased dramatically. In 1967 a total of 21 Washingtonians were known to have succumbed to heroin overdoses, and using the ratio of 200 addicts per overdose, officials estimated the city's addict population then at 4,200. The figure for last year by that measure should have been 10,400.

But even this depressing statistic was optimistic, DuPont believes, because officials now have evidence that many overdose deaths were undetected. In July 1970 the District of Columbia coroner began including a complete drug-screening test in all autopsies performed on persons between the ages of ten and 40. Once the new procedure was instituted, the number of deaths attributed to drugs soared, and during the last six months of 1970, the coroner identified 42 of these deaths as resulting from overdose. This pushed the yearly overdose rate to 84 and sent the addict census climbing to 16,800.

DuPont's report may have broad implications for authorities in other U.S. cities. Officials in New York City, who base their figures heavily on police, hospital and treatment-program records rather than on the kind of screening now performed in the capital, estimate that there are 150,000 heroin addicts in the nation's largest city. Washington's experience suggests that the New York figure may be far too low.

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