How do we identify new drugs of abuse? How do policymakers at all levels of government and addiction professionals receive the most up-to-date data and information about the rapidly changing drug abuse situation? How do we monitor and assess emerging patterns of drug abuse? The answer is the Community Epidemiology Work Group (CEWG), the epidemiological compass of the National Institute on Drug Abuse (NIDA).

The CEWG provides community-level, epidemiological surveillance data concerning the health, criminal justice, and social consequences of drug abuse by regularly analyzing both quantitative and qualitative research data across various geographical locations. By so doing, the CEWG provides current descriptive data and information about new drugs of abuse, new patterns of use, emerging related diseases (such as HIV/AIDS and hepatitis C), and new vulnerable populations at risk. The CEWG-generated information, in turn, is essential to improving the prevention and treatment of drug abuse.

Local trends reported twice a year
Established in 1976 by the National Institute on Drug Abuse (NIDA), the CEWG consists of researchers from 20 cities and one state across the United States who regularly track emerging drug abuse trends in their respective areas. Twice a year, using the most recent data available from medical examiners, hospital emergency rooms, addiction treatment centers, and law enforcement, each CEWG representative prepares a report on local drug abuse trends. NIDA then convenes a meeting of all 21 CEWG reporters to get an up-to-date snapshot of drug abuse trends across the country.

As a long-standing, fundamental part of the epidemiological research program at NIDA, CEWG has been around for 28 of NIDA's 30-year history. The CEWG includes Atlanta, Baltimore, Boston, Chicago, Denver, Detroit, Los Angeles, Honolulu, Miami, Minneapolis/St. Paul, Newark, New Orleans, New York City, Philadelphia, Phoenix, St. Louis, San Diego, San Francisco, Seattle, Washington, D.C., and the state of Texas. The CEWG model has also been adopted around the globe in Europe, Asia, Africa, Canada, the Caribbean, and Mexico.

Based on the notion that drug abuse trends are uniquely specific to the communities in which they occur, the CEWG recognizes the value of engaging researchers in the analysis of local substance abuse phenomenon. A drug abuse pattern in one community may look quite different in another area, or be entirely absent. For instance, while the Minneapolis/St. Paul area recently reported the rising abuse of methamphetamine, particularly among girls attracted by the promise of heightened energy and rapid weight loss, eastern cities have not experienced this trend.

The 'go-to' source on major drug trends
"The CEWG has been the first to identify every major drug abuse trend this country has seen," according to Nicholas J. Kozel, CEWG founder and former associate director of the Division of Epidemiology, Services and Prevention Research for NIDA. "While not highly visible to the general public, within the field of drug abuse the CEWG is highly regarded as the go-to source for current information. The significant contributions of the CEWG are well known within the highest levels of government."

The CEWG was the first to identify the rapidly rising abuse of the smokable form of cocaine known as "crack" in the 1980s. Though initially known by different names in different cities, such as "gravel," "rock," "freebase," or "bazuco," by 1986 everyone knew it by the name of crack. The CEWG representatives documented a nationwide epidemic of crack use that peaked in most U.S. cities in the late 1980s.

In the early 1990s, the CEWG served as an early warning network to identify rising heroin abuse among middle-class, young suburbanites who smoked it. Sam Cutler, the CEWG representative from Philadelphia, was first to report the use of "blunts"--hollowed-out cigars that are refilled with marijuana. And in the wake of Hurricane Andrew in 1992, which significantly disrupted drug trafficking activities in South Florida, Jim Hall, the CEWG representative from Miami, was the first to detect the emerging abuse of Rohypnol, also known as "Roofies." Rohypnol, the long-acting benzodiazepine that induces memory loss, soon became widely known as "the date-rape drug." This predatory use of drugs to render victims helpless continues to this day.

Later in the 1990s, the CEWG reported the growing use of MDMA (ecstasy), ketamine, and GHB by young adults and teenagers at party settings. And along with abuse came the "word on the street" that these new drugs were essentially low-risk and harmless. In response, in 1999 NIDA launched a comprehensive public information campaign about the actual dangers of these "club drugs": heart attack, stroke, hyperthermia and respiratory arrest.

The most recent CEWG meeting, held in June 2004 in Washington, D.C., found: (1) rising nonmedical use of prescription drugs across all cities; (2) the expanding ravages of methamphetamine abuse, especially in the western and central states; and (3) a resurgence of cocaine abuse in some cities.

For more information about CEWG, go to www.drugabuse.gov/about/organization/CEWG.

--by Carol Falkowski

Carol Falkowski, director of research communications at Hazelden Foundation, has represented the Minneapolis/St. Paul metropolitan area in the Community Epidemiology Work Group since 1986. Find her reports online at www.hazelden.org/research and click on "drug abuse trends." Falkowski is also author of the reference book Dangerous Drugs: An Easy-to-Use Reference for Parents and Professionals.

Published in The Voice, Summer 2004