The degree to which NSDUH underestimates the prevalence of heroin use disorder is enormous. In 2010, a research team combined NSDUH data with that from other studies to determine that NSDUH could only identify 60,000 of the 1 million Americans who used heroin daily or near daily heroin users. As most daily or nondaily heroin users would meet diagnostic criteria for heroin use disorder, NSDUH’s most recent estimate of 591,000 probably didn’t even capture the depth of the problem back in 2010, which was before the heroin problem exploded.

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The true level of heroin use disorder today could easily be double or even triple NSUDH’s estimate, but no one can truly know. As successive Congresses have clamped down on federal spending, many government agencies have been forced to curtail their research capacity. National programs that gathered substance use data from people entering jails and from emergency room patients fell under the budget ax in 2014 and 2011, respectively.

Government-reported heroin overdose figures also understate the severity of the epidemic. Death certificates completed by county coroners are the root data source for state and federal government estimates of the extent of the overdose epidemic. Professor Christopher J. Ruhm of the University of Virginia recently demonstrated that many death certificates in drug overdoses cases do not specify the drug or drugs involved. Correcting for this problem, he estimated the true heroin death rate in the U.S. is 22 percent above the government’s official figures.