Drug-related medical emergencies — More than two thirds of people suffering from addiction see a primary-care or urgent-care physician every six months, and many others are seen regularly by medical specialists. ¹²⁰ The DAWN survey provides information on the health consequences of drug use by capturing data on emergency department (ED) episodes that are related to the use of an illegal drug or the nonmedical use of a legal drug.^*** It is important to remember that DAWN data show only one dimension of the total consequences of drug use. It does not measure the prevalence of drug use in the population, the untreated health consequences of drug use, or the impact of drug use on health-care settings other than hospital EDs.

In 1998, there were an estimated 542,544 drug-related ED episodes and 982,856 ED drug mentions in the coterminous United States.¹²¹ Nationally, the number of ED episodes and mentions remained relatively stable between 1997 and 1998. Among the drugs mentioned most frequently in ED reports, alcohol in combination with drugs (185,002), cocaine (172,014), and heroin/morphine (77,645) were statistically unchanged from 1997 to 1998 while marijuana/hashish mentions increased 19 percent (from 64,744 to 76,870). In drug-related ED episodes, overdose (245,164) was the most frequently cited reason for the drug-related ED visit; suicide (189,897) and dependence (189,094) were the most frequently cited motives for taking substances — both unchanged from 1997 to 1998.¹²² Total drug-related ED episodes were stable across gender, race/ethnicity, and most age subgroups, based on comparisons with 1997 and 1998. However, total episodes increased 9 percent (from 218,630 to 239,172) among patients aged thirty-five and older.¹²³

Spreading of infectious diseases — Among the serious health and social issues related to drug abuse is the spread of infectious diseases. Drug abuse is a major vector for the transmission of AIDS and other sexually transmitted diseases, hepatitis, and tuberculosis — and for the infliction of violence.¹²⁴ Chronic users are particularly susceptible to infectious illnesses and are considered "core transmitters." Of the 18,361 cases of tuberculosis reported to the CDC in 1998, 2.9 percent were drug-related, down from 3.3 percent in 1997. There was a decline in drug-related AIDS cases between 1997 and 1998 among men from 33.3 percent in 1997 to 32.9 percent in 1998; among women, this number declined from 43.8 percent in 1997 to 42.3 percent in 1998.¹²⁵ Although no reliable estimate of the proportion of Hepatitis B cases that are drug-related is available, the number of Hepatitis B cases from 1996 to 1997 (the most recent year for which data are available) declined from 10,637 to 10,416.¹²⁶

Homelessness — Drug abuse is a contributing factor in the problem of homelessness. Although only a minority (thirty-one percent) of the homeless suffer from drug abuse or alcoholism exclusively, inappropriate use of these substances compounds other diseases for many homeless people with mental illness who are "dually diagnosed." ¹²⁷ Substance abusers with other illnesses experience homelessness of a longer duration and are more likely to be chronically without a residence.¹²⁸ Homelessness generates tremendous social and human costs. The general public is poorly served by having people with serious and chronic illnesses, such as addiction, living on the street. Further, addiction treatment tends to be less effective when recipients lack stable housing.¹²⁹ Of those who are currently homeless, twenty-five percent have ever been treated for drug abuse — thirty-six percent have received inpatient treatment and twenty-seven percent have received outpatient care.¹³⁰ Thirty-eight percent of those who are currently homeless have received inpatient treatment three or more times. ¹³¹ Homeless persons may be able to obtain residential treatment but with no recovery venue other than a shelter, such treatment is often ineffective.

Drug use in the workplace — According to the 1998 NHSDA, most drug users are employed. More than 73 percent of current illicit drug users aged 18 and older are employed full or part-time — more than 8.3 million workers.¹³² Among full-time workers, aged 18-49, 7.7 percent were current illicit drug users in 1997 as were 9.3 percent of part-time workers.¹³³ In 1998 6.4 percent of full-time workers reported current illicit drug use as did 7.4 percent of part-time workers.¹³⁴ As national unemployment rates decreased, rates of drug use among the unemployed have risen. In 1998, 18.2 percent of unemployed adults aged 18 or older were current illicit drug users, compared to 13.8 percent in 1997.¹³⁵ In 1997, occupations with the highest drug-use rates, among full-time workers, aged 18-49, were food preparers, waiters/waitresses and bartenders (19 percent), construction (14 percent), other service occupations (13 percent), and material movers (10 percent).¹³⁶

Drug use is estimated to cost fourteen billion dollars a year in decreased productivity.¹³⁷ In 1997, those who reported current illegal drug use were more likely than those who reported no drug use to have worked for three or more employers in the past year (9.3 percent versus 4.3 percent), to have skipped one or more days of work in the past month (12.9 percent versus 5 percent), or to have voluntarily left an employer in the past year (24.8 percent versus 15.4 percent).¹³⁸

Cocaine, Heroin, and Marijuana Hospital Emergency Room Mentions

Source: SAMHSA, 1998 DAWN Emergency Department Data

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* Overdose deaths, including accidental and intentional drug poison-ing, accounted for 90 percent of drug-induced mortalities in 1995. Other drug-induced causes of death involved drug psychoses, drug dependence, and nondependent use of drugs.

* * Based on a review of the scientific literature, 32 percent of HIV/AIDS deaths were drug-related and included in the estimate of drug-related deaths. The following were also counted: 4.5 percent of deaths from tuberculosis, 30 percent of deaths from hepatitis B; 20 percent of deaths from hepatitis non-A/none-B; 14 percent of deaths from endocarditis; and 10 percent of deaths from motor vehicle acci-dents, suicide (other than by drug poisoning), homicide, and other deaths caused by injuries.

*** A drug episode is an emergency department visit that was related to the use of an illegal drug(s) or the nonmedical use of a legal drug for patients aged six years and older. A “drug mention” refers to a sub-stance that was mentioned (as many as four) during a single drug-related episode.