II. America's Drug Use Profile
Consequences of Illegal Drug Use
Illegal drugs -- such as heroin, marijuana, cocaine and methamphetamine -- inflict serious damage upon America and its citizens every year. Accidents, crime, domestic violence, illness, lost opportunity, and reduced productivity are the direct consequences of substance abuse. Drug and alcohol use by children often is associated with other forms of unhealthy, unproductive behavior, including delinquency and high-risk sexual activity.
Illegal drugs cost our society approximately $110 billion each year.8 The greatest cost of drug abuse is paid in human lives, either lost directly to overdose, or through drug abuse-related diseases such as tuberculosis, sexually transmitted diseases (STDs), hepatitis, and acquired immunodeficiency syndrome (AIDS). Traffic accidents caused by alcohol- and drug-impaired drivers; street crime committed by addicts to support their addiction; and resources expended to apprehend, sentence, treat, and incarcerate drug abusers are the burdens borne by taxpayers year after year.
Drug use erodes human potential. It is associated with a broad array of antisocial behavior that limits children from the outset of their lives. Children who begin to smoke marijuana at an early age are much more likely to not finish school and to engage in acts of theft, violence and vandalism and other high-risk behavior than are children who do not smoke marijuana.9 Studies of adult users of cocaine and heroin have found that youth use of marijuana correlates strongly with later use of cocaine and heroin. Children agedtwelve to seventeen who use marijuana are eighty-five times more likely to use cocaine than children of the same age who have never used those substances.10 But no study, statistic, or survey accurately reflects the suffering and heartbreak that occurs when a loved one sinks into addiction.
Drug-related deaths remain near historic highs. The Substance Abuse and Mental Health Services Administration (SAMHSA)'s Drug Abuse Warning Network (DAWN) Medical Examiner Report annually examines drug-related deaths -- exclusive of deaths from AIDS, homicide, and where the drug of abuse was unknown --in forty-one major metropolitan areas across the country. DAWN reports drug-related deaths climbed throughout the 1990s, but appear to have leveled off at about 9,300 per year.11 Drug-related deaths declined among those aged eighteen to thirty-four, but were offset by an increase among those aged thirty-five and older, particularly those aged forty-five to fifty-four. This trend may reflect the aging of the drug-abusing population in America, indicating that those who started drug abuse in the 1960s and 1970s are now succumbing to the cumulative health effects of years of abuse.
Source: HHS Drug Abuse Warning Network
The National Center for Health Statistics (NCHS) reports 14,843 drug-induced deaths for 1996. Drug-induced deaths, a subset of drug-related deaths, are more narrowly defined. They are identified from death certificate information indicating the cause of death to be drug psychoses, drug dependence, non-dependent use of drugs, accidental drug poisoning, suicide using drugs, assault by using drugs, and other drug poisoning deaths. Drug-induced causes exclude accidents, homicides, and other causes such as AIDS that are indirectly related to drug use.12
Drug-related medical emergencies remain near historic highs. The DAWN program reports drug-related hospital emergency room visits and provides a snapshot of the health consequences of America's drug problem.13 DAWN indicates that drug-related emergency room episodes remained statistically constant, with 514,347 episodes in 1996 and 527,058 in 1997.14 The only age group showing a statistically significant increase from 1996 to 1997 was ages 18-23, which saw a 6 percent increase from 98,625 episodes in 1996 to 104,647 episodes in 1997. The most frequently recorded reason for drug-related emergency room visits in 1997 was overdose, which comprised 46 percent of all episodes. The most common motive for drug use -- the reason the patient took the drug which led to the emergency room visit -- was suicide attempt or gesture, which comprised 36 percent of all episodes, followed by drug dependence as a motive for drug use (34 percent), then recreational use as a motive (11 percent).15
Source: HHS Drug Abuse Warning Network
Reported emergency rooms mentions for both cocaine and heroin in 1997 showed no statistically significant change from 1996, when mentions were at their highest levels since 1978. Cocaine-related mentions remained statistically constant from 1996 to 1997, at about 160,000. While the total number of cocaine cases remained constant, the largest percentage of increase in cocaine mentions during this period (1996-1997) was among those aged twelve to seventeen (41 percent, which increased from 2,581 to 3,360).16 Even with this huge increase in youth mentions, a high percentage of cocaine episodes involved older Americans. In the second half of 1990, those aged thirty-five and older accounted for three in every ten cocaine episodes. By the first half of 1997, this age group accounted for nearly half of all admissions, implying that the population of cocaine abusers is aging.17
Source: Rice et al. 1990; Robert Wood Johnson Foundation. 1993; National Institute on Drug Abuse & National Institute on Alcohol Abuse and Alcoholism, March 1998
Heroin-related emergency room mentions showed a slight, statistically insignificant decline between 1996 (73,846) and 1997 (72,010), although this number is significantly higher than in 1991.18 Methamphetamine-related emergency room episodes in 1997 (17,154) were more than 50 percent higher than in 1996 (11,002), and approached the level of the peak year of 1994.19 The increase in 1997 may reflect that methamphetamine, which was relatively scarce in 1996, is now more readily available. It may also indicate a data anomaly in 1996, which appears to be an unusually low year for methamphetamine mentions. Indeed, geographic analysis of admissions to treatment for methamphetamine use shows a clear, tide-like spread of methamphetamine use from the west coast into the Midwest. Marijuana and hashish mentions continued to climb upward, continuing a trend that began in the first half of 1992. 1997 saw 64,744 emergency room mentions for marijuana/hashish, an increase of 20 percent from the year before.
Spreading of infectious diseases. Illegal drug users and people with whom they have sexual contact run high risks of contracting gonorrhea, syphilis, HIV, hepatitis, and tuberculosis. Chronic users are particularly susceptible to infectious diseases and are considered "core transmitters." The National Institute on Drug Abuse (NIDA) has concluded that drug abuse is both a serious health and social issue since drug abuse is a major vector for the transmission of many serious infectious diseases -- particularly AIDS, hepatitis and tuberculosis -- and for the infliction of violence.20 Finally, in an era in which health care costs are rising, drug abuse poses an intolerable burden on an already strained system. NIDA estimated that health care expenditures due to drug abuse cost America $9.9 billion in 1992 and nearly twelve billion dollars in 1995.21
Homelessness. A correlation exists between drug abuse and homelessness. Ventura County, California, authorities estimate that 40 percent of their homeless population abuse drugs or alcohol.22 A San Francisco study found that from December 1997 to November 1998 drug abuse was the leading killer of the homeless. Of the estimated 4,000 homeless, there were 157 deaths in a twelve-month period. Sixty-two were attributed to drug overdose. Other causes of death, such as suicide and AIDS, may have had an origin, if not a proximate cause, in drug abuse as well.23
Cost of drug abuse to workplace productivity. According to SAMHSA's 1997 National Household Survey on Drug Abuse (NHSDA), an estimated 6.7 million (or 60 percent of current illegal drug users who are of working age) current illegal drug users were employed full-time. This represents 6.5 percent of the full-time labor force aged eighteen and older.24 Another 1.6 million current users (or 14 percent of working age drugusers) worked part-time.25 This translates to a current drug use rate of 7.7 percent among part time workers. In the same period, an estimated 13.8 percent of unemployed Americans were current drug users; thus, drug abuse is twice as prevalent among the unemployed compared to those employed full-time.26 Overall, 73 percent of working age Americans who are current drug users are employed.
Source: ONDCP Paper, What America's Users Spend on Illegal Drugs
Drug users are less dependable than other workers and decrease workplace productivity. They are more likely to have taken an unexcused absence in the past month; 12.1 percent did so compared to 6.1 percent of drug-free workers. Illegal drug users get fired more frequently (4.6 percent were terminated within the past year compared to 1.4 percent of non-users). Drug users also switch jobs more frequently; 32.1 percent worked for three or more employers in the past year, compared to 17.9 percent of non-drug-using workers. One-quarter of drug users left a job voluntarily in the past year.27 This high turnover increases training and other productivity-related costs to American businesses. NIDA and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimated that the cost to America in lost productivity due to drug abuse was $69.4 billion in 1992.28