Chapter II (continued)

10. The Consequences of Illegal Drug Use

Increased crime, domestic violence, accidents, illness, lost job opportunities, and reduced productivity can be linked to illegal drug use. Every year Americans of all ages engage in unhealthy, unproductive behavior as a result of substance abuse.

The Economic Costs Relating to Alcohol and Drug Abuse Economic Cost of Drug Abuse


Source: 1998 National Institute on Drug Abuse and National Institute on
Alcohol Abuse and Alcoholism

Economic loss — Illegal drugs exact a staggering cost on American society. In 1995, they accounted for an estimated $110 billion in expenses and lost revenue.116 This public-health burden is shared by all of society, directly or indirectly. Tax dollars pay for increased law enforcement, incarceration, and treatment to stem the flow of illegal drugs and counter associated negative social repercussions. NIDA estimated that health-care expenditures due to drug abuse cost America $9.9 billion in 1992 and nearly twelve billion dollars in 1995.117

In 1999, Americans Spent $63.2 Billion on Illegal Drugs


*Projected figures from models based on 1998 data
Source: 1999 ONDCP-What American Users Spend on Illegal Drugs

Drug-related deaths — Illegal drug use is responsible for the deaths of thousands of Americans annually. In 1997, the latest year for which death certificate data are published, there were 15,973 drug-induced deaths in America.118 Drug-induced deaths result directly from drug consumption, primarily overdose.* In addition, other causes of death, such as HIV/AIDS, are partially due to drug abuse. Using a methodology that incorporates deaths from other drug-related causes, ONDCP estimates that in 1995 there were 52,624 drug-related deaths. This figure includes 14,218 drug-induced deaths for that year, plus mortalities from drug-related causes.** SAMHSA's Drug Abuse Warning Network (DAWN) collects data on drug-related deaths from medical examiners in forty-one major metropolitan areas. DAWN found that drug-related deaths have steadily climbed throughout the 1990s.119

Drug-Induced Deaths


Source: 1999 Centers for Disease Control and Prevention

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

* 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.