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STATISTICS FOR USA
A study prepared by The Lewin Group for the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism estimated the total economic cost of alcohol and drug abuse to be $245.7 billion for 1992. Of this cost, $97.7 billion* was due to drug abuse. This estimate includes substance abuse treatment and prevention costs as well as other healthcare costs, costs associated with reduced job productivity or lost earnings, and other costs to society such as crime and social welfare. The study also determined that these costs are borne primarily by governments (46 percent), followed by those who abuse drugs and members of their households (44 percent).
The 1992 cost estimate has increased 50 percent over the cost estimate from 1985 data. The four primary contributors to this increase were (1) the epidemic of heavy cocaine use (2) the HIV epidemic (3) an eightfold increase in state and Federal incarcerations for drug offenses, and (4) a threefold increase in crimes attributed to drugs.
More than half of the estimated costs of drug abuse were associated with drug-related crime. These costs included lost productivity of victims and incarcerated perpetrators of drug- related crime (20.4 percent); lost legitimate production due to drug-related crime careers (19.7 percent); and other costs of drug-related crime, including Federal drug traffic control, property damage, and police, legal, and corrections services (18.4 percent). Most of the remaining costs resulted from premature deaths (14.9 percent), lost productivity due to drug-related illness (14.5 percent), and healthcare expenditures (10.2 percent).
The White House Office of National Drug Control Policy (ONDCP)** conducted a study to determine how much money is spent on illegal drugs that otherwise would support legitimate spending or savings by the user in the overall economy. ONDCP found that, between 1988 and 1995, Americans spent $57.3 billion on drugs, broken down as follows: $38 billion on cocaine, $9.6 billion on heroin, $7 billion on marijuana, and $2.7 billion on other illegal drugs and on the misuse of legal drugs
2000 Monitoring the Future Study (MTF)*
Since 1975, the MTF has annually studied the extent of drug abuse among high school 12th graders. The survey was expanded in 1991 to include 8th and 10th graders. It is funded by NIDA and is conducted by the University of Michigan's Institute for Social Research. The goal of the survey is to collect data on past month, past year, and lifetime drug use among students in these grade levels. This, the 26th annual study, was conducted during spring 2000.**
The 2000 MTF marks the fourth year in a row that illicit drug use among 8th, 10th, and 12th graders remained stable or decreased in some cases. Since the 1999 MTF, reductions in cigarette smoking occurred in all three grades, with statistically significant decreases in 2000. Other reductions occurred in cocaine and crack use for 12th graders; hallucinogens and LSD for 10th and 12th graders; heroin and inhalants for 8th graders; and methaqualone (a sedative) for 12th graders.
Since 1996 or 1997, there have been decreases in the use of inhalants, hallucinogens such as LSD, and smoked methamphetamine ("ice").
The few statistically significant increases from the 1999 MTF to the 2000 MTF were in the use of Ecstasy among all three grade levels, anabolic-androgenic steroids among 10th graders, and heroin use among 12th graders.
Perceived Risk of Harm, Disapproval, and Perceived Availability. In addition to surveying for use of drugs among 8th, 10th, and 12th graders, MTF surveys for three attitudinal indicators related to drug use. These are perceived risk of harm in taking a drug, disapproval of others who take drugs, and perceived availability of drugs.
From 1999 to 2000, perceived risk of harm in smoking one or more packs of cigarettes per day increased among 8th graders, from 54.8 percent in 1999 to 58.8 percent in 2000; and among 10th graders, from 62.7 percent to 65.9 percent.
Perceived risk of harm in regularly using smokeless tobacco increased among 10th graders, from 44.2 percent in 1999 to 46.7 percent in 2000.
However, perceived harm in taking crack occasionally decreased among 10th graders, from 79.1 percent in 1999 to 76.9 percent in 2000. Tenth graders' perceived harm in trying cocaine powder once or twice decreased from 51.6 percent in 1999 to 48.8 percent in 2000; and their perceived harm in trying it occasionally decreased from 73.6 percent to 70.9 percent.
For 12th graders, the perceived risk of harm in taking anabolic steroids decreased, from 62.1 percent in 1999 to 57.9 percent in 2000. Also, 12th graders' perceived harm in taking one or two drinks of alcohol decreased, from 8.3 percent to 6.4 percent.
Disapproving of people who try marijuana once or twice increased among 8th graders, from 70.7 percent in 1999 to 72.5 percent in 2000; and among 12th graders, from 48.8 percent o 52.5 percent. Disapproval of those who take LSD regularly, however, decreased among 8th graders, from 72.5 percent in 1999 to 69.3 percent in 2000.
The perceived availability of Ecstasy increased among 12th graders, from 40.1 percent in 1999 to 51.4 percent in 2000. The proportion of 12th graders perceiving increased availability of hallucinogens other than LSD also increased, from 29.5 percent to 34.5 percent. Decreases in perceived availability occurred among 8th graders for alcohol, dropping from 72.3 percent in 1999 to 70.6 percent in 2000; and for cigarettes, dropping from 71.5 percent to 68.7 percent. Among 10th graders, perceived availability decreased for crack, from 36.5 percent in 1999 to 34.0 percent in 2000; for cocaine powder, from 36.7 percent to 34.5; and for cigarettes, from 88.3 percent to 86.8 percent.
Cigarette Use. The 2000 MTF found that cigarette use among teens dropped significantly, with past month smoking down from 17.5 percent in 1999 to 14.6 percent in 2000 among 8th graders, and from 34.6 percent to 31.4 percent among 12th graders. Daily smoking in the past month declined from 15.9 percent in 1999 to 14.0 percent in 2000 among 10th graders, and from 23.1 percent to 20.6 percent among 12th graders.
At the same time, perceived risk of harm from smoking a pack or more of cigarettes per day increased among 8th and 10th graders, from 54.8 percent in 1999 to 58.8 percent in 2000 among 8th graders, and from 62.7 percent to 65.9 percent among 10th graders. Also, the perceived availability of cigarettes declined among 8th and 10th graders (it is not a measure for 12th graders). For example, 71.5 percent of 8th graders in 1999 felt it would be "fairly easy" or "very easy" to get cigarettes, and this percentage dropped to 68.7 percent in 2000.
The use of smokeless tobacco remained stable from 1999 to 2000 among the three grade levels. Its use has decreased since a peak in 1994/1995. Among 12th graders, past month smokeless tobacco use has decreased from 12.2 percent in 1995 to 7.6 percent in 2000. The decrease among 10th graders is from 10.5 percent in 1994 to 6.1 percent in 2000. Among 8th graders, it has decreased from 7.7 percent in 1994 to 4.2 percent in 2000.
Ecstasy. From 1999 to 2000, the use of Ecstasy (or "MDMA") increased among all three grade levels. For 10th and 12th graders, this is the second consecutive year MDMA use has increased. Past year use of Ecstasy increased among 8th graders from 1.7 percent in 1999 to 3.1 percent in 2000; from 4.4 percent to 5.4 percent among 10th graders; and from 5.6 percent to 8.2 percent among 12th graders. Also among 12th graders, the perceived availability of Ecstasy rose from 40.1 percent in 1999 to 51.4 percent in 2000 (not measured for 8th and 10th graders).
African American students show considerably lower rates of Ecstasy use than white or Hispanic students. For example, past year use among African American 12th graders is 1.3 percent, compared to 7.6 percent for white 12th graders and 10.6 percent for Hispanic 12th graders.
Steroids (anabolic-androgenic). Use of steroids remained unchanged among 8th and 12th graders from 1999 to 2000. Among 10th graders, however, the past year use of steroids increased from 1.7 percent in 1999 to 2.2 percent in 2000. Most steroids users are male and, among male students, past year use of these substances was reported by 2.2 percent of 8th graders, 3.6 percent of 10th graders, and 2.5 percent of 12th graders. In addition, the 2000 MTF noted a decrease among 12th graders in the perceived risk of harm from using steroids.
Marijuana. Since 1999, marijuana use has remained stable in all three grades and for all three use categories. The increases in use seen during the mid-1990s have leveled off or decreased and, among 8th graders, have decreased significantly. Among 10th graders, past year use decreased from a peak of 34.8 percent in 1997 to 32.2 percent in 2000. Past year marijuana use among 8th graders decreased from 18.3 percent in 1996 to 15.6 percent in 2000.
Cocaine and Crack. Past year use of cocaine decreased significantly among 12th graders, from 6.2 percent in 1999 to 5.0 percent in 2000; crack use in the past year decreased from 2.7 percent to 2.2 percent for 12th graders. This was the first decrease in cocaine and crack use among 12th graders since the early 1990s. Modest declines have appeared in all other categories and grade levels since 1998. Of note is the past year use of crack by 8th graders, decreased from a 10-year high of 2.1 percent in 1998 to 1.8 percent in 1999, where it remained in 2000.
Although the perceived availability of crack and cocaine decreased among 10th graders from 1999 to 2000, there was also a decrease in their perceived risk of harm from these drugs. The proportion of 10th graders who perceived risk of harm in taking cocaine powder occasionally decreased from 73.6 percent in 1999 to 70.9 percent in 2000; from 51.6 percent to 48.8 percent for trying cocaine once or twice; and from 79.6 percent to 76.9 percent in taking crack occasionally.
Alcohol. Alcohol use has generally remained stable in the past few years among 8th and 10th graders and, more recently, among 12th graders. Among 8th graders, daily drinking in the past month decreased significantly from 1.0 percent in 1999 to 0.8 percent in 2000. Among 12th graders, however, the perceived risk of harm in trying one or two alcoholic drinks decreased, from 8.3 percent in 1999 to 6.4 percent in 2000.
In 2000, 30.0 percent of 12th graders, 26.2 percent of 10th graders, and 14.1 percent of 8th graders reported binge drinking (5+ drinks in a row) in the 2 weeks prior to the survey. Nearly one-third (32.3 percent) of 12th graders, 23.5 percent of 10th graders, and 8.3 percent of 8th graders reported having "been drunk" in the month prior to the survey. This is the highest percentage of 10th graders in this category since the MTF began including them, in 1991.
More than 70 percent of 8th graders perceive alcoholic beverages as "fairly easy" or "very easy" to get, although this percentage has decreased, from 72.3 percent in 1999 to 70.6 percent in 2000.
Heroin. Among 8th graders, past year heroin use declined from 1.4 percent in 1999 to 1.1 percent in 2000. This decline in heroin use among 8th graders is the first since 1997 (1.3 percent).
Among 12th graders, however, past year heroin use rose from 1.1 percent in 1999 to 1.5 percent in 2000, resulting in the highest rate of heroin use among 12th graders since the MTF began. This trend may reflect the increasing availability of high-purity heroin in smokable and snortable form.
Use of opiates other than heroin remained stable from 1999 to 2000, but use of opiate drugs is at its highest level since the MTF began, with 10.6 percent of 12th graders reporting lifetime use, 7.0 percent past year, and 2.9 percent past month.
Inhalants. Inhalant use continues to be more prevalent among 8th graders than students in the other two grades. Lifetime use of inhalants among 8th graders decreased from 19.7 percent in 1999 to 17.9 percent in 2000. During the 10 years that data have been collected for 8th graders, inhalant use was highest in 1995, with percentages of 21.6 for lifetime use, 12.8 for past year use, and 6.1 for past month use.
Methamphetamine. This was added to the MTF as a drug category in 1999. Rates of methamphetamine use remained stable from 1999 to 2000 in all three grades, for all three categories. Past year use was reported by 4.3 percent of 12th graders, 4.0 percent of 10th graders, and 2.5 percent of 8th graders.
Monitoring the Future Study: Trends in Prevalence of Various Drugs for 8th-Graders, 10th-Graders, and High School Seniors**
Since 1990, estimates of drug-related visits to hospital emergency rooms have increased. In 1995, 531,800 drug-related visits occurred, up slightly from 1994. More than half of these visits were due to drug overdoses. Nearly 143,000 cocaine-related visits occurred, with increases noted in people age 35 and older. Heroin-related visits increased by 19 percent from 1994, and marijuana-related visits increased by 17 percent. Methamphetamine-related visits decreased by 34 percent from the first to second half of 1995
This fact sheet highlights information from the latest meeting (December 2000) of NIDA's Community Epidemiology Work Group (CEWG).* These highlights cover current and emerging trends in drug abuse for 21 major U.S. metropolitan areas. The findings are intended to alert the general public, policy makers, and authorities at the local, State, regional, and national levels to the latest trends in drug abuse.
The CEWG network of researchers are from Atlanta, Baltimore, Boston, Chicago, Denver, Detroit, Honolulu, Los Angeles, Miami, Minneapolis/St. Paul, Newark, New Orleans, New York, Philadelphia, Phoenix, St. Louis, San Diego, San Francisco, Seattle, Texas, and Washington, D.C.
CEWG members assess drug abuse patterns and trends from a variety of health and other drug abuse indicator sources, including the Treatment Episode Data Set (data from treatment facilities) and the Drug Abuse Warning Network (emergency room mentions and medical examiner deaths involving illicit drugs), both of which are funded by the Substance Abuse and Mental Health Services Administration; the Arrestee Drug Abuse Monitoring program, funded by the National Institute of Justice; information on drug seizures, price, and purity, from the Drug Enforcement Administration; the Uniform Crime Reports, maintained by the Federal Bureau of Investigation; and poison control centers. These data are enhanced with qualitative information from ethnographic research, focus groups, and other community-based sources.
Findings presented at the December 2000 CEWG meeting are based on 1999 and 1998 data and on comparisons of these data with those from earlier time periods.
Extent of Use
In 1999, about 14.8 million Americans were current users of illicit drugs, meaning they used an illicit drug at least once during the month prior to being interviewed for the latest National Household Survey on Drug Abuse,1 an annual nationwide survey among Americans age 12 and older. About 3.5 million were dependent on illicit drugs; an additional 8.2 million were dependent on alcohol.
Trend indicators for cocaine/crack use continued to show a downward trend in 18 of the 21 CEWG metropolitan areas in 1999. The downward trend was striking in areas of the northeast, mid-Atlantic, and northern Midwest region of the U.S.
For example, emergency room mentions involving cocaine/crack dropped 24.3 percent between 1998 and 1999 in New York. Other cities seeing statistically significant decreases were Boston, Dallas, Newark, Washington, D.C., and New Orleans.
Cocaine/crack indicators still remain elevated in most areas, however, and emergency room mentions were at their highest levels in 4 years in Denver, Los Angeles, Miami, Minneapolis/St. Paul, and Phoenix. Data show that cocaine is frequently used with other drugs.
Decreases from 1998 to 1999 for adult male arrestees testing positive for cocaine/crack occurred in Chicago, Los Angeles, New Orleans, New York, Philadelphia, San Diego, and Seattle. Increases were seen in Dallas, Minneapolis/St. Paul, Philadelphia, and Washington, D.C. Increases in cocaine-positive tests for adult female arrestees occurred in Dallas, Chicago, Phoenix, Minneapolis, New Orleans, and Seattle. Notable decreases in cocaine-positive female arrestees occurred in Los Angeles and New York.
An increase in availability and use of cocaine was reported in Denver, Detroit, New York, New Orleans, Philadelphia, Seattle, and Los Angeles. Regionally, arrestee and school survey data indicate cocaine emerging as a significant problem at the Texas-Mexico border. Also, crack use in Atlanta is moving to rural areas outside the city.
CEWG indicators for heroin/morphine abuse increased in 1999 in 15 CEWG sites, located in all regions of the country. Heroin/morphine ranked first in drug-related emergency room mentions in eight CEWG areas.
CEWG members continued to report increases in heroin indicators among young populations. For example, emergency room mentions of heroin among the 18-25 year old category increased 51.4 percent from 1997 to 1999.
Emergency room mentions of heroin decreased from 1998 to 1999 in Dallas, Honolulu, and San Diego, and were stable in Los Angeles, Newark, New York, and San Francisco. Emergency room data show that heroin is often used in combination with cocaine.
From 1998 to 1999, opiate-positive rates for adult male arrestees increased in four cities and decreased in three. The increases were seen in two cities where they had previously been very low (Atlanta and Dallas). Comparable adult female arrestee data showed increases in eight cities, with the largest observed in Dallas.
The purity of heroin was highest in Newark, Philadelphia, Boston, and New York in 1999, ranging from 60.2 percent to 76.7 percent purity.
There are indications that marijuana abuse is stabilizing in some CEWG areas, after an upsurge in use from 1990-1998. Emergency room mentions of marijuana decreased in 1999 in 10 CEWG areas (Boston, New Orleans, and San Diego in particular) and stabilized in Newark. The lowest rates were in San Diego, Minneapolis/St. Paul, and San Francisco. The highest rates of marijuana emergency room mentions in 10 years, however, occurred in Denver, Los Angeles, Miami, and Washington, D.C. Statistically significant increases occurred in Baltimore, Minneapolis/St. Paul, and Phoenix from 1998 to 1999.
While indicators such as emergency room admissions remained stable or decreased in 1999, CEWG members reported increases in treatment admissions where marijuana was the primary drug of abuse. Data also showed that marijuana was the most likely illicit drug to be used in combination with other substances, including hydrocodone (Lorcet®, Lortab®, Vicodin®) and Ecstasy. In Dallas, there were reports of young marijuana users dipping joints in embalming fluid containing phencyclidine (PCP) or in codeine cough syrup.
Among juvenile arrestees in 1999, marijuana was the most commonly used drug by both males and females. More than half the juvenile males and nearly 40 percent of the females tested positive for marijuana.
Indicators for methamphetamine use appeared to trend downward from 1997 through the first half of 1999, but showed indications of increasing again during the last half of 1999. Use of the drug continued to spread to areas outside the west coast and southeast, where abuse has been most concentrated. There were reports of considerable abuse in the Seattle area, increasing use in Atlanta, and a growing demand for smoked methamphetamine ("ice") in Honolulu.
Reports from 11 CEWG areas indicate that methamphetamine was used along with other drugs at raves, and there were indications that methamphetamine activity was increasing in areas where it had not been a major problem in the past.
Emergency room mentions of methamphetamine increased 26.5 percent between the first and second 6-month periods of 1999. Significant increases occurred in San Diego, San Francisco, Los Angeles, Seattle, Denver, and Phoenix. Some CEWG areas reported abuse of methamphetamine with Viagra.
San Diego reported the highest percentage of adult male and female arrestees testing positive for methamphetamine in 1999. Also testing positive in San Diego in 1999 were 15.8 percent of juvenile male and 18.2 percent of juvenile female arrestees, and 22 percent of Hispanic juvenile male and 16.7 percent of Hispanic adult female arrestees.
Abuse of Ecstasy, or MDMA (methylenedioxymethamphetamine), in 1999 became more widespread in 17 CEWG areas: Atlanta, Baltimore, Boston, Chicago, Denver, Detroit, Miami, Minneapolis/St. Paul, New Orleans, New York, Philadelphia, San Diego, San Francisco, Seattle, St. Louis, Texas, and Washington, D.C. In Boston, MDMA was the most frequently mentioned drug in telephone calls to the Poison Control Center during the first three quarters of 2000.
CEWG members reported that MDMA was being used in a variety of normal recreational and social settings in addition to raves, by a wide variety of age groups. Emergency room data showed that marijuana/hashish abuse in combination with MDMA increased from 8 mentions in 1990 to 796 in 1999.
CEWG members identified several legal, prescription drugs as emerging drugs of abuse in 1999. These include clonazepam (a benzodiazepine) and the controlled substances hydrocodone (Lorcet®, Lortab®, Vicodin®), hydromorphone (Dilaudid®), and oxycodone (Percodan®, Percocet®). Abuse of one or more of these drugs was reported in New Orleans, Phoenix, St. Louis, Texas, and Washington, D.C.
Hydrocodone appeared to be the most widely abused of these drugs. From 1993 to 1999, hydrocodone emergency room mentions increased from 6,115 to 14,639. Among marijuana/hashish emergency room mentions, combined use with hydrocodone increased from 8 in 1990 to 840 in 1999. In some areas, hydromorphone and oxycodone pills are substituted for heroin by heroin abusers.
Drug abuse can occur at any stage in a woman's life. Of women who use illicit drugs, however, about half are in the childbearing age group of 15 to 44. In 1992/1993, NIDA conducted a nationwide hospital survey to determine the extent of drug abuse among pregnant women in the United States. This National Pregnancy and Health Survey* still provides the most recent national data available.
The survey found that of the 4 million women who gave birth during the period, 757,000 women drank alcohol products and 820,000 women smoked cigarettes during their pregnancies. There was a strong link among cigarette, alcohol, and illegal drug use. Thirty-two percent of those who reported use of one drug also smoked cigarettes and drank alcohol.
Survey results showed that 221,000 women used illegal drugs during their pregnancies that year, with marijuana and cocaine being the most prevalent: 119,000 women reported use of marijuana and 45,000 reported use of cocaine. The survey estimated that the number of babies born to these women was 222,000, a close parallel to the number of mothers. Generally, rates of any illegal drug use were higher in women who were not married, had less than 16 years of formal education, were not working, and relied on some public source of funding to pay for their hospital stay.
Despite a generally decreasing trend in the use of drugs from 3 months before pregnancy and through the pregnancy, women did not discontinue drug use. However, findings from other NIDA research on women in treatment, for example, indicate that once women are successfully detoxified and enrolled in a treatment program, their motivator to stay drug free is their children.
The survey also pointed to issues of prevalence differences among ethnic groups. While the rates of illegal substance abuse were higher for African Americans, the estimated number of white women using drugs during pregnancy was larger at 113,000 than the number of African-American women at 75,000, or Hispanic women at 28,000.
As for the legal drugs, estimates of alcohol use were also highest among white women at about 588,000, compared to 105,000 among African-American women, and 54,000 among Hispanic women. Whites had the highest rates of cigarette use as well: 632,000 compared with 132,000 for African Americans and 36,000 for Hispanics.
Rates of marijuana use were highest among those under 25 and rates of cocaine use were higher among those 25 and older.
In Fiscal Year 1995, there were nearly 1.9 million admissions to publicly funded substance abuse treatment.
For other information on treatment trends, visit the Substance Abuse and Mental Health Services Administration, Office of Applied Studies web site at http://www.samhsa.gov/oas/oasftp.htm, or call the National Clearinghouse for Alcohol and Drug Information at 1-800-729-6686.