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Impact of Drugs on Society

The trafficking and abuse of drugs in the United States affect nearly all aspects of our lives. The economic cost alone is immense, estimated at nearly $215 billion. The damage caused by drug abuse and addiction is reflected in an overburdened justice system, a strained healthcare system, lost productivity, and environmental destruction.

The Demand for Illicit Drugs

NSDUH data show that in 2008, 14.2 percent of individuals 12 years of age and older had used illicit drugs during the past year. Marijuana is the most commonly used illicit drug, with 25.8 million individuals 12 years of age and older (10.3%) reporting past year use. That rate remains stable from the previous year (10.1%) (see Table B1 in Appendix B). Psychotherapeutics4 ranked second, with 15.2 million individuals reporting past year "nonmedical use" in 2008, a decrease from 16.3 million in 2007. In 2008, approximately 5.3 million individuals aged 12 and older reported past year cocaine use, 850,000 reported past year methamphetamine use, and 453,000 reported past year heroin use.

Rates of drug use vary by age. Rates are highest for young adults aged 18 to 25, with 33.5 percent reporting illicit drug use in the past year. Nineteen percent of youth aged 12 to 17 report past year illicit drug use. Finally, 10.3 percent of adults aged 26 and older report past year illicit drug use. These rates are relatively stable when compared with 2007 rates.

In 2008, approximately 2.9 million individuals tried an illicit drug or used a prescription drug nonmedically for the first time, representing nearly 8,000 initiates per day. More than half of these new users (56.6%) report that marijuana was the first illicit substance that they had tried. Other past year illicit drug initiates report that their first drug was a psychotherapeutic drug used nonmedically (29.6%), an inhalant (9.7%), or a hallucinogen (3.2%). By drug category, marijuana and pain relievers used nonmedically each had an estimated 2.2 million past year first-time users. Also identified frequently as the first drug used by initiates were tranquilizers (nonmedical use--1.1 million), ecstasy/MDMA (0.9 million), inhalants (0.7 million), cocaine (0.7 million), and stimulants (0.6 million). Methamphetamine appears to be fading in popularity among initiates. In 2008, an estimated 95,000 individuals tried methamphetamine for the first time--a 39 percent decrease from the 2007 estimate (157,000) and a 70 percent decrease from the 2004 estimate (318,000).

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The Consequences of Illicit Drug Use

The consequences of illicit drug use are widespread, causing permanent physical and emotional damage to users and negatively impacting their families, coworkers, and many others with whom they have contact. Drug use negatively impacts a user's health, often leading to sickness and disease. In many cases, users die prematurely from drug overdoses or other drug-associated illnesses (see text box). Some users are parents, whose deaths leave their children in the care of relatives or in foster care. Drug law violations constitute a substantial proportion of incarcerations in local, state, and federal facilities and represent the most common arrest category.

Colombian Cocaine Producers Increase Use of a Harmful Cutting Agent

Since late 2007, cocaine has increasingly contained levamisole, a pharmaceutical agent that typically is used for livestock deworming. According to Drug Enforcement Administration (DEA) Cocaine Signature Program data, before 2008, less than 10 percent of the tested wholesale-level cocaine samples contained levamisole. By 2009, approximately 71 percent of the tested cocaine samples contained levamisole. Because levamisole is being found in kilogram quantities of cocaine, investigators are confident that Colombian traffickers are adding it as part of the production process, possibly to enhance the effects of the cocaine. However, levamisole can be hazardous to humans, especially those with weakened immune systems. Ingesting levamisole can cause a person to develop agranulocytosis, a serious, sometimes fatal, blood disorder. At least 20 confirmed and probable cases of agranulocytosis, including two deaths, have been associated with cocaine adulterated with levamisole. The consequences of abusing levamisole are serious enough that in September 2009, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a nationwide public alert on its effects.

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Impact on Health and Health Care Systems

Drug use and abuse may lead to specialized treatment, ED visits (sometimes involving death), contraction of illnesses, and prolonged hospital stays.

In 2008, NSDUH estimated that 7 million individuals aged 12 and older were dependent on or had abused illicit drugs in the past year, compared with 6.9 million in 2007. The drugs with the highest dependence or abuse levels were marijuana, prescription pain relievers, and cocaine. The number of individuals reporting past year marijuana abuse or dependence was 4.2 million in 2008, compared with 3.9 million in 2007; the number of individuals reporting past year prescription pain reliever abuse or dependence was 1.7 million in both 2007 and 2008; and the number of individuals reporting past year cocaine abuse or dependence was 1.4 million in 2008, compared with 1.6 million in 2007.

Many individuals who become dependent on illicit drugs eventually seek treatment. The Treatment Episode Data Set (TEDS) provides information regarding the demographics and substance abuse patterns of treatment admissions to state-licensed treatment facilities for drug dependence. In 2007, there were approximately 1.8 million admissions to state-licensed treatment facilities for illicit drug dependence or abuse. The highest percentage of admissions reported opiates as the primary drug of choice (31%, primarily heroin) followed by marijuana/hashish (27%), cocaine (22%), and stimulants (13%). Although approaches to treatment vary by drug, more than half of the admissions were to ambulatory (outpatient, intensive outpatient, and detox) facilities rather than residential facilities. (See Table B2 in Appendix B for data on admissions for specific drugs.)

Individuals often experience adverse reactions to drugs--including nonfatal overdoses--that require them to go to the hospital. In 2006, the Drug Abuse Warning Network (DAWN) reported that of 113 million hospital ED visits--1,742,887 (1.5%)--were related to drug misuse or drug abuse. An estimated 31 percent of these visits involved illicit drugs only, 28 percent involved CPDs, and 13 percent involved illicit drugs in combination with alcohol. When drug misuse or abuse plays a role in these ED visits, the most commonly reported substances are cocaine, marijuana, heroin, and stimulants (typically amphetamines or methamphetamine).

A 2007 DAWN survey of 63 metropolitan areas found an average of 12.1 deaths per 100,000 persons related to drug use.5 Rates of drug-related deaths range from 1.1 per 100,000 in Sioux Falls, South Dakota, to 26.1 per 100,000 in the New Orleans area. DAWN also records the number of drug-related suicide deaths. In 2007, the number of drug-related suicides per 100,000 persons ranged from less than one in several jurisdictions (including Chicago, Dallas-Fort Worth, and Minneapolis) to 6.2 per 100,000 in Fargo, North Dakota. To put these statistics in perspective, the Centers for Disease Control and Prevention (CDC) reports other nonnatural death rates as follows: Motor vehicle accidents, 15.1 per 100,000; nontransport accidents (e.g., falls, accidental drownings), 24.4 per 100,000; suicide, 11.1 per 100,000; and homicides, 6.2 per 100,000.

The consequences of drug use usually are not limited to the user and often extend to the user's family and the greater community. According to SAMHSA, combined data from 2002 to 2007 indicate that during the prior year, an estimated 2.1 million American children (3%) lived with at least one parent who was dependent on or abused illicit drugs, and 1 in 10 children under 18 lived with a substance-addicted or substance-abusing parent.6 Moreover, the U.S. Department of Health and Human Services estimated in 1999 that substance abuse was a factor in two-thirds of all foster care placements.

Many states have enacted drug-endangered children laws to protect children from the consequences of drug production, trafficking, and abuse. Typically associated with methamphetamine production, drug-endangered children are exposed not only to abuse and neglect but also to fires, explosions, and physical health hazards such as toxic chemicals. In 2009, 980 children were reported to the El Paso Intelligence Center (EPIC) as present at or affected by methamphetamine laboratories, including 8 who were injured and 2 who were killed at the laboratories. These statistics do not include children killed by random gunfire associated with drug activity or who were physically or sexually abused by a "caretaker" involved in drug trafficking or under the influence of drugs.

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Impact on Crime and Criminal Justice Systems

The consequences of illicit drug use impact the entire criminal justice system, taxing resources at each stage of the arrest, adjudication, incarceration, and post-release supervision process. Although drug courts and diversion programs in many jurisdictions have helped to alleviate this burden (see text box), substance abuse within the criminal justice population remains widespread.

Drug Courts

To alleviate the burden that drug use and abuse have caused to the nation's criminal justice system, most jurisdictions have developed drug courts or other diversion programs aimed at breaking the drug addiction and crime cycle. In these nonadversarial, coordinated approaches to processing drug cases, participants receive a full continuum of treatment services, are subject to frequent urinalyses, and experience strict judicial monitoring in lieu of traditional incarceration. Once the offender successfully completes treatment, charges may be dropped.

Since the first drug court became operational in Miami in 1989, the number of drug courts has grown each year, and such courts now exist in all 50 states as well as the District of Columbia, Northern Mariana Islands, Puerto Rico, and Indian Country. As of July 2009, there were 2,038 active drug court programs and 226 in the planning stages. Research has shown that drug courts are associated with reduced recidivism by participants and result in cost savings. For instance, a 2006 study of nine California drug courts showed that drug court graduates had recidivism rates of 17 percent, while a comparison group who did not participate in drug court had recidivism rates of 41 percent. A study of the drug court in Portland, Oregon, found that the program reduced crime by 30 percent over 5 years and saved the county more than $79 million over 10 years. With success stories abundant, drug courts have gained approval at the local, state, and federal levels.

The most recent annual data from the Federal Bureau of Investigation (FBI) show that 12.2 percent of more than 14 million arrests in 2008 were for drug violations, the most common arrest crime category. The proportion of total drug arrests has increased over the past 20 years: in 1987, only 7.4 percent of all arrests were for drug violations. Approximately 4 percent of all homicides in 2008 were drug-related, a percentage that has not changed significantly over the same 20-year period.

The characteristics of populations under correctional supervision reflect these arrest patterns. According to the Bureau of Justice Statistics (BJS), 20 percent of state prisoners and 53 percent of federal prisoners are incarcerated because of a drug offense. Moreover, 27 percent of individuals on probation and 37 percent of individuals on parole at the end of 2007 had committed a drug offense.

The drug-crime link is also reflected in arrestee data. In 2008, the Arrestee Drug Abuse Monitoring (ADAM) II program found that the median percentage of male arrestees who tested positive in the 10 ADAM II cities for any of 10 drugs, including cocaine, marijuana, methamphetamine, opioids, and phencyclidine (PCP), was 67.6 percent, down slightly from 69.2 percent in 2007. Other data reflect the link as well. In 2002, a BJS survey found that 68 percent of jail inmates were dependent on or abusing drugs and alcohol and that 55 percent had used illicit drugs during the month before their offense. In 2004, a similar BJS self-report survey identified the drug-crime link more precisely: 17 percent of state prisoners and 18 percent of federal prisoners had committed their most recent offense to acquire money to buy drugs. Property and drug offenders were more likely than violent and public-order offenders to commit crimes for drug money.

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Impact on Productivity

Premature mortality, illness, injury leading to incapacitation, and imprisonment all serve to directly reduce national productivity. Public financial resources expended in the areas of health care and criminal justice as a result of illegal drug trafficking and use are resources that would otherwise be available for other policy initiatives.

There is a great loss of productivity associated with drug-related premature mortality. In 2005, 26,858 deaths were unintentional or undetermined-intent poisonings; in 2004, 95 percent of these poisonings were caused by drugs. Although it is difficult to place a dollar value on a human life, a rough calculation of lost productivity can be made based on the present discounted value of a person's lifetime earnings.

There are also health-related productivity losses. An individual who enters a residential drug treatment program or is admitted to a hospital for drug treatment becomes incapacitated and is removed from the labor force. According to TEDS data, there were approximately 1.8 million admissions to state-licensed treatment facilities for illicit drug dependence or abuse in 2007. Productivity losses in this area alone are enormous. Health-related productivity losses are higher still when lost productivity associated with drug-related hospital admissions (including victims of drug-related crimes) is included.

The approximately one-quarter of offenders in state and local correctional facilities and the more than half of offenders in federal facilities incarcerated on drug-related charges represent an estimated 620,000 individuals who are not in the workforce. The cost of their incarceration therefore has two components: keeping them behind bars and the results of their nonproductivity while they are there.

Finally, there is productivity lost to drug-related unemployment and drug-related absenteeism. According to the 2008 NSDUH, 19.6 percent of unemployed adults may be defined as current users of illicit drugs. Based on population estimates from the same study, this translates into approximately 1.8 million unemployed individuals who were current drug abusers. Further, approximately 8 percent of individuals employed full time and 10.2 percent of individuals employed part-time were current users of illicit drugs. Individuals who are employed but have chronic absenteeism resulting from illicit drug use also accrue substantial lost productivity.

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Impact on the Environment

The environmental impact of illicit drugs is largely the result of outdoor cannabis cultivation and methamphetamine production. Many of the chemicals used to produce methamphetamine are flammable, and the improper storage, use, and disposal of such chemicals that are typical among methamphetamine producers often lead to fires and explosions at clandestine laboratories. Additionally, the process used to produce methamphetamine results in toxic chemicals--between 5 and 7 pounds of waste per pound of methamphetamine--that are typically discarded improperly in fields, streams, forests, and sewer systems, causing extensive environmental damage.

Currently, there are no conclusive estimates regarding the nationwide cost of methamphetamine production site remediation because many of the methamphetamine laboratories and dumpsites in the United States are undiscovered due to their clandestine locations. However, in California alone, from January through December 10, 2009, the California Department of Toxic Substance Control responded to and cleaned up 232 laboratories and dumpsites at a cost of $776,889, or approximately $3,349 per site.

Outdoor cannabis cultivation, particularly on public lands, is causing increasing environmental damage. Grow site operators often contaminate and alter watersheds, clear-cut native vegetation, discard garbage and nonbiodegradable materials at deserted sites, create wildfire hazards, and divert natural water courses. For example, cultivators often dam streams and redirect the water through plastic gravity-fed irrigation tubing to supply water to individual plants. The high demand for water often strains small streams and damages downstream vegetation that depend on consistent water flow. In addition, law enforcement officials are increasingly encountering dumpsites of highly toxic insecticides, chemical repellants, and poisons that are produced in Mexico, purchased by Mexican criminal groups, and transported into the country for use at their cannabis grow sites. These toxic chemicals enter and contaminate ground water, pollute watersheds, kill fish and other wildlife, and eventually enter residential water supplies. Moreover, the National Parks Conservation Association (NPCA) reports that while preparing land for cannabis cultivation, growers commonly clear the forest understory, which allows nonnative plants to supplant native ones, adversely affecting the ecosystem. They also terrace the land--especially in mountainous areas--which results in rapid erosion.

Limited research on the environmental impact of the improper disposal of pharmaceuticals7 indicates that contamination from dissolved pharmaceutical drugs is present in extremely low levels in most of the nation's water supply. The harm to aquatic life and the environment has not been determined, and according to the Environmental Protection Agency, scientists have found no evidence of adverse human health effects from the minute residue found in water supplies. Nonetheless, as a precaution based on environmental research to date, the ONDCP and the Food and Drug Administration suggest that consumers use take-back programs to dispose of unused prescription drugs (see text box in Vulnerabilities section).


4. Nonmedical use of prescription-type psychotherapeutics includes the nonmedical use of pain relievers, tranquilizers, stimulants, and sedatives but excludes over-the-counter drugs.
5. DAWN defines drug-related deaths as deaths that are natural or accidental with drug involvement, deaths involving homicide by drug, and deaths with drug involvement when the manner of death denoted by the medical examiner is "could not be determined."
6. Data include alcohol dependence or alcohol abuse.
7. The research also included antibiotics, steroids, and more than 100 pharmaceuticals.

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