Escolar Documentos
Profissional Documentos
Cultura Documentos
DRAFT
Pgs. 0 - 19
Teri Abel
2011
Contents
Introduction .................................................................................................................................................. 3
Illicit Drug, Alcohol and Tobacco
U.S. Overview ........................................................................................................................................ 5
Illicit drug use ................................................................................................................................... 5
Alcohol use ..................................................................................................................................... 11
Tobacco use ................................................................................................................................... 13
Trending |US ................................................................................................................................. 14
Abuse and Dependence ................................................................................................................. 16
Treatment ...................................................................................................................................... 18
Georgia Overview................................................................................................................................ pp
Georgia Narrative ....................................................................................................................................... pp
SA Spending—back‐end ............................................................................................................................. pp
U.S. ..................................................................................................................................................... pp
Georgia ............................................................................................................................................... pp
Culturally Centered Models of Care............................................................................................... pp
SA Spending—front‐end ............................................................................................................................ pp
U.S. ..................................................................................................................................................... pp
Prevention ...................................................................................................................................... pp
Federal Targets .............................................................................................................................. pp
Georgia ............................................................................................................................................... pp
Policy Implications .............................................................................................................................. pp
Grants list ....................................................................................................................................... pp
References .................................................................................................................................................. pp
2
Introduction
The United States is the world’s third most policy makers, and health care systems
populous country, the inhabitants of which should assume will be longstanding.
enjoy a relatively high collective and per Against this backdrop stands the state of
capita disposable income. It represents an Georgia with a differentiated challenge in
open society and one with the fullest array substance abuse and the provision of
of entry points and border crossings.1 As substance abuse and related mental health
such, the U.S. is an ideal market and target treatment.
for the illegal drug industry, and it attracts
the world’s most creative and aggressive Georgia intersects significantly with a
drug traffickers. More broadly, America is strategic collection of major arteries of our
also the largest producer and user of interstate highway system—in particular I‐
prescription drugs. 95, I‐85, and I‐20—in direct logistical service
to a wholesale ground distribution network
This constellation of fundamental for illegal drugs. Georgia is home to the
attributes—size, wealth, openess, and south’s largest city and the world’s busiest
prevalence of prescription drug use—is airport. It borders the Atlantic Ocean along
uniquely American. It therefore supports a 192 miles of the Atlantic Coastal Plain. It
prevailing potential for Americans’ use and includes an ethnic population correlating to
abuse of illicit and legal drugs, alongside the a 38% disproportionately at‐risk group. It
potential need for substance abuse (SA) enjoys a high population growth rate and a
treatment and related mental health growing need for public services. It is home
treatment for millions of Americans. to both significant urban and rural
These attributes also durably interlock in a populations claiming a broad spectrum of
manner that federal and state governance, microcultural experience mapping to a
diversity of culturally accented drug use.
1
According to the U.S. Drug Enforcement By American standards and U.S. Census
Administration, annually there are approximately 60 calculus Georgia is poor and has relatively
million people who enter the U.S. on greater than limited state resources—particularly during
675,000 commercial and private flights, 6 million long bouts of economic recession—and,
who arrive by sea, and 370 million who come by
land. Also, annually 116 million vehicles cross the
therefore, has relatively limited state
borders between the U.S. and Canada and between service provision. By global standards,
the U.S. and Mexico. Greater than 90,000 passenger however, Georgia’s 9th largest U.S.
and merchant vessels dock at U.S. ports with ships population at nearly 10 million still
carrying upwards of 9 million shipping containers represents a critical population of affluent
wielding 400 million tons of cargo. An additional
157,000 smaller vessels visit many American coastal
Americans, and globally, illegal drug use
towns. The United States Drug Enforcement strongly and positively correlates with
Administration (DEA), “DEA Briefs & Background, affluence.
Drugs and Drug Abuse, State Fact Sheets”, online
athttp://www.justice.gov/dea/pubs/state_factsheet
Toward effective management of this
s.html. fundamental economic tension—adequate
resources by residents to procure illicit and
3
4
U.S. Overview
Illicit Drug Use
Among nations, the United States is the foremost and most
The U.S. disproportionate substance abuser.2 Comprising less than 5% of the
disproportionately world’s population, it consumes two‐thirds of the world’s illicit drugs.3,4
leads the world in The United States is the world’s largest consumer of cocaine, Colombian
both illicit and heroin, Mexican heroin and Mexican marijuana, and it is a major
prescription drug consumer of ecstasy and Mexican methamphetamine.5
use.
The United States also leads the world in the use of prescription drugs,
notably painkillers, using 77% of the world’s oxycodone and over 99% of
2
Degenhardt L, Wai‐Tat Chiu, Nancy Sampson, Ronald C. Kessler, James C. Anthony, et al., “Toward a Global View
of Alcohol, Tobacco, Cannabis, and Cocaine Use: Findings from the WHO World Mental Health Surveys”, PloS Med,
(2008), online at http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050141 .
3
Joseph A. Califano, Jr, High Society: How Substance Abuse Ravages America and What to Do About It (New York:
PublicAffairs Press, 2007), 9.
4
Herein “illicit drug” is used per usage by the National Survey on Drug Use and Health (NSDUH) as sponsored by
the Substance Abuse and Mental Health Services Administration (SAMHSA). It effectively includes all illegal drugs
in the U.S., and all legal prescription‐type drugs and other substances that are intentionally used nonmedically (i.e.,
used without a prescription of the individual's own or simply for the experience or feeling the drugs cause). Hence,
per SAMHSA’s use, both a substance and its usage can be illicit.
NSDUH reports it obtains information on the following nine categories of illicit drug use: marijuana, cocaine,
heroin, hallucinogens, inhalants, and nonmedical use of prescription‐type pain relievers, tranquilizers, stimulants,
and sedatives. In these categories, hashish is included with marijuana and crack is considered a form of cocaine.
Several drugs are grouped under the hallucinogens category, including LSD, PCP, peyote, mescaline, psilocybin
mushrooms, and "ecstasy" (MDMA). Inhalants include a variety of substances, such as nitrous oxide, amyl nitrite,
cleaning fluids, gasoline, spray paint, other aerosol sprays, and glue. The four categories of prescription‐type drugs
(pain relievers, tranquilizers, stimulants, and sedatives) cover numerous medications available by prescription.
NSDUH reports combine the four prescription‐type drug groups into a category referred to as
"psychotherapeutics." Also included in this grouping are drugs that originally were prescription medications but
currently may be manufactured and distributed illegally, such as methamphetamine, which is included under
stimulants.
Illicit drugs exclude alcohol and tobacco, even if used illegally (for example by minors) or abusively (for example
in binge drinking), and these two substances are analyzed separately by SAMHSA. Use of over‐the‐counter drugs is
not included in NSDUH results.
United States, Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies,
National Survey on Drug Use and Health (NSDUH), Results from the 2008 National Survey on Drug Use and Health:
National Findings (2009), Rockville, MD., online at http://oas.samhsa.gov/nsduh/2k8nsduh/2k8Results.pdf .
5
United States, The Central Intelligence Agency, “The World Fact Book,” online at
https://www.cia.gov/library/publications/the‐world‐factbook/fields/2086.html .
5
the world’s hydrocodone in 2008, use correlated with increased risk and
incidence of drug diversion, abuse and dependence.6 Indeed, in the U.S.
the most diverted and abused pharmaceuticals are ones containing
hydrocodone and oxycodone.7
In 2008, an estimated 20.1 million Americans aged 12 or older, or 8% (1
in 12.5 persons) of that age group, were current (past month) illicit drug
users, meaning they had used an illicit drug during the month prior to the
Substance Abuse and Mental Health Services Administration’s (SAMHSA)
survey interview.8,9 In order of decreasing prevalence respectively,
marijuana, psychotherapeutics and cocaine were the three most used
illicit drugs by persons aged 12 or older.10 Marijuana was used at a rate
of 6.1% of persons aged 12 or older representing 15.2 million past month
users.11 Nonmedically used psychotherapeutics were used at a rate of
2.5% with 6.2 million past month users, and cocaine was the 3rd most
used illicit drug by persons aged 12 or older with a usage rate of 0.7%
representing 1.9 million current cocaine users.12
6
International Narcotics Control Board (INCB), Annual Report, Operation of the international drug control system
(2009) New York, NY, online at http://www.incb.org/pdf/annual‐report/2009/en/AR_09_E_Chapter_II.pdf .
7
INCB Annual Report (2009).
8
SAMHSA (2009).
9
Surveyed populations excluded institutionalized persons and active duty military personnel.
10
SAMHSA (2009).
11
SAMHSA (2009).
12
SAMHSA (2009).
6
Figure 1
U.S. Past Month Illicit Drug Use among Persons Aged 12 or Older: 2008
Source: NSDUH 2008.
1
Illicit Drugs are defined as in footnote 4.
Among the 20.1 million illicit drug users aged 12 years or older in 2008
Marjiuana is the
were also multiple illicit drug users. Illicit drug users of marijuana
most widely used
exclusively, the most widely used illicit drug, constituted a majority, or
Illicit drug.
57.3%, of all illicit drug users. Illicit drug users who were nonusers of
marijuana constituted 24.3% of all illicit drug users, and users of
marijuana and at least one other illicit drug constituted 18.4% of illicit
drug users.13
13
SAMHSA (2009).
7
Figure 2
2008 Illicit drug use in terms of marijuana use,
the most commonly used illicit drug
Although marijuana does not pose as serious a public health problem as
Marjiuana has do drugs like cocaine, heroin and methamphetamine, today’s marijuana
increased in ∆9‐ can be up to five times more potent than the cannabis of the 1970s,
THC potency over according to the National Institute on Drug Abuse (NIDA), a potency that
time, has disproportionately affected certain minority users.14
disproportionately
affecting certain
minorities.
Illicit drug use in 2008 varied among persons aged 12 or older by
Illicit drug use race/ethnicity as summarized in Figure 3 with highest rates reported for
varies meaningfully mixed race respondents and lowest rates reported for Asians. African
by race/ethnicity. Americans ranked second highest in illicit drug use at 10.1%.15
14
Compton, Wilson M., et al., “Prevalence of Marijuana Use Disorders in the United States”, The Journal of the
American Medical Association, (2004), online at http://jama.ama‐assn.org/cgi/content/full/291/17/2114 .
This study conducted for NIDA compared marijuana use in 2001 and 2002 with use during the previous decade.
Although the percent of the population using the drug remained stable for the periods, dependence on or abuse of
the drug increased significantly, particularly among young black men and women and among young Hispanic men.
Higher concentrations of delta‐9‐tetrahydrocannabinol, known as 9‐THC, were believed to be the likely reason
for the increased dependency. The potency of 9‐THC in confiscated marijuana from police seizures increased by
66% from 3.08% in 1992 to 5.11% in 2002.
15
SAMHSA (2009).
8
Figure 3
Past Month Illicit Drug Use among Persons Aged 12 or Older, by
Race/Ethnicity: 2008
Source: NSDUH 2008.
Aside from varying with race, current illicit drug use varied significantly
Illicit drug use with age, gender, degree of education, college student status,
varies meaningfully employment status, criminal justice population status (for example, the
by a range of socio‐ status of being on parole or under other supervised release), current
economic factors. cigarette and alcohol use, and geographic area of residence.
Among all age ranges, that range from 18‐22 years was a particularly
strong risk factor for current illicit drug use. Nonuse of illicit drugs across
this span of years was reported to favorably correlate with increased
chances of life‐long sobriety.
Among these variances were those deemed socioeconomically accented,
including employment status and criminal justice population status. The
unemployed current use rate of 19.6% greatly exceeded that for persons
in the category who were employed part time with a current use rate of
10.2%, and those who were employed full time with a current use rate of
8.0%.16 However, underscoring a general correlation between illicit drug
use and affluence, most drug users in 2008 were employed. The survey
did note an uptick from 2007 to 2008 in the percentage of unemployed
current illicit drug users—already disproportionately high—and further
16
SAMHSA (2009).
9
reported this increase to correlate with the uptick in unemployment over
the same period.17
Regarding criminal justice populations, an estimated 18.3% of persons
aged 18 or older and on parole or other supervised release from prison at
some time during the past year were current illicit drug users, compared
to only 7.8% of those neither on parole nor supervised release.18 In
addition, among adults on probation at some time in the past year,
23.9% reported current illicit drug use in 2008, a rate considerably higher
than the previous year’s rate of 7.5%.19
Summary illicit drug use from 2002 – 2008 remained well within a
percentage point of difference as indicated in Figure 4. However, the
U.S. population was estimated to have increased over the same period by
16,570,932 or 5.5%, a population nearly as large as that of the state of
Florida.20
Figure 4
Past Month Use of Selected Illicit Drugs among Persons Aged 12 or
Older: 2002‐2008
Source: NSDUH 2008.
+ Difference between this estimate and the 2008 estimate is
statistically significant at the .05 level.
17
SAMHSA (2009).
18
SAMHSA (2009).
19
SAMHSA (2009).
20
United States Census Bureau, “Annual Estimates of the Resident Population for the United States, Regions,
States, and Puerto Rico: April 1, 2000 to July 1, 2009”, Table 1, online at
http://www.census.gov/popest/states/NST‐ann‐est.html.
10
Alcohol use
Among persons aged 12 or older who were reported users of alcohol, or
Despite a 5th 51.6% of that age group corresponding to 129 million persons, whites in
highest Current Use 2008 reported the highest rate for current use of alcohol at 56.2%. The
rank by African rate was next highest for persons reporting two or more races at 47.5%.
Americans and It was 43.3% for American Indians or Alaska Natives, 43.2% for Hispanics,
overall steady or 41.9% for blacks, and 37.0% for Asians.21
declining alcohol
use for Americans Current binge alcohol use had the lowest rate among Asians
generally, (11.9 percent) and the highest (25.6 percent) among Hispanics. Rates for
unprecedented other racial/ethnic groups were 20.4 percent for blacks, 22.0 percent for
lifestyle marketing persons reporting two or more races, 24.0 percent for whites, and
trends make 24.4 percent for American Indians or Alaska Natives.
African Americans
a demographic to All modes of alcohol use by race as defined by SAMHSA—current, binge,
watch. and heavy—were surveyed and are summarized in Figure 5.
Figure 5
Current, Binge, and Heavy Alcohol Use among Persons Aged 12 or
Older, by Race/Ethnicity: 2008
Note: Due to low precision estimates for Native Hawaiians or Other Pacific
Islanders are not shown.
Source: NSDUH 2008.
21
SAMHSA (2009).
11
For persons aged 18 and older, the 2008 NSDUH also found strong
positive and negative correlations with alcohol use and other variables,
including level of education, college enrollment status, employment
status and even geographic area. The 2008 NSDUH reported either
statistically insignificant growth in all alcohol use over NSDUH 2007
figures or slight declines in use.22
22
Going forward, however, recent industry promotion of alcohol products marketed to the African American
demographic through a scheme of proven marketing and entertainment platforms are notable. Particularly so are
strong lifestyle brands in high profile entertainers and music industry moguls.
Examples include a 2007 multiyear deal between the Diageo plc company (DEO) and Sean John Combs (“Diddy”).
In this deal Combs, presumed by the Forbes business medium to be the wealthiest Hip‐Hop artist and to ultimately
owe most of his wealth to his alcohol venture, will receive a 50% share of profits from Ciroc Vodka. In the March
2011 Forbes column titled “Why Diddy Will Be Hip‐Hop’s First Billionaire”, Forbes staff quoted Edward Jones & Co.
equity analyst, Jack Russo, who stated:
“The product is important. But the name on the product is about ten times as important.”
Forbes further noted:
“…Executives at Diageo could never have expected just how much Diddy’s presence would boost sales. In 2007
sleepy Ciroc was moving cases at a rate of 60,000 per six months, or 120,000 per year. In 2009 Diddy’s second
year with the brand, Ciroc moved 400,000 cases. This year Ciroc is on pace to sell more than 1 million cases.
The boom was fueled in large part by Diddy’s diligent shilling—on billboards, in lyrics, on Twitter and even
through a self‐proclaimed nickname, “Ciroc Obama.”
Hence, Combs’ affiliation with Ciroc Vodka conferred a 733% volume growth rate of the product in only 4 years.
Diageo senior vice‐president for consumer planning, Jim Mosely, stated after the Combs partnership was
announced:
“Only twice in my career have I seen an immediate response in our brand tracking”…“We saw it really take off
in the African‐American community, and it has started to broaden its appeal. Throughout the entire economic
recession, it was one of the few brands that never slowed down.”… “As a community, African‐Americans are
leaders in terms of style, fashion and image,”…“They can take brands and make them very big themselves.”
See FT.com “Diddy factor invigorates vodka sales for Diageo”, online at http://www.ft.com/cms/s/0/4690a934‐
dc8d‐11df‐84f5‐00144feabdc0.html#axzz1O9xa6stC . For comparison, the “Diddy factor” in case volumes for
Diageo at a 733% increase in 4 years, exceeds by 700% the total revenue increase from all Nike Corporation
product lines combined 4 years after Michael Jordan’s endorsement in 1984 of Nike Air Jordan athletic shoes. See
archived Nike Annual Reports online at http://invest.nike.com/phoenix.zhtml?c=100529&p=irol‐reportsOther .
Perhaps encouraged by the “Diddy factor”, the Diaego company also recently announced a new Crown Royal
drink partnership promoting, “The Crown Life”, with Atlanta recording artist, Antwan “Big Boi” Patton of the rap
duo Outkast.
Forbes reported 3rd wealthiest Hip‐Hop artist and brand, Dr. Dre (Andre Young) acquired an equity stake in Drinks
American Holdings, Inc. that launched his premium brand of cognac and a sparkling vodka in 2008. Dr. Dre is
reportedly also looking to enter the imported premium tequila business.
Rapper Snoop Dogg (Calvin Broadus), who like Combs has over 3 million twitter followers, has endorsed “Blast”, a
high alcohol content drink which debuted in April 2011, that appeals to urban minors with fruit flavors and brightly
colored cans. It is reported to contain in one 23.5‐ounce (700‐milliliter) can the equivalent alcohol consumed from
drinking 5 servings of alcohol or approximately one six‐pack of American beer. Over a dozen U.S. states have
termed it a “binge in a can” and 18 state Attorneys General, deeming it “impossible to drink responsibly”, have
formally asked maker Pabst Brewing Company to remove the product from the market. See The Christian Science
Monitor, “Blast, a fruity Pabst drink, gets scrutiny. Whom is Snoop Dogg selling it to?”, April 22, 2011, online at
http://www.csmonitor.com/USA/2011/0422/Blast‐a‐fruity‐Pabst‐drink‐gets‐scrutiny.‐Whom‐is‐Snoop‐Dogg‐
selling‐it‐to , and The Marin Institute, “Attorneys Tell Pabst to Dump ‘Binge in a Can’ Blast”, April 21, 2011.
Rapper Chris "Ludacris" Bridges is promoting a stake in a new 80 proof spirit called Conjure Cognac.
12
Tobacco use
In 2008, 28.4% of Americans aged 12 or older, an estimated 70.9 million
Tobacco product
persons, were current (past month) users of a tobacco product. For this
use from 2002 to
age range, 23.9%, an estimated 59.8 million persons, were current
2008 has held
cigarette smokers in particular.
steady.
Alcoholic products aside, new behavioral norms invoking alcohol consumption and explicit abuse are effectively
marketed, and currently feature prominently in entertainment products popular with urban and African American
audiences. In 2010, recording artist Trey Songz released a hugely successful song “Bottoms Up” that affirms
alcohol consumption and particularly insobriety. As of the date of this document’s writing the official song video
had been viewed on Youtube approximately 45 million times (for perspective, representing several million more
than the most recent U.S. Census count of African Americans in the U.S. population), while unofficial video
versions have been viewed several million times more.
In lyrics to another widely popular song invoking inebriation titled “Wasted”, recording artist Gucci Mane raps
with characteristic urban precision and experiential detail about alcohol induced insobriety, even in the chorus
quantifying and celebrating consumption not in terms of drinks but of cases.
Song lyrics have long been controversial, but the New York Times Science page recently reported a study of song
lyrics over three decades that statistically identified trends in language, subject matters and dispositions in music
that were correlated to separate trends found in studies and surveys on general culture. See New York Times, “A
Generation’s Vanity, Heard Through Lyrics”: April 26, 2011, page D1 of the New York print edition; online at
http://www.nytimes.com/2011/04/26/science/26tier.html?_r=2&src=ISMR_AP_LO_MST_FB . One implication is
that other correlations may be revealed between lyrically codified cultural norms and trending cultural behavior
pertaining to alcohol consumption.
Aforementioned ventures also surpass all traditional notions of “endorsements”. Relative to his Diageo deal
Combs himself noted the distinction, declaring himself not simply an endorser, but a “luxury brand builder.”
Online at http://www.popsugar.com/Diddy‐Expands‐His‐Empire‐732895. Hence, key about industry icons is their
function as efficient channels to loyal markets, some that may be moved to consume across a range of products
with one tweet, swiftly defining whole cultural norms of not only music, but also language, disposition and broad
consumption allegiances across fashion, automobiles, fragrances or cosmetics‐‐‐“lifestyle”.
Undeniably and to degrees heretofore unprecedented, shareholders and alcohol industry staples within and
beyond the U.S. economy, have bet that like fashion and other industries, the alcoholic beverage industry can grow
key market share among African Americans. The implications are that 2008 NSDUH 5th place status in Current Use
of Alcohol by African Americans, however consistent in the past, is not assumed by industry to be inflexible going
forward, and, hence, nor are previous levels of binge or heavy alcohol consumption, both severer defined uses
than “current”.
Finally, declined levels of alcohol consumption as reported by modern surveys of 8th, 10th, and 12th grade
students may still underreport for the African American demographic in this age range, as young African
Americans, with some of the highest secondary school drop out rates, may be underrepresented in such surveys.
See Monitoring the Future’s report on 2010 Data from In‐School Surveys
of 8th‐, 10th‐, and 12th‐Grade Students, online at http://monitoringthefuture.org/data/10data.html#2010data‐
drugs , and The Distilled Spirits Council of the United States’ report 2010 Monitoring the Future Survey: Teen
Drinking Rates Reach Historic Low, online at 2010 Monitoring the Future Survey: Teen Drinking Rates Reach
Historic Low.
Irrespective, they are a demographic minority with limited impact on overall prevalence for any age groups,
arguably making this demographic‐‐‐one that can be hidden numerically among a national majority but also
disproportionately targeted by powerful alcohol industry marketing campaigns‐‐one to watch.
13
Figure 6
Past Month Tobacco Use among Persons Aged 12 or Older: 2002‐2008
Source: NSDUH 2008.
In decreasing order, the 2008 current use rate of a tobacco product
among persons aged 12 or older was 48.7% for American Indians or
Alaska Natives, 37.3% for persons who reported two or more races, 30.4
% for whites, 28.6% for blacks, 21.3% for Hispanics and 13.9% for Asians.
Between 2002 and 2008, statistically significant changes in past month
use of tobacco products were not particularly observed.
Trending | US
The greatest change in illicit drug use over the 6 year period preceding
Currently the two
the 2008 NSDUH survey occurred among methamphetamine users (a
biggest illicit drug
stimulant within the psychotherapeutic category) with decreases in use
trends are a decline
by over half between 2006 and 2008.23,24 The numbers of past‐month
in
users for this period were estimated at 731,000 in 2006, 529,000 in 2007,
methamphetamine
and 314,000 in 2008.
use and an increase
in prescription drug
Declines in methamphetamine use are suspected to have linkage to
abuse.
increased U.S. and Mexico restrictions on cold medicines and
decongestants, ingredients that partly sourced local cottage industry
23
SAMHSA (2009).
24
NIDA InfoFacts: Methamphetamine, online at http://www.nida.nih.gov/infofacts/methamphetamine.html.
14
methamphetamine manufacturing in the U.S.25 In contrast cocaine and
heroin, being plant derivatives, are less susceptible to production shocks
and are unlikely to have as comparable an elastic supply relative to any
prohibition as that had by methamphetamine production. 26
Also occurring in recent years were dramatic increases in emergency
room admissions to U.S. hospitals for legal drug abuse, particularly abuse
of prescription painkillers, also within the psychotherapeutic category.
There occurred a two‐fold increase in emergency room visits for legal
drug abuse from 2004 – 2008.27 Increases cut across age, gender,
race/ethnicity, education, employment status, and region.
Figure 7
Rates of emergency department (ED) visits* for nonmedical use of
selected opioid analgesics, by type in the United States from 2004—
2008
Source: SAMHSA's Drug Abuse Warning Network (DAWN), 2004‐‐2008.
* Per 100,000 population.
† 95% confidence interval.
§ Rate significantly less than the rate in 2008, by two‐sided t test (p<0.05).
¶ Drug types include combination products (e.g., combinations of oxycodone and
aspirin).
25
“Speedy decline: Success in the war against methamphetamines—at a certain price”, The Economist, (2008)
online at http://www.economist.com/node/11293716?story_id=11293716 .
26
The Economist (2008).
27
United States, Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies,
The TEDS Report ‐ Substance Abuse Treatment Admissions Involving Abuse of Pain Relievers: 1998 and 2008 (2010),
Rockville, MD., online at http://oas.samhsa.gov/2k10/230/230PainRelvr2k10.cfm.
15
The number of emergency room visits to U.S. hospitals for legal drug
abuse now equals that for illicit drug abuse.28,29 Indeed, abuse of
prescribed drugs after increasing over the past 10 years now rivals the
abuse of all other drugs except cannabis.30 This has led the Office of
National Drug Control Policy and President Obama’s Drug Czar Gil
Kerlikowske to declare abuse of prescription drugs as the fastest growing
drug problem in the United States today.31,32
Abuse and Dependence
In 2008, an estimated 22.2 million persons aged 12 or older were
classified with substance dependence or abuse in the past year or 8.9%
of those aged 12 or older.33,34 Of these, 3.1 million were classified with
dependence on or abuse of alcohol and illicit drugs, 3.9 million were
dependent on or abused illicit drugs but not alcohol, and 15.2 million
were dependent on or abused alcohol but not illicit drugs.35
28
United States, Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report
(MMWR), Emergency Department Visits Involving Nonmedical Use of Selected Prescription Drugs‐‐‐United States,
2004—2008 (Washington, DC: CDC, 18 June 2010), online at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5923a1.htm?s_cid=mm5923a1_w
Morbidity and Mortality Weekly Report (MMWR).
29
Per NSDUH, nonmedical use of prescription‐type pain relievers, tranquilizers, stimulants, or sedatives is defined
as use of at least one of these medications without a prescription belonging to the respondent or use that
occurred simply for the experience or feeling the drug caused.
30
United States, SAMHSA’s Office of Applied Studies, Substance Abuse Treatment Admissions Involving Abuse of
Pain Relievers: 1998 and 2008, Report of the International Narcotics Control Board for 2005, Pg 57, online at
http://www.incb.org/pdf/e/ar/2005/incb_report_2005_3.pdf .
31
CDC Online Newsroom, “Study Shows 111 Percent Increase in Emergency Department Visits Involving
Nonmedical Use of Prescription Opioid Pain Relievers in Five‐Year Period,” press release, 17 June 2010, online at
http://www.cdc.gov/media/pressrel/2010/r100617.htm .
32
The increase in emergency room captured abuse of prescription drugs is qualitatively believed by officials of
SAMHSA and administrators of the NSDUH to be attributable less to an increase in the number of people abusing
prescription drugs and more to the severity of use by those who do abuse these drugs. Similarly, the level of
treatment demanded by abusers of methamphetamine per TEDS Trends in Methamphetamine use 1997‐2007 has
increased over a period coinciding with the actual decrease in the drug’s number of past users per NSDUH. Hence,
NSDUH’s psychotherapeutic category has not indicated a great increase in prevalence that might be anticipated by
a determination of prescription drug abuse as the fastest growing drug problem in the United States.
33
SAMHSA (2009).
34
This exceeds and is distinguished from the number of past month illicit drug users estimated by the 2008 NSDUH
at 20.1 million Americans aged 12 or older.
35
SAMHSA (2009).
16
Figure 8
Substance Dependence or Abuse in the Past Year among Persons Aged
12 or Older: 2002‐2008
Source: NSDUH 2008.
Past month illicit drug use categories do correlate directly with those of
drug abuse or dependence in the past year in keeping with the usage
patterns of Figure 1:
Figure 9
Dependence on or Abuse of Specific Illicit Drugs in the Past Year among
Persons Aged 12 or Older: 2008
Source: NSDUH 2008.
17
As was the case from 2002 through 2007, the rate of substance
dependence or abuse for males aged 12 or older in 2008 was about twice
as high as the rate for females. Among youths aged 12 to 17, however,
the rate of substance dependence or abuse among males was lower than
the rate among females in 2008 (7.0 vs. 8.2 percent).
Figure 10
Substance Dependence or Abuse in the Past Year, by Age and Gender:
2008
Source: NSDUH 2008.
Treatment
SAMHSA defines “treatment need” as having a substance use disorder or
About 90% of
receiving treatment at a specialty facility (hospital inpatient, drug or
persons classified
alcohol rehabilitation, or mental health centers) within the past 12
as needing SA
months.36 The 2008 NSDUH reports that 9.2% of persons aged 12 or
treatment did not
older or 23.2 million persons so aged, needed treatment for an illicit drug
receive it, but only
or alcohol use problem.37 Of these, 2.3 million, representing 0.9% of
about 5% of those
persons aged 12 or older and 9.9% of those who needed treatment,
needing felt they
received treatment at a specialty facility.
needed treatment;
less than a quarter
Consequently, 20.8 million persons or 8.3% of those aged 12 or older,
of those sought it.
needed treatment for an illicit drug or alcohol use problem but did not in
36
SAMHSA (2009).
37
SAMHSA (2009).
18
the past year receive such treatment at a specialty SA facility.38 Of this
group classified as needing SA treatment but who did not receive
treatment at a specialty facility in the past year, 4.8% or 1 million persons
reported that they felt they did need such SA treatment.39 About one
quarter of those or 23.3% reported that they made an effort to procure
such SA treatment.40
38
SAMHSA (2009).
39
SAMHSA (2009).
40
SAMHSA (2009).
19