Drug Abuse in America
I. The Problem of Prescription Drug Abuse
America has a long-standing drug problem. The trade and use of illicit drugs in the US represents perhaps the most vile and disruptive part of American life.[1] This is because drugs change who we are. People who would otherwise be absolutely normal and caring human beings do unimaginably horrible things while on drugs. Drugs quite often distort our view of the world, and along with it our reasoning – misleading and urging usat times to act antisocially. The enormous sums of money that can be made selling drugs have created powerful economic interests that corrupt governments;many of these have become gangs and cartels that survive on terror and intimidation.[2]
Ignoring for the moment the more general issue of substance abuse (i.e. alcohol, tobacco, and drugs), drug abuse can be conveniently divided into two types of pathologies – the abuse of legally obtained prescription drugs and the use of illegal or prohibited drugs.
The abuse of prescription drugs is difficult to control because it is often carried out using perfectly acceptable transactions with the medical and pharmaceutical communities.We often need pain killers and opioids to help us overcome our afflictions.[3]Prescription drugs may nevertheless find their way into the hands of abusers when prescriptions are forged, or when they are used by other people not on the prescription, or when they are used in excess of what is needed.
The White House’s Office of National Drug Control Policy describes the prescription drug control problem in America in the following way
Prescription drug abuse is the Nation's fastest-growing drug problem, and the Centers for Disease Control and Prevention has classified prescription drug abuse as an epidemic. While there has been a marked decrease in the use of some illegal drugs like cocaine, data from theNational Survey on Drug Use and Healthshow that nearly one-third of people aged 12 and over who used drugs for the first time in 2009 began by using a prescription drug non-medically.
Some individuals who misuse prescription drugs, particularly teens, believe these substances are safer than illicit drugs because they are prescribed by a healthcare professional and dispensed by a pharmacist. Addressing the prescription drug abuse epidemic is not only a top priority for public health, it will also help build stronger communities and allow those with substance abuse disorders tolead healthier, more productive lives.[4] (my bolding and italics)
What prescription drugs are being abused in America and how big is the problem? There are generally three large categories of prescription drugs that are abused.[5] These are
(1) Opioids
(2) Central Nervous System Depressants
(3) Stimulants
Opioids work to insulate the brain and spinal cord from any stimulus that might generate a painful response by attaching to proteins in these organs called opioid receptors. These protein sheaths inhibit the perception one has to pain. Naturally this retards one’s response time and can induce sleepiness and confusion in individuals. Interestingly, some types of opioids have a similar chemical structure to heroin. Central Nervous System Depressants are sedatives or tranquilizers that affect the brain by chemically slowing the communication between brain cells through enhancing the production of a particular kind of acid (gamma-aminobutyric acid) useful in retarding neurotransmission. These types of sedatives are used to reduce anxiety and promote sleep. In general, they should not be combined with other drugs or alcohol. Users of these drugs can develop a tolerance for them, leading naturally to a risk of dependence and addiction. The last category of abused prescription drugs is stimulants. These types of drugs raise blood pressure, heart rate, and respiration. Because this last category of drugs has been abused by the public on such a large scale, the medical community has recently become wary of prescribing them unless absolutely necessary for very specific types of disorders. Stimulants operate on neural transmitters in the brain, in particular monoamines (e.g. dopamine). The release of these neural transmitters can produce feelings of euphoria and this provides a basis for eventual addiction. There is also a strong chance of a buildup of tolerance and hence dependence. Later, when the drugs are discontinued, withdrawal symptoms may appear making it difficult to kick the habit. Diet pills and weight control medicine are a major part of this last grouping and are well known to be abused by thousands of people attempting to lose weight.
Figure 1 shows the extent of the problem of prescription drug abuse in the
Figure 1 Prescription Drug Abuse
US. The estimates show that prescription drug abuse involved about 9 million people in 2010 (Note: the title below the graphic has not been correctly updated for the data). Well over half of these were abusing pain killers. OxyContin and Vicodin have both become the drugs of choice for abusive recreational use.[6]
Figure 2 shows the percentage of seniors in high school abusing prescription drugs. Note that marijuana can be prescribed in some states as
Figure 2 High School Seniors Abusing Prescription Drugs
a type of medical treatment.
Proposed remedies to the prescription drug abuse problem have been discussed by many concerned parties. Essentially, all of these proposals and policies seek to increase greater self-supervision and, in some cases, greater governmental oversight. The most important of these are the prescription drugs monitoring programs (PDMP), where both doctors and pharmacists are required by law to enter in prescription details into a state database. The databases from PDMP can then be checked to see if individuals are getting prescriptions from multiple sources. By May 2011, 48 states had enacted legislation to require some form of PDMP, and 34 of these are already operational. Naturally, schools have become particularly sensitive to monitoring students for drug use and this has had a positive effect of reducing teen usage. Stricter sentencing for drug usage has become less popular as a means of reducing drug abuse – partly because of the enormous costs involved in such cases, partly because of a desire to insulate young people from serious criminals, and partly due to the fact that drug users are often seen as victims of the system and addiction.
II. The Illicit Drug Problem in the US
The second of America’s drug problems is its buying and selling of illicit drugs. These drugs would include such things as marijuana, cocaine and crack cocaine, hallucinogens (such as LSD), methamphetamine, ecstasy, heroin, etc. Of this group, marijuana by far is the most abused drug with over 18 million past-month users in 2011.[7] From 2007 to 2011, the rate of use of marijuana increased from 5.8% of the target population to 7.0%. Overall, in 2011 there were about 22.5 million Americans of age 12 or older who used illicit drugs, in general. It would not be far wrong to assume that about 9% of Americans above the age of 12 have used illegal drugs during the previous month. If we limit our view to only those between the ages 12 – 17 we find that roughly 10% of such youths engaged in illicit drug usage during the previous month. However, this rate has been falling over the past decade. In 2002 the rate stood at 11.6% and later fell to 9.3% in 2008. The rise in usage lately has been due almost entirely to an increase in marijuana usage. Marijuana use is especially high for individuals between the ages 18-15 reaching a peak of 19% of this targeted population in 2011.
Figure 3 shows that drug use for the past month has remained relatively constant among the general population above 12 years of age (note that many users do not use frequently, so past month would measure more serious users).
Another important driver of drug usage is the baby boomer cohort. This group has always had a high rate of drug usage and this has translated into an older group of drug users in the US. For example, in 2002 the rate of drug usage for people between the ages 50-59 stood at 2.7%. This figure rose to a much higher rate of 6.3% in 2011.
Figure 3
One troubling statistic is the rise in heroin use in the US. Figure 4 shows how that the number of people above 12 years of age that have used heroin in the past month have increased dramatically. Despite the fact that the Actual number of users is not in the millions, the fact that it has increased by over 200,000 since 2002 is particularly disappointing. This is a statistic worthy of greater research and understanding. As was reported in a news story in 2011, part of the problem is the high price of pain killers such as OxyContin, which has encourage the growth of poppy fields in Mexico to
Figure 4
supply a cheap substitute (i.e. heroin) to users. The story states
"The heroin numbers have skyrocketed," said William Ruzzamenti, a former federal anti-narcotics agent who now heads a federally funded regional drug task force in California's Central Valley. "Just in our little area, we've already surpassed all seizures from last year, and we're not even to July yet."
At about $15 a hit, heroin is a lot cheaper than prescription painkillers such as oxycodone (known by its brand name, OxyContin), which can cost $50 to $80 a tablet on the black market. Both opiates, they have similar highs.[8]
III. Dealing with the Drug Problem in America
The federal government uses the Drug Enforcement Administration (DEA), a subsidiary branch of the US Justice Department, to help control the trafficking of drugs in the US. The DEA follows federal law in its efforts to reduce the sale and use of illicit drugs. The most important of these laws is the Controlled Substances Act, which was enacted in 1970 under Title II of the Comprehensive Drug Abuse Prevention and Control Act. This law established a series of five schedules of controlled substances, with the most rigidly controlled being classified as Schedule I and the least rigidly controlled being classified as Schedule V. Heroin, ecstasy, and LSD are examples of Schedule I drugs (as is marijuana and peyote, currently), while opium, cocaine, morphine, and OxyContin are examples of Schedule II drugs. Schedule V drugs would include certain types of cough suppressants, many having codeine as an ingredient.
The DEA controls drugs by making arrests of people buying, selling, and using drugs and by making seizures of drug when possible. Figure 5 shows the number of total drug arrests made by DEA since 1986. The rise of arrests after the 1980s is an indication of both an increase in the number of
Figure 5
Drug Arrests (DEA)
Source: DEA website, downloadable data, unit = persons
users and a more determined policy to incarcerate users and sellers. This has led to an explosion of the prison population in the US. Drug arrests have now seemingly stabilized at about 30,000 arrests per year, down from 40,000 per year in the late 1990s. Not only has this led to an increase in prison populations, but it has also jammed the courts making it difficult to get speedy trials.
Figure 6 shows the seizure of drugs by the DEA. It is plotted using the number of kilograms of drugs seized as the unit of measure. In the top
Figure 6
Drugs Seized
Source: DEA Websiste, unit = kilograms
graph it is clear that seizures of methamphetamine and heroin have been growing since the early 1990s. The second graph indicates that while seizures of marijuana have grown substantially in recent years, the amount of cocaine has been somewhat constant or even declining. Neither of the two graphs gives one a clear idea of how tight the markets have become in these drugs. Instead, law enforcement tends to look at the price (using a base year) of drugs in the underground market. A high price indicates that supply has been severely resticted while a low price indicates that interdiction has not been particularly successful. One example of this is shown in a table on on the next page. This table displays the average street price of heroin in the US for a number of years. Clearly the price of heroin in the US has been falling substantially over the years. This indictaes that interdiction efforts have not been very successful. Supply for heroin has been outpacing demand for heroin.
Questions:
#1. The drug problem in the US consists of two main parts. What are these parts and how are they different?
#2. Which organization has classified the US prescription drug problem as an epidemic? Why did it say that?
#3. What are the three main categories of prescription drugs that are commonly abused? How are they different from each other?
#4. What percentage of people 12 years and older take drugs illegally or abuse drugs? Why are baby boomers large drug users?
#5. What is the difference between drug abuse and substance abuse? Why is there a need for a difference?
#6. The DEA follow federal laws governoring the prohibition and use of drugs. Explain briefly this law including the drug schedules.
#7. How are drugs controlled in the US? Have arrests and seizures been very effective? Why not put all drug users in prison?
#8. Jeffrey Miron of Harvard claims that some drugs should be legalized and regulated. Do you agree?
[1] The US government has recently reoriented its approach to drug control. It now classifies its programs as being designed to fight substance abuse – a much more general term including tobacco, alcohol, and drugs. This is in line with a similar attempt by the American Psychiatric Association and the WHO to broaden the scope of the problem. These authorities now see that the issue is not one of simply abuse or not; rather, a spectrum of usage exists, where behavior can be classified by degrees.
[2] Terrorism here is defined as a threat or an act of violence, not carried out by the armed forces of a sovereign nation, that aims to dispirit, intimidate, demoralize, or degrade the opposition to particular political or socio-economic interests. In the context of controlled substances, the drug cartels could be thought of as engaging in narco-terror, although there are some authorities who would claim that the illegal trade in drugs constitutes criminal activity rather than terrorism, per se. An important aspect of this distinction is that, if it were deemed terror, as buyers of narcotics, millions of Americans would be party to financially supporting such activity. This would place the US in the difficult spot of declaring suppliers terrorist, while purchasers would be free of such an opprobrium.
[3] Opioids include such things as Vicodin, OxyContin, morphine, and codeine – even Lomotil, which is typically used to relieve coughs and diarrhea.
[4] See
[5] Our discussion of prescription drug abuse is taken in part from the publication Prescription Drugs: Abuse and Addiction, National Institute on Drug Abuse, Research Report Series, first published in 2001, later revised in October 2011, US Department of Health and Human Services, National Institutes of Health, pp. 1-15.
[6] In many cases, the medical and pharmacological communities are tied to the large scale illegal production and sale of these drugs. See for example, “Pharmacists indicted in alleged L.A. Oxycontin ring”,
[7] These statistics are taken from the 2011 National Survey on Drug Use and Health, an annual survey sponsored by the Substance Abuse and Mental Health Services Administration. Most of the statistics on drug use attempt to make a distinction between whether or not one has ever used an illicit drug and whether one has used it recently (say within the last month or year). A summary of the results of the survey are contained in the “Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings”, US Department of Health and Human Services, Substance Abuse and Mental Health, and Center for Behavioral Health Statistics and Quality, September, 2012.
[8] See “As poppy fields flourish in Mexico, heroin use surges in U.S.” published online at the following address accessed 10/27/2012.