This chapter will enable you to:
- ■ Learn the social and individual consequences of drug abuse
- ■ Understand the reasons why people use drugs
- ■ Realize the extent of the drug abuse problem in the United States
- ■ Consider the various theories and explanations of drug abuse
With so many local and national governmental resources focusing on terrorism in 2016, the problem of drug abuse and addiction still remains a constant in every community across the nation. Experts agree that too many Americans need treatment for substance use disorders but do not receive it and that prescription drug abuse continues to ruin countless lives. Moreover, those who take drugs and drive threaten safety on our nation’s streets and highways.
Research shows that perceptions of the risks of drug use by young people have declined over the past decade and that this is often a predictor of future increases in drug use. Still, a considerable amount of work is needed to reform our justice system and address drug use and drug-related crime.
In 2013 an estimated 246 million people, or one out of 20 people between the ages of 15 and 64 years, used an illicit drug. The magnitude of the world drug problem becomes more apparent when considering that more than one out of 10 drug users is a problem drug user, suffering from drug use disorders or drug dependence. In other words, some 27 million people, or almost the entire population of a country the size of Malaysia, are problem drug users. Almost half (12.19 million) of those problem drug users inject drugs, and an estimated 1.65 million of those who inject drugs were living with HIV in 2013.1
This places a heavy burden on public health systems in terms of the prevention, treatment and care of drug use disorders, and their health consequences. Only
one out of every six problem drug users in the world has access to treatment, as many countries have a large shortfall in the provision of services. The annual number of drug-related deaths (estimated at 187,100 in 2013) has remained relatively unchanged. An unacceptable number of drug users continue to lose their lives prematurely, often as a result of overdose, even though overdose-related deaths are preventable.2
Notwithstanding national and regional variations in trends in drug use, the limited data available indicate that the use of opiates (heroin and opium) has remained stable at the global level. Mainly as a result of trends in the Americas and Europe, cocaine use has declined overall, while the use of cannabis and the non-medical use of pharmaceutical opioids have continued to rise. Trends in stimulant abuse vary from region to region, and some subregions such as Southeast Asia have reported an increase in methamphetamine use.
There are also indications that the number of people requiring treatment for cannabis use is increasing in most regions. The evidence suggests that more drug users are suffering from cannabis use disorders, and there is growing evidence that cannabis may be becoming more harmful. This is reflected in the high proportion of persons entering treatment for the first time for cannabis use disorders in Europe, North America, and Oceania. According to the limited information available, cannabis ranks first among the drug types for which people in Africa enter treatment for drug use.
Cannabis is by far the most frequently used drug in prisons. Though data on the subject are limited, there are indications that one third of prisoners have used a drug at least once while incarcerated. Lifetime and recent (past-month) use of heroin in prisons is much higher than that of cocaine, amphetamines, or “ecstasy.” Prison is a high-risk, controlled environment where drug use, including injecting drug use, often takes place in particularly unsafe conditions. This may explain why the prison environment can be characterized by high levels of infectious diseases, particularly HIV but also hepatitis C and tuberculosis, and by limited access to prevention and treatment, which increases the risk of contracting blood-borne viruses.
The number of people requiring treatment for stimulant abuse is also increasing globally. This is probably attributable to the sheer weight of numbers, as the prevalence of stimulant abuse is relatively high in Asia, where there is high demand for treatment but the expertise in treating stimulant-related use disorders is not at the same level of sophistication as the expertise in treating opiate use disorders.
Psychoactive substances are marketed as alternatives to internationally controlled drugs and are purported to produce effects similar to those of their “traditional” counterparts. They have the potential to pose serious risks to public health and safety. Information and research on the potential harm caused by psychoactive substances are limited, but the proliferation of the estimated 500 psychoactive substances poses a health threat to drug users and has increased demand for treatment for drug use.
Cocaine remains the primary drug of concern in Latin America and the Caribbean, whereas the use of opiates remains the most problematic form of drug use globally. This can be attributed to the relationship between the use of opiates and injecting drug use, HIV, AIDS, and overdose deaths and to the fact
that the use of opiates accounts for the majority of treatment admissions for drug use in Asia and Europe.
Public perceptions about the rehabilitation of drug-dependent persons tend to oversimplify the magnitude of drug dependence. There is no quick and simple remedy for drug dependence. It is a chronic health condition and, as with other chronic conditions, the affected persons remain vulnerable for a lifetime and require long-term and continued treatment. There is a growing body of research showing that many interventions aimed at preventing the initiation of drug use (or the potential transition to drug use disorders) can be effective if they address the different personal and environmental vulnerabilities of children and young people—factors that are largely beyond a person’s control.
A number of social and structural barriers clearly continue to hinder the access of women to treatment for drug use: globally, only one out of five drug users in treatment is a woman even though one out of three drug users is a woman. A large body of evidence has shown that social and biological factors relating to initiation of substance use, continued substance use and the development of problems related to substance use vary considerably between men and women.
Men are three times more likely than women to use cannabis, cocaine, and amphetamines, whereas women are more likely than men to misuse prescription opioids and tranquillizers. As the likelihood that initiation of the misuse of tranquillizers and prescription opioids may lead to regular or current use is relatively high compared with other drugs, this remains an area of particular concern for women. Available data on HIV prevalence among people who inject drugs show that, in many countries, women who inject drugs are more vulnerable to HIV infection than their male counterparts and that the prevalence of HIV is higher among women who inject drugs than among their male counterparts.
Some progress has been made toward achieving the target set in the 2011 Political Declaration on HIV and AIDS of reducing by 50 percent HIV transmission among people who inject drugs by 2015. Although the number of newly diagnosed cases of HIV among people who inject drugs declined by roughly 10 percent, from an estimated 110,000 in 2010 to 98,000 in 2013, this target is unlikely to be met.3
The transmission of infectious diseases such as HIV and hepatitis C and the occurrence of drug overdoses are only some of the risk factors that lead to the level of mortality among people who inject drugs being nearly 15 times higher than would normally be expected among people of comparable age and gender in the general population.
Not all drug overdoses are fatal; different studies have estimated that only one out of 20–25 overdose cases is fatal. Non-fatal overdoses are underreported and are a common experience among drug users; however, the cumulative risk of death increases with each successive overdose.4
Now that we have caught a glimpse of the world’s illicit drug problem, let’s consider the extent to which illicit drugs and illicit drug use in the United States have
created problems domestically. When seeking to understand the extent of drug abuse in the United States, one has a number of statistical resources to query. For example, both the Federal Bureau of investigation and the Drug Enforcement Administration publish statistics on drug abuse. Furthermore, the National Institute of Drug Abuse also publishes statistics along with the annual Michigan State University Monitoring the Future studies which examine drug abuse among teens. Each of these resources are instructive in helping us understand the nation’s drug problem and while the numbers differ somewhat from one source to another, they demonstrate basically the same trends of drug abuse throughout the nation.
For example, in 2015, the National Institute of Drug Abuse (NIDA) reported that an estimated 24.6 million Americans aged 12 or older—9.4 percent of the population—had used an illicit drug in the past month. This number is an increase from 8.3 percent in 2002. The increase mostly reflects a recent rise in use of marijuana, the nation’s most commonly used illicit drug.
In 2013, there were almost 20 million current marijuana users—about 7.5 percent of people aged 12 or older—up from 14.5 million (5.8 percent) in 2007. In that same year, 6.5 million Americans aged 12 or older (or 2.5 percent) had used prescription drugs non-medically in the past month. Prescription drugs include pain relievers, tranquilizers, stimulants, and sedatives. And 1.3 million Americans (0.5 percent) had used hallucinogens (a category that includes ecstasy and LSD) in the past month. Cocaine use has gone down in the last few years. In 2013, the number of current users aged 12 or older was 1.5 million. This number is lower than in 2002 to 2007 (ranging from 2.0 million to 2.4 million). Methamphetamine use was higher in 2013, with 595,000 current users, compared with 353,000 users in 2010.5
The abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that affects the health, social, and economic welfare of all societies. It is estimated that between 26.4 million and 36 million people abuse opioids worldwide, with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin.6
The consequences of this abuse have been devastating and are on the rise. For example, the number of unintentional overdose deaths from prescription pain relievers has soared in the United States, more than quadrupling since 1999. There is also growing evidence to suggest a relationship between increased non-medical use of opioid analgesics and heroin abuse in the United States.7
There were just over 2.8 million new users of illicit drugs in 2013, or about 7,800 new users per day. Over half (54.1 percent) were under 18 years of age. Next most common are prescription pain relievers, followed by inhalants (which is most common among younger teens). In 2013, 22.6 percent of 18- to 20-year-olds reported using an illicit drug in the past month.8
This increase is, in part, due to the aging of the baby boomers, whose rates of illicit drug use have historically been higher than those of previous generations.
In 2013, 4.2 million Americans met clinical criteria for dependence or abuse of marijuana in the past year—more than twice the number for dependence/abuse of prescription pain relievers (1.9 million) and nearly five time...