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Addiction Statistics in 2019: Landscape of Drug Abuse in the U.S.

Drug abuse in the U.S. remains a complex and complicated public health problem.

There are still many socioeconomic factors that breed a likelihood for drug use to develop among vulnerable populations. While there are some causes for optimism, the landscape of drug addiction across the U.S. remains somewhat bleak.

The National Survey on Drug Use and Health

Every 30 days, around 24.6 million people in America use some kind of illegal drug, according to most statistical measures. As many as 9 percent of people over the age of 12 are involved in some kind of illegal activity with illicit drugs or recreational abuse of prescription drugs.

Every year, the Substance Abuse and Mental Health Services Administration publishes the National Survey on Drug Use and Health, which is sent to 67,500 people sponsored by SAMHSA to take the survey. The results form the most accurate readings of the consumption of drugs, alcohol, and tobacco in the U.S.

The 2017 survey (the most recent one for which figures are available) found that marijuana is the most commonly abused drug in the United States, with roughly 19.8 million users. Coming in second was the nonmedical use of prescription drugs, with 6.5 million people. Cocaine had 1.5 million users, followed by hallucinogens with 1.3 million people. Ranking at the bottom were methamphetamine (595.000) and heroin (300,000).

Optimism and Concern

More recent figures have found that the rate of prescription medication overdoses has notably declined. Preliminary (incomplete) figures from Centers for Disease Control and Prevention found that drug overdoses dropped by 4.2 percent in 2018, following a decade-long precipitous rise.

However, as NPR reported, the drop isn’t universal across America. In some states, the rate of prescription drug overdoses increased. Missouri, for example, is one of 18 states that continues to experience a yearly rise in overdose fatalities. While most of the country celebrated a better year, Missouri deaths increased by 17 percent in 2018, despite “so many efforts to save lives and improve lives,” in the words of an associate research professor at the University of Missouri-St. Louis.

The Third Wave

opioid epidemic

Public health experts look at two main takeaways for this disparity.

On one hand, they credit increased outreach, education, treatment, and mental health counseling for driving down the number of fatal opioid overdoses.

On the other hand, the synthetic opioid fentanyl has been blamed for causing what is known as the “third wave” of the opioid epidemic (following prescription medication in the first wave and heroin in the second), which might be behind the spike in fatality rates in specific states. It might simply come down to some states having more fentanyl in the drugs that are smuggled through their borders than other states.

In the case of Missouri, authorities noted fentanyl-related overdoses, which they attributed to “an increase in the proportion of fentanyl in [the] drug supply.” To that point, even as the CDC announced its preliminary reporting on the improved overdose figures, it noted that fentanyl deaths have continued unabated.

Geographic Differences

Similarly, other variations in how drugs are cut can be the reason why one state suffers a high overdose rate, while its neighbor does not. For example, stimulant drugs (like cocaine and methamphetamine) have a different geographic profile than fentanyl. Even then, the mortality rates are not always consistent. Each state handles its respective drug problem in different ways, and each state has unique problems that contribute to the effectiveness, and lack thereof, of those solutions.

And some states simply do not have the necessary resources to give vulnerable populations the social safety net they need. In Missouri (which the St. Louis Post-Dispatch writes in May 2019 has been on a “50-year economic slump”), the state government struggles with a lack of housing and rising incarceration rates, both of which breed the conditions that make drug abuse fester.

A Success Story

Then there is Ohio, which was one of the success stories from the CDC’s data. Despite having 4,000 reported opioid-related deaths in 2018, this was a 22 percent drop from the previous year (a time when the state had one of the highest opioid overdose death rates in the country). Health officials are cautiously optimistic, warning that the landscape of drug abuse in the state is “still a nightmare.” A 22 percent reduction is encouraging, but it is still a long way from being satisfactory.

The CDC’s preliminary analysis found that 67,744 people died from drug overdoses in 2018, which is still several thousand less than 2017, but still far in excess of even the worst of the statistics during the AIDS epidemic of the 1980s.

The Landscape of Marijuana Use

Eleven states now allow for the recreational sale and use of marijuana. Of these, data from the SAMHSA survey indicates that the use of marijuana has gone up in Alaska, Colorado, and Oregon, starting from the years that the respective ballot measures passed.

The New York Times writes that when Colorado began selling recreational marijuana in 2014; the ballot measure was approved in 2012. The number of emergency-room visits because of marijuana-related problems has increased, as has the rate of hospitalizations, poison center cells, and mental health issues connected to increased marijuana use, per Preventive Medicine. These rates are influenced by chronic users who show signs of physical dependence and children who unintentionally consume edible products. 

Almost twice as many residents of Colorado smoke marijuana as the rest of America, according to SAMHSA, with a slight increase in the number of adults who use marijuana since recreational sales were legalized. However, continues the Times, thousands of other Colorado residents purchase and use products from dispensaries without any incident.

Some families have moved out of the state, fearful of the environment caused by widespread acceptance of cannabis use. Overall, however, “state surveys do not show an increase in young people smoking pot.” Upward of 80 percent of Colorado’s youth and teenagers do not identify as current marijuana users, even as they admit to having tried the drug. Indeed, teenage marijuana use has dipped since medical marijuana sales went up in 2009, and it has not shown any rise since full cannabis legalization.

Problems Accompanying Legalization

Problems still exist, however. Schools report catching more students using marijuana, while the number of students drinking alcohol has dropped. Marijuana is the number one reason school authorities have to punish their students or turn them over to the police for more serious violations.

Nonetheless, “the overall number of students being expelled for drug infractions has actually fallen since legalization,” partly because the ballot measure lessened the “zero-tolerance” policies at schools.

One of the goals of Colorado Amendment 64, the popular initiative ballot measure to change Colorado’s constitution on the statewide policy for marijuana, was to drive down the number of low-level marijuana charges. This has been broadly successful, but African Americans are still disproportionately targeted for small-time drug offenses, at rates nearly twice those of white Americans for the same crimes. Similarly, African-American and Latinx students are often arrested for marijuana use and ownership at a higher rate than their fellow white students.

Washington State’s Situation

In 2018, the Journal of Substance Abuse Disorders published finding that showed only a modest increase in past-year marijuana use after the drug was legalized. Researchers working in Washington state (which, in 2012, became the second state to legalize recreational marijuana use) calculated that there was only a 1.2 percentage point increase (from 24.3 percent to 25.6 percent) in reported marijuana use in the state. The figures were calculated from 3,451 adults who were asked about their cannabis consumption before the 2012 legalization and their cannabis consumption in the year before the study was conducted.

Talking to the Public Health Institute, the lead author of the study suggested that people were more likely to admit their past use of marijuana because the drug is legal to use in Washington, and because there is broadly less stigma around marijuana use than there used to be. In late 2018, Pew Research Center reported that a record 62 percent of Americans felt that recreational marijuana use should not be criminalized.

Looking specifically at teenage marijuana use, researchers in Washington state noticed that rates of consumption declined immediately after recreational cannabis was legalized in 2012. What happens in youth use of marijuana following legalization “is an important public health question,” said the co-author of the study that was published in JAMA.

The RAND Corporation writes that the statistics coming out of Washington state are useful for understanding marijuana use among adolescents because of how the initial survey includes enough participants from the state’s students, providing researchers with enough information to monitor use across the state over a period of time.

In detail, there was more of a drop in marijuana use among students during 2014 and 2016, compared to past years. Eighth graders, for example, used less marijuana in that time period, from 9.8 percent to 7.3 percent. Similar drops were noted among 10th graders.

Factors of Marijuana Use in Teens

The research team noted that while this is a cause for optimism regarding underage use of a drug, there remains insufficient evidence to ascertain whether legalization affects adolescent marijuana use over time. In other words, there is still no answer to address the connection between the legalization of recreational marijuana and student use, and the low youth use figures should not be interpreted as victory for one side in the debate. Teens are subject to a variety of factors, the study co-author noted, and those factors will influence behavior in very different ways.

Such factors could include everything from marijuana advertising and marijuana in popular culture to even how easily marijuana dispensaries can be accessed. Even if a state capitol legalizes recreational cannabis sales, “commercialization in local neighborhoods” will potentially be a bigger factor in determining the likelihood of marijuana use among students, adolescents, and teenagers. 

The research team noted that while this is a cause for optimism regarding underage use of a drug, there remains insufficient evidence to ascertain whether legalization affects adolescent marijuana use over time. In other words, there is still no answer to address the connection between the legalization of recreational marijuana and student use, and the low youth use figures should not be interpreted as victory for one side in the debate. Teens are subject to a variety of factors, the study co-author noted, and those factors will influence behavior in very different ways.

Such factors could include everything from marijuana advertising and marijuana in popular culture to even how easily marijuana dispensaries can be accessed. Even if a state capitol legalizes recreational cannabis sales, “commercialization in local neighborhoods” will potentially be a bigger factor in determining the likelihood of marijuana use among students, adolescents, and teenagers. 

Methamphetamine’s Rise

rise in meth use

While the opioid crisis tends to be given the most attention, researchers worry about a dramatic increase in other forms of addiction that are rapidly changing the landscape of drug abuse in the U.S. Between 2011 and 2017, for example, the percentage of opioid users who also reported using methamphetamine in the preceding month jumped from 19 percent to 34 percent.

Specifically, the use of crystal meth was at a high of 82 percent. Rates of recreational use of prescription stimulants, such as Adderall and Ritalin, were at 15 percent.

The Lancet pointed to cases in Wisconsin and Oregon, where “increasing numbers of people use both [methamphetamine and opioids],” leading to a new appraisal of drug trends in the U.S. What had been a “lull” in the respective meth epidemic is now over, and deaths related to methamphetamine consumption now account for 11 percent of the total number of fatal overdoses.

Researchers writing in the Drug and Alcohol Dependence journal in late 2018 agreed, calculating the “marked increase in the past-month use of methamphetamine in individuals with a primary indication of opioid use disorder.” Data suggested that people addicted to opioids would turn to methamphetamine because they were desperate for a substitute, and to stave off opioid withdrawal syndrome (so debilitating that some people have compared the process to death itself). The stimulant still provided them with a euphoric high, one that balanced out the depressive effects of their opioids (allowing users to even go to work and continue functioning after consuming opioids). The researchers noted that restricting access to prescription opioids might be connected with the rise of methamphetamines. 

In Ohio’s Vinton County (population 13,435, making it the smallest in the state), “more and more users are turning to cheap amphetamine” because of regulations that have cut down on the flow of opioids in an area where it was easier to buy opioids than it was fresh produce, writes NPR.

Speedballing

This form of polydrug use is not new; it even has a name, “speedballing,” referring to the historic use of cocaine and heroin to counteract the respective stimulant and depressant effects (with the intention of trying to enjoy both primary effects). The difference now is that the rate for simultaneous opioid and methamphetamine use is much higher than the speedball trend of the past.

Methamphetamine and illicit opioids are produced in much higher quantities, with much higher chemical purities, sold for much cheaper, and typically mixed with more unknown products. This create a perfect storm that has seen the staggering rise of fentanyl use and overdose in America, elevating the rates of methamphetamine use as well.

MD Edge writes that this is significant because polydrug use is exponentially more dangerous than single-drug use, especially as drug traffickers mix unknown substances in with their batches to cut down on their costs. People often have no idea what they are snorting or injecting into their veins, so some of the polydrug use may be completely unintentional.

The Forgotten Killer

The New York Times reported this as, “Meth, the forgotten killer is back [and] everywhere.” In Oregon, where the Lancet reported its figures, deaths related to methamphetamine overdoses have eclipsed those from opioids.

Part of the problem is that drug cartels in Central and South America have seen the resurgence of the black market for meth and are exporting the products and chemicals accordingly. Border patrol agents are confiscating upward of 20 times the amount of methamphetamine they did in 2009.

The meth itself has changed. It is purer, cheaper, and much more lethal than it used to be.

Not much is statistically known about the simultaneous use of methamphetamines and opioids, mostly because the first and second waves of the opioid epidemic (prescription medications and heroin, respectively) have drastically changed every metric and standard for measuring drug addiction. The reintroduction of methamphetamine to the equation continues to rewrite hitherto conventional knowledge about drug addiction, especially as the proliferation of fentanyl has led to the third wave of the opioid epidemic. 

Changing the Future of Treatment

While Oregon and Wisconsin experienced the greatest rise in the co-use of meth and opioids, the research also found that similar use was taking place in the Northeast and Midwest, among white Americans ages 18 to 44, who lived in both rural and suburban settings.

Researchers say that this change to the landscape of drug abuse in the U.S. has highlighted the need to change how substance abuse itself is treated. Treating opioid abuse alone might become increasingly inefficient because people will always avail themselves of the plethora of other drugs on the market. More opioid users are now polydrug abusers, said one researcher, and the treatment community needs to respond to this change.

The Landscape of Drug Abuse in the U.S.

Other findings from the most recent National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration are detailed below:

Drug Abuse by Age

  • Approximately 4 percent of the American adolescent population (ages 12 to 17) met the criteria for a substance use disorder (992,000 teenagers, or 1 in 25 teens). Approximately 443,000 of them were positive for alcohol use disorder, and 741,000 suffered from use disorders of other drugs. 
  • Around 5.1 million young adults (1 in 7 people between the ages of 18 to 25) had a substance use disorder; 3.4 million suffered from alcohol use disorder, and 2.5 million from a disorder related to other drugs. Heroin use in this age group doubled from 2007. 
  • Over 13.5 million adults (26 and over) had a substance abuse problem; 10.6 million with alcohol, 4.3 million with other drugs. 
  • Over 1 million adults, ages 65 and older, reported a substance use disorder in the 2017 survey. More than 975,000 of them reported alcohol use disorder, and 93,000 a disorder of other drug use. A third of this population reported struggling with alcohol before they turned 65. 
  • Between 21 percent and 66 percent of people aged 65 and up also suffered from a mental health disorder as well as their substance use problem.

Gender & Ethnicity

In terms of gender, 9.4 percent of men and 5.2 percent of women over the age of 12 reported a substance abuse problem. Generally, men are more likely to abuse illegal drugs than women, but women are equally prone to addiction as men.

In terms of ethnicity and race, Native Americans and Alaska Natives over the age of 12 had the highest rate of substance abuse, at 12.8 percent. White Americans had a 7.7 percent rate of substance abuse, while 6.8 percent of African Americans had a substance use disorder.

Hispanics or Latinos reported at 6.6 percent. Asian-Americans had the lowest rate of substance abuse, with 3.8 percent of respondents reporting in the affirmative.

Abuse by Types of Drug

When it comes to the nature of drug use, SAMHSA’s survey found that 966,000 American adults struggled with cocaine addiction in 2017, and 652,000 reported a heroin use disorder.

Over the past 20 years, heroin use has been on the rise in most demographic groups in the United States. People addicted to alcohol are two times more likely to also have a heroin problem; those who struggle with marijuana addiction are thrice more likely. People addicted to cocaine are 15 times more likely, and being addicted to prescription drugs carries a 40 percent chance of developing a heroin addiction.

The most commonly abused form of prescription drugs in 2017 were pain relievers, sedatives, stimulants, and tranquilizers. That year of reporting found that 1.7 million people had a pain reliever use disorder. Women are more likely to quickly develop a dependence on their prescription medication than men due to a greater chance of having chronic pain (and to then be prescribed painkillers in higher doses).

Around 4.1 million American adults (12 and up) had a marijuana use disorder in 2017. Most of them were between the ages of 12 and 25. Six percent of fulltime college students smoked marijuana every day, more than triple the number from two decades ago.

In the 2017 survey, 14.5 million Americans reported struggling with alcohol use disorder. Over 50 percent of all American adults have a family history of alcoholism or problem drinking. More than 10 percent of children live with at least one parent who has a drinking problem.

As many as 88,000 people die every year from alcohol-related causes. Alcohol is the third-leading cause of preventable death in the country (coming after tobacco use and obesity).

Of the 78,529 cases of liver disease in American adults, 47 percent of them were due to alcohol problems, and as many as 40 percent of all the hospital beds in the United States are used to treat conditions related to dangerous alcohol consumption.

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