Drug abuse is a worldwide epidemic. At present, global reports on drug abuse highlight that the US is associated with the highest rate of prescription pill abuse (e.g., opioids, tranquilizers, and stimulants).1 Within the US, prescription drugs rank third in terms of abuse, behind alcohol and marijuana (in first and second place respectively).2
To consider the extent of the drug problem in the US, it is useful to see its rankings on specific drugs of abuse. The following is selected information about US rates of abuse by drug type:
- The US ranks second in consumption of marijuana, sandwiched between Iceland in first place and New Zealand in third place.
- While Scotland and Spain hold first and third place for frequency of cocaine use among residents, the US ranks third overall.
- El Salvador is the only country that has more residents abusing prescription stimulants than the US.
- Though the US ranks first in prescription opioid abuse, it does not rank in the top 10 for opiate abuse (e.g., heroin, opium, morphine, etc.). The three countries with the gravest heroin abuse statistics are Afghanistan, Seychelles, and Iran.
- The US comes in at eighth place for ecstasy abuse. The top three countries experiencing the greatest abuse of this designer drug are Australia, New Zealand, and Scotland.
- Regarding non-prescription stimulant drugs, the US has settled into fifth place behind El Salvador, Philippines, Australia, and New Zealand.3
These comparative statistics lead to an important deduction: The US has made the top 10 list of drug abuse levels for all drugs studied with the exception of heroin. It’s not that the US doesn’t have a serious heroin problem, it’s just that other countries are facing an even deeper heroin problem. Researchers consider the US to be currently experiencing a heroin epidemic.
Though the US maintains its position as a world leader on politics and economics, the country is by no means a role model for abstinence. But the US is not alone; according to one study, richer nations tend to have the worst drug problems.4 The good news, however, is that wealthier nations like the US have the resources to offer drug treatment services to those in need.
Drug Use Rates in the US
The Substance Abuse and Mental Health Services Administration sponsors the National Survey on Drug Use and Health (NSDUH). The NSDUH is a multilayered survey, with one of those layers being devoted to studying the rates of abuse of particular drugs. The 2014 NSDUH reviewed use of the following illicit drugs: marijuana, prescription opioids, prescription stimulants, prescription stimulants, methamphetamine, prescription sedatives, cocaine, heroin, hallucinogens (including LSD and ecstasy), and inhalants. The following statistics reflect the use rates by each drug type:
- Approximately 27 million Americans in the 12-or-older age group (10.2 percent of the population in this age group) were current illicit drug users (i.e., they used an illicit drug in the month prior to the survey).
- About 22.2 million people in the 12-or-older age group (8.4 percent of the population in this age group) currently used marijuana.
- An estimated 6.5 million individuals in the 12-or-older age group currently used prescription drugs for a nonmedical purpose. Prescription drugs include pain-relieving opioids, stimulants, tranquilizers, and sedatives.
- Of the 6.5 million people who abused prescription drugs, approximately 4.3 million used opioids.
- Of this 6.5 million, 1.9 million Americans in the 12-or-older age group currently abused tranquilizers.
- Of this 6.5 million, 1.6 million people in the 12-or-older age group were currently abusing prescription stimulants, including 569,000 methamphetamine users.
- Approximately 330,000 Americans in the 12-or-older age group were currently using prescription sedatives (represents 0.1 percent of the population in this age group).
- An estimated 1.5 million people in the 12-or-older age group were currently using cocaine, including 354,000 individuals who were using crack-cocaine; this translates to 0.6 percent of the population/cocaine and 0.1 percent/crack-cocaine.
- Approximately 435,000 Americans in the 12-or-older age group currently used heroin; this corresponds to 0.2 percent ofthe population in this age group.
- About 1.2 million Americans in the 12-or-older age group currently used hallucinogens; this represents 0.4 percent of the population in this age group.
- An estimated 287,000 Americans were currently using LSD (0.1 percent of the population in this age group) and about 609,000 Americans were currently using ecstasy (0.2 percent of the population in this age group).
- Approximately 546,000 people aged 12 or older were current users of inhalants (0.2 percent of the population in this age group). Inhalants include substances like glue, cleaning fluids, gasoline, nitrous oxide, spray paint, and other aerosol sprays.5
Statistics are not embodied; they don’t attach faces and bodies to numbers. To really appreciate the magnitude of drug use in America, consider three visual examples. Per the 2014 NSDUH results, the number of people who use heroin would fill nearly five times the capacity of Ben Hill Griffin Stadium in Gainesville, Florida. Let’s go to New York City now. There are 102 floors in the Empire State Building. Imagine about 42,156 people on each floor of the Empire State Building. That’s the number of individuals who misused prescription opioids in 2014. Going all the way west now, picture the University of California at Berkeley student body 718 times over (the school had 37,581 students in 2014). That’s the number of people who were estimated to be currently using an illicit drug.
Prevalence of Substance Use Disorders in the US
The 2014 NSDUH also provides information on the prevalence of substance use disorders. It is necessary to explain the term substance use disorder, which is an official and diagnosable mental health condition per the Diagnostic and Statistical Manual of Mental Disorders (DSM).6 The DSM is currently in its fifth edition (DSM-5) and reflects ongoing strides in the area of addiction diagnosis. The fifth edition combines substance dependence and substance abuse into one substance use disorder continuum from a mild to severe grade. Each substance use disorder is diagnosed in terms of the particular drug of abuse (e.g., stimulant use disorder, alcohol use disorder, etc.) but the diagnostic criteria tend to be similar.
To receive a mild diagnosis, a person typically has to have 2-3 symptoms out of potential 11 symptoms. In other words, the more symptoms that are present, the higher the severity of the substance use disorder.7 The 2014 NSDUH asked a sample of the population aged 12 or older about their substance use practices to determine if a substance use disorder was present. The 2014 NSDUH results provide the following insights, all of which pertain to the 12-or-older age group and reflect information about the past year:
- Of those individuals who were determined to have a substance use disorder, almost four out of five had an alcohol use disorder while one in three had a substance use disorder that involved an illicit drug.
- Approximately one in eight Americans with a substance use disorder had both an illicit drug use disorder and an alcohol use disorder.
- The survey estimated that 17 million Americans studied had an alcohol use disorder (6.4 percent of the population aged 12 or older).
- An estimated 7.1 million who had an illicit drug use disorder (2.7 percent of the population in the 12-or-older age group).
- About 4.2 million individuals had a marijuana use disorder (1.6 percent of the population in the 12-or-older age group).
- Approximately 1.9 million Americans had an opioid (i.e., pain reliever) use disorder (0.7 percent of the population in the 12-or-older age group).
- Around 913,000 Americans had a cocaine use disorder (0.3 percent of the population in the 12-or-older age group).
- An estimated 586,000 people had a heroin use disorder (0.2 percent of the population in the 12-or-older age group).8
isThis statistical representation of the prevalence of substance use disorders helps to shed light on the fact that recreational drug use can progress into a substance use disorder. Public education on the high occurrence of substance use disorders can hopefully serve to remind people that no one is immune from addiction. All substance use disorders are treatable, but it’s a matter of when treatment begins. Having a substance use disorder, or even using drugs recreationally, means that a person is at an increased risk for engaging in dangerous acts, such as drunk or drugged driving.
Drunk and Drugged Driving: The Numbers
Much of the discussion about drug abuse, in general, pertains to its impact on a person’s health, but drugs also have an impact on a person’s behavior. For example, drugs impair a person’s ability to operate machinery, perform basic tasks, and drive a car. But drugs can actually change a person’s brain and tell them that they can do anything, including driving while under the influence. In other words, drugs cause a person to lose perspective on their ability to drive and may even encourage them to drive, with potentially devastating consequences. The National Institute on Drug Abuse (NIDA) provides the following illuminating
facts on drunk or drugged driving in the US:
So far, the statistics discussed mainly relate to crashes and the information that such crashes provides about the driver’s drug use. But not everyone who drives under the influence is detected each time they do so. On average, a person drives drunk over 80 times before being arrested for the first time.12 This statistic highlights the need for drug treatment help or an intervention as soon as drug abuse sets in. It means that each fatal and nonfatal crash is likely to be preventable because it’s probably not the first time the driver used alcohol or other drugs before driving. Armed with the foregoing statistics, it is hopefully easier for a person to be even more vigilant about their own alcohol and drug use and that of others in relation to driving. Total abstinence is truly the only safe policy when it comes to alcohol, other drugs, and driving.
- In 2013, more than 31 million people operated a car after using alcohol and/or other drugs. The highest rate was in the 18-25 age group.
- It is more common for people to drive after marijuana use than alcohol use.
- Per a 2009 post-mortem study of drivers involved in a fatal crash, one in three tested positive for drugs.
- High school seniors who drove under the influence of marijuana were 65 percent more likely to crash while driving.
- Of college students who used marijuana in the month prior to the NIDA survey, one in eight drove a car while high, and almost one in two were passengers in a car operated by a person who had used this drug.9
Mothers Against Drunk Driving (MADD) is one of the most vocal and well-known organizations dedicated to educating the public on the perils of driving under the influence. The organization was founded by a mother who lost her child to drunk driving and then transformed her grief into a mission to help save lives.10 As part of its education and advocacy, MADD collects different findings from various local and nationwide surveys. The following statistics and facts shed light on the reality of driving under the influence in the US:
- Approximately 57 percent of drivers who were fatally involved in a car accident had drugs or alcohol in their system, and 17 percent had both.
- Drugs other than alcohol are found in 18 percent of drivers who were involved in a fatal crash.
- In 2013, 3.8 percent of the population (9.9 million people) reported driving after using an illicit drug. The occurrence was highest in the 18-25 age group (10.6 percent of this group reported this activity).
- Of the drivers admitted to hospital emergency rooms after a car crash, over 50 percent had drugs other than alcohol in their bodies, with marijuana present almost 25 percent of the time.
- More than 33 percent of teenage drivers in the 11th and 12th grades believe they drive better under the influence of marijuana.11
Drug Overdose Statistics
Stated most broadly, an overdose occurs when people consumes too high a volume of a drug for their physiological makeup. Individuals who use illicit drugs or abuse prescription medications, mix drugs with alcohol or other drugs, have a mental health disorder, or have overdosed in the past face a heightened risk of overdose.13 It is difficult to generalize about what causes an overdose, so it’s best to consider an example. Opioid prescription medications and heroin directly affect the area of the brain that regulates breathing. As a result, the consumption of an excessive amount of this drug type can result in respiratory depression and even death. There will typically be visible signs, such as slowed breathing, pinpoint pupils, and unconsciousness. In 2010, there were approximately 16,651 overdose deaths that involved prescription opioids and 3,036 that involved heroin.14
The National Institute on Drug Abuse publishes statistical data on overdose deaths involving some of the most common illicit drugs.15 The following findings relate to survey years 2001-2014:
- Prescription drugs: Overall, there was a 2.8-fold increase in the number of overdose fatalities that involved prescription drug abuse.
- Prescription opioid painkillers: Although there was a slight decrease in the number of overdose deaths between 2011 and 2014, there was a 3.4-fold increase in the number of overdose fatalities related to prescription opioid painkillers from 2001 to 2014.
- Benzodiazepines: Drugs in this category include calm-inducing drugs such as Xanax, Klonopin, and Valium. From 2001 to 2014, there was a steady increase in the number of fatalities with the exception of a slight dip in 2012. Overall, there was a fivefold increase in the number of overdose fatalities that involved benzodiazepines.
- Cocaine: Compared to some other drugs, cocaine-involved fatal overdoses have an up-down presentation. From 2001 to 2014, there appears to be at least 3,900 overdose deaths per year with a high around 7,500 (in 2006). Overall, from 2001 to 2014, there was a 42 percent increase in the number of overdose fatalities that involved cocaine.
- Heroin: The greatest increase in the number of fatal overdoses occurred in relation to heroin. From 2001 to 2014, there was a sixfold increase. Whereas from 2001 to 2010, there were moderate increases and dips in the number of overdose deaths, the number steadily climbed from 2011 to 2014.16
Though there has been a significant increase in the number of heroin-involved deaths, and the US is entrenched in an opioid abuse epidemic, but there is some encouraging news. Today, there is an antidote available for individuals who are experiencing an opioid overdose (e.g., an overdose on heroin, morphine, or prescription pain relievers). Naloxone, an opioid antagonist, can counteract respiration system depression or central nervous system depression. Due to laws around use of naloxone, laypeople can be trained to administer this emergency drug as needed. This antidote to opioids can be sprayed into the overdosing person’s nose or injected into the body.17 The hope is that as long as drug abuse continues, there will come a day that an emergency response medication will be available that can reverse any type of drug overdose.
According to the 2014 National Survey on Drug Use and Health (NSDUH), the number of individuals who seek treatment for drug abuse remains low. The NSDUH for 2014 did not include treatment statistics in its report but published its findings in a separate Substance Abuse and Mental Health Services Administration news update on September 17, 2015. Per that news update:
- The survey found that 22.5 million Americans in the 12-or-older age group needed treatment for a substance use disorder yet only 2.6 million received rehab services at a specialized facility during the prior year.
- Of those individuals who were considered to be in need of treatment, 96 percent felt they did not need it.
- Most often, those individuals who did not get treatment stated that the reason was that they did not have adequate health insurance or felt they could not afford rehab services.
- The number of individuals who were in treatment was comparable to levels in prior years.18
Some readers may question whether individuals who say they do not seek treatment because of finances are really just making an excuse. This is a complex issue because when people are steeped in drug abuse, they are often motivated both physiologically and socially to protect that drug use, even at risk of experiencing an accident or fatal overdose. But in some instances, fears of the expense of a drug rehab program may be a real barrier to treatment.
The Fix provides information on different facets of drug abuse and recovery, and the articles are often written by people with firsthand experience. According to one article, successfully getting into a treatment program without adequate health insurance or financing can be a real challenge for some.19 For example, individuals who have a criminal record involving a felony may not be eligible for Medicaid or other publically funded programs. Another possibility is that a person may have a co-occurring mental health disorder and substance use disorder, and is unable to find a bed in a rehab center with treatment that accommodates a dual diagnosis.20
Whatever the obstacles, it is important for a person in need of treatment to know that there are professionals who are dedicated to providing help. The following individuals will likely be able to provide guidance: a primary care physician, a psychiatrist, a social worker/case manager, an addiction specialist, a trained interventionist, or an intake counselor or therapist at a local rehab center. Whether individuals set up a rehab treatment admission on their own or with the help of family, friends, or a professional, there are certain elements that will need to be addressed, such as locating an appropriate program, applying for health insurance, or coordinating coverage with a health insurance carrier. Typically, a rehab center can handle all of these matters once their services are engaged.
- Griffiths, S. (November 30, 2015). “Drug map reveals the substances YOUR country is addicted to: Scotland is hooked on cocaine, Iceland smokes the most cannabis and opiates are rife in the US.” Daily Mail. Accessed May 20, 2016.
- “Prescription Drugs.” (June 28, 2015). National Council on Alcohol and Drug Dependence. Accessed May 20, 2016.
- Griffiths, S. “Drug map reveals the substances YOUR country is addicted to: Scotland is hooked on cocaine, Iceland smokes the most cannabis and opiates are rife in the US.”
- “Global Study Finds Drug Abuse Highest in Richer Nations.” (January 6, 2012). Health Day. Accessed May 20, 2016.
- “Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health.” (2015) Substance Abuse and Mental Health Services Administration. Accessed May 20, 2016.
- “Substance-Related and Addictive Disorders.” (2013). American Psychiatric Association. Accessed May 21, 2016.
- “Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health.” (2015).
- “Drugged Driving.” (July 2015). National Institute on Drug Abuse. Accessed May 21, 2016.
- “About Us: MADD.” (n.d.). Mothers Against Drunk Driving. Accessed May 21, 2016.
- “Drugged Driving by the Numbers.” (n.d.). Mothers Against Drunk Driving (MADD). Accessed May 21, 2016.
- “Drunk Driving Statistics.” (n.d.). Mothers Against Drunk Driving (MADD). Accessed May 21, 2016.
- Ellis, M. (June 5, 2013). “Drug Overdose.” Healthline. Accessed May 21, 2016.
- “Information Sheet on Opioid Overdose.” (November 2014). World Health Organization. Accessed May 21, 2016.
- “Overdose Death Rates.” (December 2015). National Institute on Drug Abuse. Accessed May 21, 2016.
- “Understanding Naloxone.” (n.d.). Harm Reduction Coalition. Accessed May 21, 2016.
- “More Americans continue to receive mental health services, but substance use treatment levels remain low.” (September 17, 2015). Substance Abuse and Mental Health Services Administration. Accessed May 21, 2016.
- Castillo, T. (October 5, 2015). “Why Is It So Difficult to Get Drug Treatment?” The Fix. Accessed May 21, 2016.