Drugged Out America

Overview

In 2001, an estimated 15.9 million Americans aged 12 or older were current illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 7.1 percent of the population aged 12 years old or older. The percentage of the population using illicit drugs increased from 6.3 percent in 1999 and 2000 to 7.1 percent in 2001. Between 2000 and 2001, statistically significant increases were noted for the current use of marijuana (4.8 to 5.4 percent), cocaine (0.5 to 0.7 percent), pain relievers (1.2 to 1.6 percent), and tranquilizers (0.4 to 0.6 percent). A change in NHSDA questions on hallucinogens caused the estimated rate of use of this category of drugs to increase from 0.4 to 0.6 percent between 2000 and 2001. Marijuana is the most commonly used illicit drug. In 2001, it was used by 76 percent of current illicit drug users. Approximately 56 percent of current illicit drug users consumed only marijuana, 20 percent used marijuana and another illicit drug, and the remaining 24 percent used an illicit drug but not marijuana in the past month. Therefore, about 44 percent of current illicit drug users in 2001 (7.0 million Americans) used illicit drugs other than marijuana and hashish, with or without using marijuana as well. Of the 7.0 million current users of illicit drugs other than marijuana, 4.8 million were current users of psychotherapeutic drugs. This represents 2.1 percent of the population aged 12 or older, which was higher than the rate observed in 2000 (1.7 percent). Of those who reported current use of any psychotherapeutics, 3.5 million used pain relievers, 1.4 million used tranquilizers, 1.0 million used stimulants, and 0.3 million used sedatives. In 2001, an estimated 1.7 million (0.7 percent) of Americans aged 12 or older were current cocaine users and 406,000 (0.2 percent) were current crack users. Approximately 1.3 million (0.6 percent) of the population aged 12 or older were current users of hallucinogens. In 2001, an estimated 8.1 million (3.6 percent) of Americans aged 12 or older had tried "Ecstasy" at least once in their lifetime. This is more than the estimated 6.5 million (2.9 percent) lifetime users in 2000. The number of current users in 2001 was estimated to be 786,000 (0.3 percent). The 2000 NHSDA was not designed to report past month or past year use of Ecstasy. In 2001, approximately 957,000 persons aged 12 or older had used Oxycontin nonmedically at least once in their lifetime. This number is higher than estimates from both 1999 (221,000) and 2000 (399,000). The NHSDA was not designed to report past month or past year use of Oxycontin. Current heroin use was reported by an estimated 123,000 Americans in 2001. This represents 0.1 percent of the population aged 12 or older and is similar to the number estimated for 2000 (130,000).

Age

Rates and patterns of drug use show substantial variation by age. For example, 3.8 percent of youths aged 12 or 13 reported current illicit drug use in 2001 (Figure 2.3). As in other years, illicit drug use in 2001 tended to increase with age among young persons. It peaked among 18 to 20 year olds (22.4 percent) and declined steadily after that point with increasing age. Among youths aged 12 to 17, 10.8 percent were current illicit drug users. This was higher than the rate observed in 2000 (9.7 percent). Among youths aged 12 or 13, the rate of past month illicit drug use increased from 3.0 percent in 2000 to 3.8 percent in 2001, which was similar to the rate observed in 1999 (3.9 percent). There were no changes between 2000 and 2001 in rates of past month use for any of the illicit drug categories for youths aged 14 or 15. The rate of current any illicit drug use among youths aged 16 or 17 did not differ between 2000 and 2001. However, declines were noted in rates of current LSD (1.1 to 0.7 percent) and methamphetamine use (0.6 to 0.3 percent) between these 2 years. Among young adults aged 18 to 25 years, the rate of past month any illicit drug use increased between 2000 and 2001, rising from 15.9 to 18.8 percent. Increases were evident for current use of marijuana, cocaine, heroin, hallucinogens, pain relievers, tranquilizers, stimulants, and methamphetamine. There were no changes in rates of drug use among adults aged 26 or older between 2000 and 2001. The rate of current illicit drug use was 4.2 percent in 2000 and 4.5 percent in 2001. Although rates of use of most drugs in 2001 were higher among youths and young adults compared with older adults, the age distribution of users varied considerably by type of drug. About half (51 percent) of current illicit drug users were aged 12 to 25. However, in 2001, 86 percent of hallucinogen users and 76 percent of inhalant users were aged 12 to 25. Conversely, only 40 percent of cocaine users and 45 percent of nonmedical psychotherapeutics users were aged 12 to 25. In 2001, approximately 2.0 million (8.6 percent) youths aged 12 to 17 had used inhalants at some time in their lives. Although there were no observed differences in rates of inhalant use between 2000 and 2001 among youths, the proportion of persons aged 26 or older reporting inhalant use increased from 6.4 to 7.1 percent.

Gender

As in prior years, men were more likely to report current illicit drug use than women (8.7 vs. 5.5 percent) in 2001. However, rates of nonmedical psychotherapeutics use were similar for males (2.2 percent) and females (2.0 percent), consistent with previous findings for these drugs. Between 2000 and 2001, the rate of past month illicit drug use increased among both men (from 7.7 to 8.7 percent) and women (from 5.0 to 5.5 percent) aged 12 or older. Among youths aged 12 to 17, the rate of current illicit drug use was higher for boys (11.4 percent) than for girls (10.2 percent) (Figure 2.9). Although boys aged 12 to 17 had a higher rate of marijuana use than girls (8.9 vs. 7.1 percent), girls were more likely to use psychotherapeutics nonmedically than boys (3.8 vs. 2.7 percent). Among youths aged 12 to 17, there was a significant increase between 2000 and 2001 in the rate of current illicit drug use among boys (from 9.8 to 11.4 percent), but no significant difference was noted among girls (from 9.5 to 10.2 percent).

Pregnant Women

Among pregnant women aged 15 to 44 years, 3.7 percent reported using illicit drugs in the month prior to interview (based on the combined 2000 and 2001 NHSDA samples). This rate was significantly lower than the rate among women aged 15 to 44 who were not pregnant (8.3 percent). Among pregnant women aged 15 to 17, the rate of use was 15.1 percent, nearly equal to the rate for nonpregnant women of the same age (14.1 percent). In 2001, the rates of current illicit drug use were similar for white (4.0 percent), black (3.7 percent), and Hispanic (3.3 percent) pregnant women.

Race/Ethnicity

Rates of current illicit drug use among the major racial/ethnic groups in 2001 were 7.2 percent for whites, 6.4 percent for Hispanics, and 7.4 percent for blacks. The rate was highest among American Indians/Alaska Natives (9.9 percent) and persons reporting more than one race (12.6 percent). Asians had the lowest rate. Although Asians as a group had the lowest rate of current illicit drug use, there were variations among the Asian subgroups. For persons aged 12 or older, the rates were 1.3 percent for Chinese, 2.2 percent for Asian Indians or Filipinos, 3.0 percent for Vietnamese, 4.5 percent for Japanese, 5.0 percent for Koreans, and 5.1 percent for Pacific Islanders excluding Native Hawaiians (Figure 2.12). To ensure adequate sample sizes for these population subgroups, these estimates are based on combined 2000 and 2001 NHSDA data. Based on combined 2000 and 2001 data, rates of past month illicit drug use in the Hispanic population aged 12 or older were 9.2 percent for Puerto Ricans, 5.8 percent for Mexicans, 3.7 percent for Cubans, and 3.6 percent for Central or South Americans. Among youths aged 12 to 17, the rate of current illicit drug use was highest among American Indians/Alaska Natives (23.0 percent for combined 2000 and 2001 data).

Education

Illicit drug use rates are generally correlated with educational status. Among adults aged 18 or older in 2001, college graduates had the lowest rate of current use (4.3 percent). The rate was 7.6 percent among those who had not completed high school. This is despite the fact that adults who had completed 4 years of college were more likely to have tried illicit drugs in their lifetime when compared with adults who had not completed high school (47.2 vs. 32.0 percent).

College Students

In the college-aged population (i.e., those aged 18 to 22 years old), the rate of current illicit drug use was nearly the same among full-time undergraduate college students (20.6 percent) as for other persons aged 18 to 22 years, including part-time students, students in other grades, or nonstudents (21.7 percent). Between 2000 and 2001, there were no significant differences observed in the rate of current illicit drug use among full-time undergraduate college students; however, among other persons aged 18 to 22, the rate increased from 18.2 percent in 2000 to 21.7 percent in 2001.

Employment

Current employment status is also highly correlated with rates of illicit drug use. An estimated 17.1 percent of unemployed adults aged 18 or older were current illicit drug users in 2001 compared with 6.9 percent of those employed full time and 9.1 percent of those employed part time. Although the rate of drug use was higher among unemployed persons than other employment groups, most drug users were employed. Of the 13.4 million illicit drug users aged 18 or older in 2001, 10.2 million (76.4 percent) were employed either full or part time.

Geographic Area

Among persons aged 12 or older, the rate of current illicit drug use in 2001 was 8.3 percent in the West, 7.5 percent in the Northeast, 6.8 percent in the Midwest, and 6.2 percent in the South. By geographic division, rates ranged from 9.2 percent in New England division and 8.7 percent in the Pacific division to 6.2 percent in the West South Central division and 5.7 percent in the East South Central division.
The rate of illicit drug use in metropolitan areas was higher than the rate in nonmetropolitan counties. Rates were 7.6 percent in large metropolitan counties, 7.1 percent in small metropolitan counties, and 5.8 percent in nonmetropolitan counties (Figure 2.13). Completely rural nonmetropolitan counties had lower rates of illicit drug use than other types of nonmetropolitan counties. Rates were 4.8 percent in completely rural counties and 5.5 percent in less urbanized nonmetropolitan counties. Among youths in 2001, rates of any illicit drug use ranged from 14.4 percent in completely rural nonmetropolitan counties to 10.4 percent in less urbanized nonmetropolitan counties. The rate of use for youths in large metropolitan areas was 10.4 percent.

Criminal Justice Populations

In 2001, among the estimated 1.4 million adults aged 18 or older on parole or other supervised release from prison during the past year, 20.8 percent were current illicit drug users. This rate is higher than the rate for adults not on parole or supervised release (6.5 percent) and similar to the rate observed in 2000 (21.6 percent). Among the estimated 4.0 million adults on probation at some time in the past year, 24.4 percent reported current illicit drug use in 2001, which was comparable with the rate observed in 2000 (24.2 percent). This compares with a rate of 6.3 percent among adults not on probation in 2001.

Frequency of Use

Between 2000 and 2001, the frequency of marijuana use among past year users was similar. In 2001, 11.9 percent of past year marijuana users used the substance on 300 or more days in the past 12 months. This translates to 2.5 million persons using marijuana on a daily or almost daily basis over a 12-month period. Among past month users, about a third (32.0 percent, or 3.9 million persons) used marijuana more than 20 days in the past month.

Association with Cigarette and Alcohol Use

The rate of past month illicit drug use among youths and adults was higher among those who were current cigarette or alcohol users compared with those who did not use these substances. In 2001, the rate of current illicit drug use was approximately 9 times higher among youths who smoked cigarettes (48.0 percent) than it was among youths who did not (5.3 percent). Illicit drug use also was associated with the level of alcohol use. Among youths who were heavy drinkers in 2001, 65.3 percent also were current illicit drug users, whereas among nondrinkers, the rate was only 5.1 percent.

Driving Under the Influence of Illicit Drugs

An estimated 8.0 million persons reported driving under the influence of an illicit drug at some time in the past year. This corresponds to 3.6 percent of the population aged 12 or older and is significantly higher than the rate in 2000 (3.1 percent) but similar to the rate in 1999 (3.4 percent). Among young adults aged 18 to 25 years, 12.4 percent drove under the influence of illicit drugs at least once in the past year. Of the 8.0 million persons who had driven under the influence of illicit drugs in the past year, most (77 percent) had also driven under the influence of alcohol.

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Prescription Drug Use

In 2002, Americans filled 3,340,000,000 outpatient prescriptions. That's 12 prescriptions for every man, women, and child in America. Has the American dream become 2 kids, 2 cars, and a dozen drugs in each person's medicine chest?

Despite a cold economy in which most industries have seen sales drop, U.S. drug sales increased substantially in 2002, reaching $219 billion. According to NDCHealth, overall drug sales (all sources) grew 12% 2002, 18% in 2001, and 15% in 2000 (based on wholesale acquisition costs). The trend of doctors writing more and more outpatient prescriptions each year continues without pause:

2002: 3,340,000,000 Rx
2001: 3,200,000,000 Rx
2000: 2,979,000,000 Rx
1999: 2,821,000,000 Rx
1998: 2,523,000,000 Rx

The cost of these drugs has more than doubled in five years. The outlook for the future? According to Pharmacy Times last year: "For the past 3 years, prescription volume has grown by 25% in the United States, and there doesn't appear to be a slowdown in sight."

What is the goal of the drug industry? To simply sell as many drugs as possible? Yet, medications aren't like other commodities. Prescription drugs aren't the same as cars, cosmetics, or CD players. Drugs have direct, powerful effects on human systems. Most of these effects are negative, and taking multiple drugs -- as 25% of Americans do -- increases the risks exponentially. Psychologically, the growing attitude that drugs are the answer for every ache and angst is destructive for individuals and societies.

Prescription medications are the #4 leading cause of death, cause more than 1 million hospitalizations annually, and are a major cause of disability and drug dependency. Over-use of medications is rampant.