Drug Abuse in the Global Village

United states of America

Trends in Drug Abuse

Extent of Drug Abuse: Cannabis is reported the most abused drug in the United States. The annual prevalence of abuse is estimated at 6.8 per cent (17,400,000 abusers) according to the 1992 National Household Survey on Drug Abuse. The daily prevalence of abuse is estimated at 4.4 per cent of the population over 12 years of age. Most abusers are males, between 18-25 years of age, and about 36.9 per cent are females (U.N. 1992). According to the 1991 National Survey on Drug Abuse, lifetime prevalence of drug abuse is highest among young adults 18-25 years of age and is estimated at 50.5 per cent. Among adults aged 26 and older lifetime prevalence is about 32.9 per cent, and among youth between 12-17 years of age prevalence is about 13 per cent (NIDA 1991).
Cocaine is reported to follow cannabis, with annual prevalence of abuse estimated at 2 per cent and daily abuse estimated at 0.5 per cent. Abusers are predominantly male (67 per cent) and most are aged between 18-25. This age group has a lifetime prevalence of 18 per cent, and an annual prevalence 8 per cent(U.N. 1992, NIDA 1991).
Analgesics have a prevalence of abuse estimated at 1.9 per cent annually, while daily abuse is 0.3 per cent. More than half of the abusers are female (54 per cent), and most abusers are between 26-34 years of age (U.N. 1992).
Other drugs of concern are tranquilizers (annual prevalence 1.2 per cent), hallucinogenes (1 per cent), inhalents (1 per cent), amphetamines, sedatives, crack and heroin (all below 1 per cent) (U.N. 1992).
Abuser Characteristics: Abusers of most illicit drugs tend to be male, and rates for Blacks (6.6 per cent) are somewhat higher than for Whites (5.5 per cent) and Hispanics (5.3 per cent). Low education and unemployment remain highly correlated with rates of illicit drug abuse (U.N. 1992).
In 1991, lifetime prevalence of abuse for any drug was about 55 per cent among people 18 to 25 years of age, about 36 per cent for adults over the age of 26, and 20 per cent for youth between 12-17 years of age. The corresponding annual prevalence was about 29 per cent, 10 per cent, and 15 per cent respectively (NIDA 1991).
Over half of the abusers of analgesics, amphetamines, sedatives and tranquilizers are female, between 18-34 years of age (U.N. 1992).
Abusers of inhalents tend to be young males in the 12-17 age range (U.N. 1992).
Regional Variations: The illicit drug use rates remain highest in the Western States. Since 1988, the difference in prevalence by population density has narrowed, dropping in large metropolitan areas from 8.9 per cent in 1988 to 6 per cent in 1992, but remaining unchanged in non-metropolitan areas (U.N. 1992).

Trends: No increase was reported in drug abuse in 1992. Abuse of most drugs remained stable, and there was a decrease reported in the abuse of cocaine, stimulants and inhalents (U.N. 1992).

The number of illicit drug abusers in the United States has been declining since its peak in 1979. This trend is reported to be continuing with the number of drug abusers dropping from 12.8 million in 1991, to 11.4 million in 1992. A decrease in prevalence has occurred among younger people, but not among older adults. The gradual but fundamental shift in students' perceptions is attributed to the impact of education and information on young people (U.N. 1992).
The proportion of high school seniors using any illicit drug during the prior year fell from 33 per cent in 1990, to 29 per cent in 1991; and was down considerably from the peak level of 54 per cent in 1979. Similarly, among college students, annual prevalence of any illicit drug abuse fell from 33 per cent in 1990 to 29 per cent in 1991; down from a peak of 56 per cent in 1980 (University of Michigan 1992).
Although cocaine and other drug use continues to decline among high-school seniors, 8th graders in 1992 reported higher rates of illicit drug abuse than in 1991 (U.N. 1992).
Mode of intake: Heroin and morphine, cocaine, and methamphatamine are injected, according to the Drug Abuse Warning Network (DAWN). Cocaine is also smoked, as is marihuana and hallucinogenes. Barbiturates, amphetamines and hallucinogenes are ingested (U.N. 1992).
Multiple drug abuse is also reported, and many drugs are taken in combination with alcohol (U.N. 1992).

Costs and consequences in Drug Abuse: In 1991, there was an increase in the number of drug-related deaths. Most of the deaths reported to the Drug Abuse Warning Network (DAWN) involved either cocaine use (46 per cent) or heroin (36 per cent). Many of these deaths (13 per cent) involved the use of cocaine and heroin in a combination known as "speedballing". Alcohol was a factor in 37 per cent of the drug-related deaths reported to DAWN, although this includes cases where illicit drugs were also involved. Males accounted for most of the drug-related deaths, while about half of the drug-related emergency room episodes involved females (U.N. 1992).

DAWN data for the first 3 quarters of 1992 show that in comparison to the first 3 quarters of 1991, heroin-related emergency room visits increased by 25 per cent and cocaine related visits increased by 16 per cent. In general, there was a 7 per cent increase in drug-related emergency rooms episodes (U.N. 1992).
The percentages of AIDS cases associated with IV drug abuse has been increasing. In some areas of the Unites States, such as the states of New York and New Jersey, IV drug abusers have become the main AIDS risk group (PAHO 1990).
The costs of drug abuse (excluding alcohol) in 1988 were as high as US$58.4 billion (OSAP 1991).

National Responses to Drug Abuse
National Strategy: The National Institute on Drug Abuse (NIDA) is the federal agency responsible for leading and directing the Nation's drug abuse research in the country (NIDA 1991).
Since the announcement of the first National Drug Control Strategy in 1989, significant decreases have been registered in the number of abusers of all illicit drugs. Strategies have been developed that place emphasis on prevention, treatment and enforcement to induce American not to use illicit drugs at all. National objectives have been set, and by the early part of the next decade, the U.S. has committed itself to reducing overall drug abuse, as well as cocaine abuse, 65 per cent or more that 1988 rates. The goal of the strategy is to reduce demand through prevention and deterrence among new and casual abusers. This is accomplished through the application of complementary programmes involving education, community action, workplace initiatives, treatment of abusers and vigorous enforcement efforts to reduce the availability of illicit drugs (ONDCP 1992)

Actions Taken to Implement International Drug Control Treaties**
Treaty adherence: The United States of America is party to the 1961 Convention as amended by the 1972 Protocol, the 1971 Convention and the 1988 Convention.
Demand Reduction Activities
Primary Prevention:  A wide variety of prevention programmes make up part of the national drug abuse strategy. Educational programmes are widespread. Drug abuse related training is part of the education of professional groups such as doctors, nurses, pharmacists, other health workers, social workers, teachers and law enforcement personnel. Parent education training is reported available upon request, and generally takes the form of technical assistance. Information on prevention, treatment and rehabilitation is distributed at the workplace. Civic groups, professional organizations, voluntary agencies, religious groups, sports clubs and law enforcement agencies are involved in the formulation and implementation of prevention programmes. Mass media are active in promoting drug prevention messages (U.N. 1992).
Treatment and Rehabilitation:  A wide range of treatment programmes make up another part of the national strategy. Programmes available to drug abusers include detoxification, maintenance, drug free counselling, seeking out drug dependent abusers in their environment, outreach programmes, self-help groups, support to families of drug abusers, emergency aid centres, acupuncture, syringe exchange schemes and social model and recovery homes (U.N. 1992).
In 1991, a total of 442,649 clients were treated in a range of treatment facilities including, 4,319 self-help facilities, 1,460 non-residential hospital units, 953 general hospitals. There were more than two times more male than female clients (U.N. 1992).
Treatment and care programmes such as general medical care and general education are available in all prisons. In some prisons there is counselling on drug and drug-related diseases, vocational training, social reintegration after care and violence prevention programmes. About 70 per cent of the prison population (of which 90 per cent are male) are drug abusers (U.N. 1992).

Supply Reduction Activities
Arrests, Convictions and types of Offences: According to data from 1989, a total of 7,446 persons were arrested fot illicit drug possession, and 1,262 were convicted. Most of the arrests involved cocaine possession (4,066 cases), followed by cannabis (1,998 cases), stimulants (682) and heroin (546) (U.N. 1989).
A total of 17,260 persons were arrested for illicit drug trafficking in 1989, and 13,783 were convicted. Most of the arrests involved cocaine trafficking (10,472 cases), followed by cannabis (2,740), stimulants (1,915) and heroin (1,480) (U.N. 1989).
Most of the persons convicted for illicit possession or illicit drug trafficking were male and over the age of 30 (U.N. 1989).
Alcohol and other drugs are associated with up to 50 per cent of spousal abuse cases, 50 per cent of traffic fatalities, 49 per cent of manslaughter charges, 69 per cent of drownings, 62 per cent of assaults, 52 per cent of rapes, 38 per cent of child abuse and 25-30 per cent of suicides (OSAP 1991).        
Seizures: During 1989, there were 259,494 kg of marihuana seized in the border states with Mexico, representing a 25 per cent increase in seizure activity (U.N. 1989).
Supply Source of Drugs: Heroin reaching the U.S. originates in three major source areas: Southeast Asia, Mexico, and Southwest Asia. Mexican heroin dominates supply in most areas on the West Coast, Southeast Asian heroin predominates in a number of major East Coast cities, and Southwest Asian heroin predominates in Chicago and in Puerto Rico (DEA 1991).
During the last years, Colombian cartels increasingly employed Mexican organizations to transport cocaine through established Mexican trafficking routes to the Southwestern United States (U.N. 1989).
Foreign cannabis, primarily from Mexico is believed to account for 79 per cent of the total cannabis available for use in the U.S. during 1989. Domestic cannabis cultivation is estimated to have increased aproximately 20 per cent during 1989 (U.N. 1989).

References and Notes:
** The Legal, Administrative and Other Action Taken to Implement the International Drug Control Treaties section was not available by 15th January 1994.

U.N. 1989, 1991 and 1992. Replies to UNDCP Annual Reports Questionnaire  for the years 1989, 1991 and 1992.

CMO 1991. Replies to UNDCP questionnaire concerning the seven targets of the Comprehensive Multidisciplinary Outline of Future Activities in Drug Abuse Control (CMO) (1991).

DEA 1991. Worldwide Heroin Situation, 1990. Drug Enforcement Administration, U.S. Department of Justice, 1991.

NIDA 1991. Overview of the 1991 National Household Survey on Drug Abuse. National Institute on Drug Abuse. Capsules. 1991.

ONDCP 1992. Domestic Actions. The Office of National Drug Control Policy (ONDCP) Report on Progress: Domestic Demand Reduction.

OSAP 1991. Office for Substance Abuse Prevention. "The Fact Is..." National Clearinghouse for Alcohol and Drug Prevention. Spring 1991.

PAHO 1990. Epidemiology of Drug Abuse in the United States: A Summary of Methods and Findings. Bulletin of the Pan American Health Organization. vol.24 (1), 1990.

University of Michigan 1992. University of Michigan News and Information Services. Press Release. 27 January 1992.