Drug Abuse

V. Key Issues: Population Health >> E. Health Promotion >> Drug Abuse (last updated 12.8.16)

Topic Outline

1 Overview
2 War on Drugs
3 Marijuana
- 3.1 Decriminalization
- 3.2 Medical Marijuana
4 Needle Exchange Programs
5 Opiod Addiction
6 Links

Overview

Illicit drug abuse in the U.S. adds $11 billion to health costs and imposes an additional $182 billion in non-health costs related to automobile accidents, crime, lost work productivity etc. (NIDA 2012).

War on Drugs

Pew Charitable Trusts | Public Safety Performance Project (August 2015). Federal Drug Sentencing Laws Bring High Cost, Low Return (8.27.15). More than 95,000 federal prisoners are serving time for drug-related offenses—up from fewer than 5,000 in 1980. Despite substantial expenditures on longer prison terms for drug offenders, taxpayers have not realized a strong public safety return. The self-reported use of illegal drugs has increased over the long term as drug prices have fallen and purity has risen.4 Federal sentencing laws that were designed with serious traffickers in mind have resulted in lengthy imprisonment of offenders who played relatively minor roles. These laws also have failed to reduce recidivism. Nearly a third of the drug offenders who leave federal prison and are placed on community supervision commit new crimes or violate the conditions of their release—a rate that has not changed substantially in decades.
Stephen R. Kandall. Our inhumane and costly 100-year war on drugs. News and Observer. March 24, 2013. The federal “war on drugs” started in 1914 with the passage of the Harrison Anti-Narcotic Act and two 1919 Supreme Court decisions: U.S. v. Doremus, which held the Harrison Act constitutional, and Webb et al v. U.S., which made it illegal for physicians and pharmacists to dispense narcotics solely for addiction maintenance. Despite two subsequent court decisions – U.S. v. Linder in 1925 and Robinson v. California in 1962 – which attempted to modulate this “zero tolerance” campaign, America remained committed to harsh, punitive measures against a vulnerable population of addicts.
Since 1971, the “war on drugs” has cost America an estimated $1 trillion and led to 45 million drug arrests, most for nonviolent offenses. In 2007 alone, illegal drug use cost the United States an estimated $193 billion in productivity losses, anti-crime measures and health expenditures.
David Sheff. Clean: Overcoming Addiction and Ending America’s Greatest Tragedy. 374 pp. An Eamon Dolan Book/Houghton Mifflin Harcourt. $25. NYT Book Review: Sheff, a journalist, writes that America’s “stigmatization of drug users” has backfired, hindering progress in curbing addiction. The war on drugs, he says bluntly, “has failed.” After 40 years and an “unconscionable” expense that he estimates at a trillion dollars, there are 20 million addicts in America (including alcoholics), and “more drugs, more kinds of drugs, and more toxic drugs used at younger ages.”

Marijuana

Decriminalization

Auto Accident Risk.
- In a 2012 study published in the journal Psychopharmacology, only 30 percent of people under the influence of THC, the active ingredient in marijuana, failed the field test. And its ability to identify a stoned driver seems to depend heavily on whether the driver is accustomed to being stoned (New York Times, 2.18.14).
- Several researchers, working independently of one another, have come up with the same estimate: a twofold increase in the risk of an accident if there is any measurable amount of THC in the bloodstream.
Health Insurance Coverage.
- Private Health Insurance. No U.S. health insurance policies cover medical marijuana use . . . yet. The reason for this is the same reason neither Medicare nor Medicaid cover medical marijuana: the U.S. Food and Drug Administration (FDA) has not approved any drug containing or derived from marijuana because it remains a federally illegal schedule I controlled substance. Therefore, regardless of state marijuana legalization, health insurance companies are not obligated to and will not provide coverage for non-FDA-approved, federally illegal contraband.
- Consumer-Directed Health Plans (CDHPs). According to Hilary Bricken, an attorney at Harris Moure, PLLC in Seattle, “Whether consumer-directed healthcare plans or CDHPS (Health Savings Accounts, Health Reimbursement Accounts, and Flexible Spending Accounts) cover cannabis is more complicated. Under a CDHP, the insured has a personal healthcare account that can be used for copays or deductibles, with the patient having discretion on how to spend the funds for her own medical needs. Funds are deposited into and withdrawn from a CDHP tax-free. Since the patient has discretion in how her own CDHP funds shall be spent, it logically follows that CDHP funds can be used to purchase medical marijuana in a state with legalized medical marijuana. The first problem with CDHPs and medical marijuana is tax deductibility. According to the IRS, federally illegal controlled substances are not a tax-deductible medical expense. Even if you are unconcerned about tax deductibility, private insurance companies will not cover medical marijuana as part of a CDHP because of another technicality: doctors do not write prescriptions for medical marijuana, but rather recommendations. Since marijuana is still federally illegal, doctors cannot legally prescribe it. The reimbursable medical expenses from this insurance company I chose at random illustrate how insurance companies will only reimburse medication expenses pursuant to a prescription.”
Current Policies. “THC levels must be measured from blood or urine samples, which are typically taken hours after an arrest. Urine tests, which look for a metabolite of THC rather than the drug itself, return a positive result days or weeks after someone has actually smoked. Yet most states have laws that equate any detectable level of THC metabolite in urine with detectable levels of actual THC in blood, and criminalize both. Only six states have set legal limits for THC concentration in the blood” (New York Times, 2.18.14).
- In Colorado and Washington, where recreational use has been legalized, that limit is five nanograms per milliliter of blood, or five parts per billion.
- The problem, Dr. Huestis said, was that studies from Europe suggested that this limit was far too high. Ninety percent of impaired-driving cases in Sweden would be missed at that level, she said.
- The studies indicated that a better limit would be just one nanogram per milliliter, she said. But because THC builds up in fatty tissue and is released slowly over time, such a limit would ensnare frequent users who may not actually be high. Indeed, if you smoke often enough, your blood-THC content might still be five nanograms per milliliter a day after you last lit up.

Medical Marijuana

As of 11.9.15 medical marijuana had been allowed in 23 states; however, some groups remain opposed to it, including the American Society of Addiction Medicine and the American Medical Association

2016 Ballot Initiatives. Initiatives to land marijuana legalization on 2016 ballots are well underway in Arizona, California, Maine, Massachusetts, Michigan, and Nevada.
Ohio. Rejected medical marijuana ballot initiative on 11.3.15. In the immediate aftermath, the legislative plan is to engage the medical community, possibly including state funding for studies, and release a series of bills and resolutions in the coming weeks, with potential action next year. They will include a pilot program and urging Congress to drop marijuana to a lower drug classification.
Public Opinion. A majority of Americans continue to say marijuana use should be legal in the United States, with 58% holding that view, tying the high point in Gallup’s 46-year trend (according to chart shown, 12% supported legalization in 1969).
Resources
- DrugPolicy.org. Medical Marijuana.

Needle Exchange Programs

Opiod Addiction

Lembke, Anna. Drug Dealer, MD. Johns Hopkins, 172 pages, $19.95. One of the biggest culprits in the rise of opioid abuse may be a structural one: Facing draconian time pressures, doctors who suspect that a patient is misusing painkillers rarely get to talk with him about the troubles at the root of his drug problem. One reason is that payment for services is typically tied to the number of patients a clinician sees per day. Abbreviated visits mean shortcuts, like a quick refill that may not be warranted while the need for addiction treatment is overlooked.

Links

National Clearinghouse for Alcohol and Drug Information (NCADI)
National Institute on Drug Abuse (NIDA)
National Center for Addiction and Substance Abuse (Columbia University)
Substance Abuse and Mental Health Services Administration
Marijuana Policy Project
War on Drugs
The Guide to FMLA and Addiction Recovery
Council of State Governments, Knowledge Center. Mental Health and Substance Abuse.
Bureau of Justice Statistics. Drug Offenders In Federal Prisons: Estimates Of Characteristics Based On Linked Data (10.27.15). Presents a description of drug offenders in federal prison, including criminal history, demographics, gun involvement in the offense, and sentence imposed. The report examines each characteristics by type of drug involved in the offense. It also examines demographic information for the entire federally sentenced population and discusses alternative methods for defining drug offenders. Data are from a linked file created with data from the Federal Bureau of Prisons and United States Sentencing Commission. Highlights:
- This study is based on 94,678 offenders in federal prison at fiscal year end 2012 who were sentenced on a new U.S. district court commitment and whose most serious offense (as classified by the Federal Bureau of Prisons) was a drug offense.
- Almost all (99.5%) drug offenders in federal prison were serving sentences for drug trafficking.
- Cocaine (powder or crack) was the primary drug type for more than half (54%) of drug offenders in federal prison.
- Race of drug offenders varied greatly by drug type. Blacks were 88% of crack cocaine offenders, Hispanics or Latinos were 54% of powder cocaine offenders, and whites were 48% of methamphetamine offenders.
- More than a third (35%) of drug offenders in federal prison at sentencing, had either no or minimal criminal history.