BACKGROUND

The federal government probably spends $20 billion per year on a wide array of interventions to try to reduce drug consumption in the United States, from crop eradication in Colombia to mass media prevention programs aimed at preteens and their parents.1 State and local governments spend comparable amounts, mostly for law enforcement aimed at suppressing drug markets.2 Yet the available evidence, reviewed in detail in this report, shows that drugs are just as cheap and available as they have ever been.

Though fewer young people are starting to use drugs than in some previous years, for each successive birth cohort that turns 21, approximately half have experimented with illegal drugs. The number of people who are dependent on cocaine, heroin, and methamphetamine is probably declining modestly,3 and drug-related violence has appears to have declined sharply.4 At the same time, injecting drug use is still a major vector for HIV transmission, and drug markets blight parts of many U.S. cities.

The declines in drug use that have occurred in recent years are probably mostly the natural working out of old epidemics. Policy measures— whether they involve prevention, treatment, or enforcement—have met with little success at the population level (see Chapter 4). Moreover, research on prevention has produced little evidence of any targeted interventions that make a substantial difference in initiation to drugs when implemented on a large scale. For treatment programs, there is a large body of evidence of effectiveness and cost-effectiveness (reviewed in Babor et al., 2010), but the supply of treatment facilities is inadequate and,

1

The official estimate from the Office of National Drug Control Policy of $14.8 billion in fiscal 2009 excludes a number of major items, such as the cost of prosecuting and incarcerating those arrested by federal agencies for violations of drug laws. See Carnevale (2009) for a detailed analysis of the limits of the official estimate of the federal drug budget.

2

The only estimates of drug-related expenditures by state and local governments are for 1990 and 1991 (Office of National Drug Control Policy, 1993). Given the number of people prosecuted and incarcerated each year for drug offenses, that estimate remains a plausible but unsubstantiated claim.

3

The most recent published estimates only extend through 2000 (Office of National Drug Control Policy, 2001).

4

There are no specific indices that measure drug-related violence. The assumption of reduced violence reflects an inference from (1) the aging of the populations that are dependent on cocaine, heroin, and methamphetamine as reflected in the Treatment Episode Data Set, maintained by the Substance Abuse and Mental Health Administration of the U.S. Department of Health and Human Services; (2) the declining share of arrests of drug users that are for violent crimes, as reflected in the Surveys of Prison and Jail Inmates (Pollack et al., 2010); (3) the 70 percent decline in homicides since 1991; and (4) the increasing share of drug transactions that are conducted in nonpublic settings.



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