Editing Substance abuse (section)

==Society and culture==

===Legal approaches===
:''Related articles: [[Drug control law]], [[Prohibition (drugs)]], [[Arguments for and against drug prohibition]], [[Harm reduction]]''

Most governments have designed [[legislation]] to criminalize certain types of drug use. These drugs are often called "illegal drugs" but generally what is illegal is their [[license|unlicensed]] production, distribution, and possession. These drugs are also called "controlled substances". Even for simple possession, legal punishment can be quite severe (including the [[death penalty]] in some countries). Laws vary across countries, and even within them, and have fluctuated widely throughout history.

[[File:Stamp of India - 1991 - Colnect 164174 - International Conference on Drug Abuse Calcutta.jpeg|thumb|150px|1991 Indian postage stamp bearing the slogan – ''Beware of drugs'']]
Attempts by government-sponsored drug control policy to interdict drug supply and eliminate drug abuse have been largely unsuccessful. In spite of the huge efforts by the U.S., drug supply and purity has reached an all-time high, with the vast majority of resources spent on interdiction and law enforcement instead of [[public health]].<ref>{{Cite journal|author=Copeman M |title=Drug supply and drug abuse |journal=CMAJ |volume=168 |issue=9 |pages=1113; author reply 1113 |date=April 2003 |pmid=12719309 |pmc=153673 |url=http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=12719309|archive-url=https://archive.today/20090906063737/http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=12719309|url-status=dead|archive-date=2009-09-06}}</ref><ref>{{Cite journal |vauthors=Wood E, Tyndall MW, Spittal PM, etal |title=Impact of supply-side policies for control of illicit drugs in the face of the AIDS and overdose epidemics: investigation of a massive heroin seizure |journal=CMAJ |volume=168 |issue=2 |pages=165–9 |date=January 2003 |pmid=12538544 |url=http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=12538544 |pmc=140425}}</ref>  In the [[United States]], the number of nonviolent drug offenders in prison exceeds by 100,000 the total incarcerated population in the [[European Union|EU]], despite the fact that the EU has 100 million more citizens.<ref>{{Cite web |last1=Bewley-Taylor |first1=Dave |last2=Hallam |first2=Chris |last3=Allen |first3=Rob |date=March 2009 |title=The Incarceration of Drug Offenders: An Overview |url=http://www.beckleyfoundation.org/pdf/BF_Report_16.pdf |archive-url=https://web.archive.org/web/20130603004721/http://www.beckleyfoundation.org/pdf/BF_Report_16.pdf |archive-date=3 June 2013 |publisher=[[Beckley Foundation|The Beckley Foundation]] Drug Policy Programme}}</ref>

Despite drug legislation (or perhaps because of it), large, organized criminal [[drug cartel]]s operate worldwide. Advocates of decriminalization argue that drug prohibition makes drug dealing a lucrative business, leading to much of the associated criminal activity.

Some states in the U.S., as of late, have focused on facilitating safe use as opposed to eradicating it. For example, as of 2022, New Jersey has made the effort to expand needle exchange programs throughout the state, passing a bill through legislature that gives control over decisions regarding these types of programs to the state's department of health.<ref>{{Cite news |last=Post |first=Michelle Brunetti  |date=11 January 2022 |title=Bill to expand syringe access programs in NJ passes Legislature |work=[[The Press of Atlantic City]] |url=https://pressofatlanticcity.com/news/state-and-regional/bill-to-expand-syringe-access-programs-in-nj-passes-legislature/article_dca73a90-7269-11ec-b80e-1be1ad1df42f.html |archive-url=https://web.archive.org/web/20220111191842/https://pressofatlanticcity.com/news/state-and-regional/bill-to-expand-syringe-access-programs-in-nj-passes-legislature/article_dca73a90-7269-11ec-b80e-1be1ad1df42f.html |archive-date=11 January 2022}}</ref> This state level bill is not only significant for New Jersey, as it could be used as a model for other states to possibly follow as well. This bill is partly a reaction to the issues occurring at local level city governments within the state of New Jersey as of late. One example of this is in the Atlantic City Government which came under lawsuit after they halted the enactment of said programs within their city.<ref>{{Cite news |last=Shelly |first=Molly |date=29 September 2021 |title=South Jersey AIDS Alliance, residents file lawsuit to stop Atlantic City needle exchange closure |work=[[The Press of Atlantic City]] |url=https://pressofatlanticcity.com/news/local/south-jersey-aids-alliance-residents-file-lawsuit-to-stop-atlantic-city-needle-exchange-closure/article_1a17b5c2-212e-11ec-81f1-3b585ad682ec.html |archive-url=https://web.archive.org/web/20211111225403/https://pressofatlanticcity.com/news/local/south-jersey-aids-alliance-residents-file-lawsuit-to-stop-atlantic-city-needle-exchange-closure/article_1a17b5c2-212e-11ec-81f1-3b585ad682ec.html |archive-date=11 November 2021}}</ref> This suit came a year before the passing of this bill, stemming from a local level decision to shut down related operations in Atlantic City made in July that same year. This lawsuit highlights the feelings of New Jersey residents, who had a great influence on this bill passing the legislature.<ref>{{Cite news |last=Shelly |first=Molly |date=6 July 2021 |title=Advocates gather to save Atlantic City needle exchange |work=[[The Press of Atlantic City]] |url=https://pressofatlanticcity.com/news/local/advocates-gather-to-save-atlantic-city-needle-exchange/article_582a12c8-de63-11eb-b7bd-9f12e2761198.html |archive-url=https://web.archive.org/web/20220306205110/https://pressofatlanticcity.com/news/local/advocates-gather-to-save-atlantic-city-needle-exchange/article_582a12c8-de63-11eb-b7bd-9f12e2761198.html |archive-date=6 March 2022}}</ref> These feelings were demonstrated in front of Atlantic City City hall, where residents exclaimed their desire for these programs. All in all, the aforementioned bill was signed effectively into law just days after it passed legislature, by New Jersey Governor [[Phil Murphy]].<ref name="murphy bill">{{cite web |title=Governor Murphy Signs Legislative Package to Expand Harm Reduction Efforts, Further Commitment to End New Jersey's Opioid Epidemic |url=https://www.nj.gov/governor/news/news/562022/20220118b.shtml |website=Official Site of the State of New Jersey |access-date=23 September 2022 |archive-url=https://web.archive.org/web/20220624204536/https://www.nj.gov/governor/news/news/562022/20220118b.shtml |archive-date=24 June 2022 |date=18 January 2022}}</ref>

===Cost===

Policymakers try to understand the relative costs of drug-related interventions. An appropriate drug policy relies on the assessment of drug-related public expenditure based on a classification system where costs are properly identified.

Labelled drug-related expenditures are defined as the direct planned spending that reflects the voluntary engagement of the state in the field of illicit drugs. Direct public expenditures explicitly labeled as drug-related can be easily traced back by exhaustively reviewing official accountancy documents such as national budgets and year-end reports. Unlabelled expenditure refers to unplanned spending and is estimated through modeling techniques, based on a top-down budgetary procedure. Starting from overall aggregated expenditures, this procedure estimates the proportion causally attributable to substance abuse (Unlabelled Drug-related Expenditure = Overall Expenditure × Attributable Proportion). For example, to estimate the prison drug-related expenditures in a given country, two elements would be necessary: the overall prison expenditures in the country for a given period, and the attributable proportion of inmates due to drug-related issues. The product of the two will give a rough estimate that can be compared across different countries.<ref name=Prieto/>

====Europe====

As part of the reporting exercise corresponding to 2005, the European Monitoring Centre for Drugs and Drug Addiction's network of national focal points set up in the 27 European Union (EU) the member states, Norway, and the candidates' countries to the EU, were requested to identify labeled drug-related public expenditure, at the national level.<ref name=Prieto/>

This was reported by 10 countries categorized according to the functions of government, amounting to a total of EUR 2.17 billion. Overall, the highest proportion of this total came within the government functions of health (66%) (e.g. medical services), and public order and safety (POS) (20%) (e.g. police services, law courts, prisons). By country, the average share of GDP was 0.023% for health, and 0.013% for POS. However, these shares varied considerably across countries, ranging from 0.00033% in Slovakia, up to 0.053% of GDP in Ireland in the case of health, and from 0.003% in Portugal, to 0.02% in the UK, in the case of POS; almost a 161-fold difference between the highest and the lowest countries for health, and a six-fold difference for POS.

To respond to these findings and to make a comprehensive assessment of drug-related public expenditure across countries, this study compared health and POS spending and GDP in the 10 reporting countries. Results suggest GDP to be a major determinant of the health and POS drug-related public expenditures of a country. Labeled drug-related public expenditure showed a positive association with the GDP across the countries considered: r = 0.81 in the case of health, and r = 0.91 for POS. The percentage change in health and POS expenditures due to a one percent increase in GDP (the income elasticity of demand) was estimated to be 1.78% and 1.23% respectively.

Being highly income elastic, health and POS expenditures can be considered luxury goods; as a nation becomes wealthier it openly spends proportionately more on drug-related health and public order and safety interventions.<ref name=Prieto>{{cite journal | author = Prieto L | year = 2010 | title = Labelled drug-related public expenditure in relation to gross domestic product (gdp) in Europe: A luxury good? | journal = Substance Abuse Treatment, Prevention, and Policy | volume = 5 | page = 9 | doi=10.1186/1747-597x-5-9| pmid = 20478069 | pmc = 2881082 | doi-access = free }}</ref>

====United Kingdom====
The UK [[Home Office]] estimated that the social and economic cost of drug abuse<ref name="Drug Abuse">{{Cite web| title = NHS and Drug Abuse | url = http://www.nhs.uk/LiveWell/Drugs/Pages/Drugshome.aspx | publisher = [[National Health Service (NHS)]] | date = March 22, 2010 | access-date = March 22, 2010 }}</ref> to the UK economy in terms of crime, absenteeism and sickness is in excess of £20 billion a year.<ref>{{Cite web|url=http://drugs.homeoffice.gov.uk/drug-strategy/drugs-in-workplace/|archive-url=https://web.archive.org/web/20070609094530/http://drugs.homeoffice.gov.uk/drug-strategy/drugs-in-workplace/|archive-date=2007-06-09|title=Home Office — Tackling Drugs Changing Lives – Drugs in the workplace|date=2007-06-09|access-date=2016-09-19}}</ref>
However, the UK Home Office does not estimate what portion of those crimes are [[unintended consequences]] of drug prohibition (crimes to sustain expensive drug consumption, risky production and dangerous distribution), nor what is the cost of enforcement. Those aspects are necessary for a full analysis of the economics of prohibition.<ref>{{Cite web| last  = Thornton| first = Mark| title = The Economics of Prohibition| date = 31 July 2006| url= https://mises.org/story/2269}}</ref>

====United States====
{| class="wikitable" style = "float: right; margin-left:15px; text-align:center"
! Year || Cost<br />{{nobold|{{small|(billions of dollars)}}}}<ref>{{Cite web |date=December 2004 |title=The Economic Costs of Drug Abuse in the United States 1992-2002 |url=http://www.ncjrs.gov/ondcppubs/publications/pdf/economic_costs.pdf |archive-url=https://web.archive.org/web/20220901041005/https://www.ojp.gov/ondcppubs/publications/pdf/economic_costs.pdf |archive-date=1 September 2022 |publisher=[[Office of National Drug Control Policy]], [[Executive Office of the President of the United States]] |id=Publication 207303}}</ref>
|-
| 1992 || 107
|-
| 1993 || 111
|-
| 1994 || 117
|-
| 1995 || 125
|-
| 1996 || 130
|-
| 1997 || 134
|-
| 1998 || 140
|-
| 1999 || 151
|-
| 2000 || 161
|-
| 2001 || 170
|-
| 2002 || 181
|}

These figures represent overall economic costs, which can be divided in three major components: health costs, productivity losses and non-health direct expenditures.

*Health-related costs were projected to total $16 billion in 2002.
*Productivity losses were estimated at $128.6 billion. In contrast to the other costs of drug abuse (which involve direct expenditures for goods and services), this value reflects a loss of potential resources: work in the labor market and in household production that was never performed, but could reasonably be expected to have been performed absent the impact of drug abuse.
:Included are estimated productivity losses due to premature death ($24.6 billion), drug abuse-related illness ($33.4 billion), incarceration ($39.0 billion), crime careers ($27.6 billion) and productivity losses of victims of crime ($1.8 billion).
*The non-health direct expenditures primarily concern costs associated with the criminal justice system and crime victim costs, but also include a modest level of expenses for administration of the social welfare system. The total for 2002 was estimated at $36.4 billion. The largest detailed component of these costs is for state and federal corrections at $14.2 billion, which is primarily for the operation of prisons. Another $9.8 billion was spent on state and local police protection, followed by $6.2 billion for federal supply reduction initiatives.

According to a report from the Agency for Healthcare Research and Quality (AHRQ), Medicaid was billed for a significantly higher number of hospitals stays for opioid drug overuse than Medicare or private insurance in 1993.  By 2012, the differences were diminished.  Over the same time, Medicare had the most rapid growth in number of hospital stays.<ref>{{cite journal |vauthors=Owens PL, Barrett ML, Weiss AJ, Washington RE, Kronick R | title =  Hospital Inpatient Utilization Related to Opioid Overuse Among Adults, 1993–2012 | journal =HCUP Statistical Brief |issue=177 | publisher = Agency for Healthcare Research and Quality | location = Rockville, MD | date = August 2014 | url = https://www.hcup-us.ahrq.gov/reports/statbriefs/sb177-Hospitalizations-for-Opioid-Overuse.jsp}}</ref>

'''Canada'''

Substance abuse takes a financial toll on Canada's hospitals and the country as a whole. In the year 2011, around $267 million of hospital services were attributed to dealing with substance abuse problems.<ref>{{Cite news |last=[[Canadian Centre on Substance Abuse]] |date=20 November 2014 |title=Substance Abuse Costs Canadian Hospitals Hundreds of Millions of Dollars per Year - Alcohol Abuse the Prime Culprit |work=[[CNW Group|Canada Newswire]] |url=https://www.newswire.ca/news-releases/substance-abuse-costs-canadian-hospitals-hundreds-of-millions-of-dollars-per-year---alcohol-abuse-the-prime-culprit-516469751.html |archive-url=https://web.archive.org/web/20201030173853/https://www.newswire.ca/news-releases/substance-abuse-costs-canadian-hospitals-hundreds-of-millions-of-dollars-per-year---alcohol-abuse-the-prime-culprit-516469751.html |archive-date=30 October 2020}}</ref> The majority of these hospital costs in 2011 were related to issues with alcohol. Additionally, in 2014, Canada also allocated almost $45 million towards battling prescription drug abuse, extending into the year 2019.<ref>{{Cite news |date=12 February 2014 |title=CCSA Recognizes Federal Leadership on Prescription Drug Abuse |work=Indigenous Health Today |url=https://ihtoday.ca/ccsa-recognizes-federal-leadership-on-prescription-drug-abuse/ |archive-url=https://web.archive.org/web/20200926033928/https://ihtoday.ca/ccsa-recognizes-federal-leadership-on-prescription-drug-abuse/ |archive-date=26 September 2020}}</ref> Most of the financial decisions made on substance abuse in Canada can be attributed to the research conducted by the Canadian Centre on Substance Abuse (CCSA) which conduct both extensive and specific reports. In fact, the CCSA is heavily responsible for identifying Canada's heavy issues with substance abuse. Some examples of reports by the CCSA include a 2013 report on drug use during pregnancy<ref>{{Cite report |url=https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Drug-Use-during-Pregnancy-Report-2013-en.pdf |title=Licit and Illicit Drug Use during Pregnancy: Maternal, Neonatal and Early Childhood Consequences |last=Finnegan |first=Loretta |date=2013 |publisher=[[Canadian Centre on Substance Abuse]] |isbn= 978-1-77178-041-4 |archive-url=https://web.archive.org/web/20210817142723/https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Drug-Use-during-Pregnancy-Report-2013-en.pdf |archive-date=17 August 2021}}</ref> and a 2015 report on adolescents' use of cannabis.<ref>{{Cite report |url=https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Effects-of-Cannabis-Use-during-Adolescence-Report-2015-en.pdf |title=The Effects of Cannabis Use during Adolescence |last1=Tony |first1=George |last2=Vaccarino |first2=Franco |date=2015 |publisher=[[Canadian Centre on Substance Abuse]] |isbn=978-1-77178-261-6 |archive-url=https://web.archive.org/web/20220120050627/https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Effects-of-Cannabis-Use-during-Adolescence-Report-2015-en.pdf |archive-date=20 January 2022}}</ref>