Editing Substance abuse (section)

===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>