FACING FACTS

Drug Strategies

Facing Facts

Impact on Health

Alcohol, tobacco and other drugs affect the health and well-being of District residents who use them as well as those who do not, while adding to the city's health care costs. Drug abuse plays a significant role in automobile accidents, chronic illness, hospital emergency room visits, newborn health problems, mental illness and the spread of infectious disease. Drug abuse contributes to the city's unusually high death rate, which is 41 percent above the national average.(80)

Drug-Related Illness and Death

Key Findings

A large proportion of the city's emergency room visits are related to drug abuse.

Smoking is extremely costly to the District's health, in terms of both lives and dollars.

Emergency Room Visits. Out of 1.2 million ER visits in the Washington metropolitan area each year, an estimated 457,000 patients are under the influence of alcohol at the time of their visit.(81/82) In 1996, illicit drugs were a factor in 18,448 ER visits in the Washington metropolitan area (including the suburbs), according to the Drug Abuse Warning Network (DAWN).(83) Cocaine, which accounted for 54 percent of ER drug episodes in 1989, accounted for 30 percent in 1996 but remains the leading cause of drug emergencies in the city. Next is heroin, causing 13 percent of ER drug visits in 1996.(84)

Tobacco-Related Deaths and Costs. Smoking is the leading preventable cause of premature death in Washington and the nation. Smoking-attributable conditions (such as cancer, heart disease and sudden infant death syndrome) cause more than 1,700 deaths annually in the city, according to the CDC. (85) Indeed, the CDC projects that 4,927 youth in the District today will die prematurely due to smoking.

Smoking costs the District about $520 million annually, including $315 million in direct medical care and $205 million in productivity loss and premature death. At $680 for every adult resident, the District's medical costs attributable to smoking exceed the national average by nearly 80 percent. (86)

Alcohol and Other Drug Deaths. Between 1990 and 1995, at least 426 people in the District died of alcohol-related diseases. An additional 137 people died from other drug-related causes during that period, according to the CDC.(87) These are conservative estimates which only include deaths directly attributable to alcohol or other drug use; drug abuse also contributes to deaths attributed to other causes, such as fatal burns, suicides, homicides and infant deaths.

Between 1988 and 1996, 540 people died in traffic crashes in the District, almost half of which involved alcohol use by at least one driver. The National Highway Traffic Safety Administration estimates direct and indirect costs for each such fatality at $2.85 million.

The number of fatalities related to drinking and driving is not carefully measured in the District. In 1996 only 19 percent of drivers involved in fatal accidents in the city were tested for alcohol -- less than half the national testing rate (44 percent).(88)

Impact on Children

Key Findings

Parental drug abuse is involved in the overwhelming majority of the District's child abuse, neglect and foster care cases.

Foster care for children whose parents have addictions costs the city tens of millions of dollars annually.

Caring for low birth weight infants exposed to alcohol and other drugs during pregnancy costs an additional $6 million each year.

Child Welfare Cases and Addiction. In Washington, D.C., parents accused of abuse and neglect are automatically drug tested as a condition of pretrial release. The drug test results become part of the court record and can be used in making custody determinations at trial.

Among the District's 2,500 child protective cases, 85 percent involve a parent who abuses alcohol or other drugs.(89)Similarly, parental drug abuse is a factor in 75 percent of the child foster care cases in Washington, D.C., according to the Metropolitan Washington Council of Governments.(90) The figures are consistent with a GAO report, which found that parental alcohol and other drug abuse contributes to 78 percent of foster care cases nationwide.(91)

Washington's expenditures for alcohol and other drug-related foster care cases range from $11 million to $24 million annually.(92/93/94) Children in the foster care system are also at increased risk for later drug use and delinquency.

Impact of Drugs on Newborns. One in seven pregnant women admitted for delivery at city hospitals in 1992 tested positive for illicit drugs, according to NIDA's Washington, D.C., Metropolitan Area Drug Study.(95/96)Based on self-reports, nearly 15 percent of new mothers reported using illicit drugs during their pregnancy, 21 percent reported drinking alcohol, and 23 percent reported smoking cigarettes.(97)

The study found that babies of women who smoked during pregnancy were four times more likely to be low birth weight than the babies of mothers who did not smoke. Rates of low birth weight also increased for babies whose mothers used alcohol and other drugs during pregnancy.(98)

The cost of neonatal intensive care for low birth weight newborns ranges from $25,000 to $35,000 per child. Approximately 14 percent of babies born in the District are low birth weight (1,187 in 1996),(99)and at least 20 percent of them have been exposed to alcohol, tobacco or other drugs before birth.(100) Caring for these infants costs the city at least $5.9 million each year.

Like many cities, the District does not track the number of babies born with fetal alcohol syndrome (FAS), a birth defect that is commonly overlooked and underestimated nationwide. A single FAS case costs about $1.4 million over a lifetime. 101 (101)

HIV and AIDS

Key Findings

One in three AIDS cases in Washington is linked to drug use.

Among those living with AIDS in Washington, drug-related cases cost more than $10 million each year for health care alone.

Despite these alarming figures, Congress has prohibited the city from using locally-raised revenues for needle exchange programs which have been shown to reduce HIV infections among addicts without increasing drug use.

Alcohol and other drug use place Washington's high percentage of sexually active teens at greater risk for HIV infection.

Prevalence. The eighth leading cause of death nationally, AIDS, which disproportionately affects drug users, is the third leading killer in Washington.(102) The city's AIDS deathrate is more than seven times the national average (120 per 100,000 compared to 16 per 100,000).(103) [FOOTNOTE: AIDS is the leading cause of death among city residents aged 30 to 44, accounting for 46 percent of all deaths. In addition to the more than 5,000 people in the city living with AIDS, an estimated 10,000-12,000 other residents have HIV (the virus which causes AIDS). The District is expected to begin tracking HIV cases in 1999 in order to meet new CDC guidelines.]

A growing percentage of the city's AIDS cases are the result of injection drug use (IDU). By the end of 1997, 36 percent of AIDS cases in the city were linked to IDU, compared to 24 percent in 1993. The drug-related AIDS cases diagnosed in 1997 will generate lifetime health care costs exceeding $34 million dollars.

African Americans constitute nearly all (97 percent) of the AIDS cases diagnosed among injection drug users between 1994 and 1997. In populations with unusually high rates of drug use (e.g., the homeless, criminal offenders, young adults), the risk of contracting AIDS is greater.

Drug-related cases among those living with AIDS in the District generate at least $10.4 million in health care costs annually.(104)

AIDS Prevention Through Needle Exchange. Beginning in 1996, the D.C. government funded a needle exchange program run by the Whitman-Walker Clinic, a community-based provider of AIDS services. The program, which reached an estimated 3,000 injection drug users, reduced needle sharing among participants by two-thirds.(105)

Since October 1998, Congress has prohibited the city from using local funds for needle exchange programs. The ban also prohibits any federally funded organization from operating a needle exchange program in the city, even if the program is financed strictly with private funds. As a result, Whitman-Walker's $220,000 needle exchange program closed, although a fiscal impact study found that failing to provide needle exchange would cost the city $8.3 million annually.(106)

In October 1998, Whitman-Walker and local health advocates formed Prevention Works, Inc., a privately funded organization to operate a local needle exchange program.(107) The program, licensed by the D.C. Health Department, began operating in December 1998. Its future will depend on sustained financial support from the private sector.

AIDS Risks for Youth. Alcohol and other drug use can lower inhibitions and lead to high-risk behavior, including reduced condom use.(108)Although 91 percent of Washington's teenagers report being taught about HIV and AIDS in school, and 73 percent say a parent or other adult family member has discussed the topic with them, a high percentage are still at risk for AIDS.

A majority of teens in the city are sexually active (53 percent vs. 35 percent nationally). While 68 percent of those who are sexually active say they use condoms, in 1997, 21 percent of city teenagers reported using alcohol or other drugs at the time of their last intercourse; this drug use decreases the likelihood of condom use.(109) Teens in Washington are also three times more likely than teens nationwide to have intercourse before age 13 (21 percent vs. 7 percent) and more than twice as likely to have at least four sexual partners (38 percent vs. 16 percent) -- factors which also increase their risk for contracting HIV.

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