Defining Our Priorities

240 Summary remarks DEFINING OUR PRIORITIES L. RUDY BROOMES7 M.D.1 LINDA L. HAWKINS, M.D.2 RUEBEN WARREN, D.D.S., M.P.H., Dr.P.H.3 DR. Warren: I work for the Centers for Disease Control (CDC), the nation's prevention agency. The CDC is one of several agencies within the Public Health Service. While CDC historically has not dealt with drug abuse issues, the agency is now being required to address many of the adverse consequences resulting from the use and abuse of drugs. The health consequences of the use and abuse of both legal and illegal drugs are well documented. I will not insult you by reciting information that you undoubtedly already know. However, CDC is responsible for data gathering ; thus, there are a few statistics worth showing. Recently, the National Center for Health Statistics (NCHS), which is a part of CDC, reported that almost 10,000 persons had died from drug-related causes in the United States. These deaths include dependent and non-dependent use of drugs, and also poisoning from medically prescribed and other drugs. This is the so-called direct mortality from drug use, as reported by NCHS. This is a rather narrowly defined method to relay the tremendous impact of drug deaths in the United States. Nonetheless, using these data, the mortality—that is, the deaths related to drugs—was one to 1.8 times higher for males than for females. The mortality fromdrug-related causes for African-Americans particularly was one to 2.2 times higher than for the white population. Even with this rather narrow view of the drug problem, the gender, ethnic, and racial implications are tremendous. 1 Chief, Psychiatry Service, Carl Vinson Veterans Affairs Medical Center, 1826 Veterans Boulevard , Dublin, GA 31021 215600 San Pedro, Suite 204, San Antonio, TX 78232 3 Assistant Director for Minority Health, Centers for Disease Control & Agency for Toxic Substances and Disease Registry, U.S. Public Health Service, Atlanta, GA 30333 Journal of Health Care for the Poor and Underserved, Vol. 3, No. 1, Summer 1992 _____________________Broomes, Hawkins & Warren__________________241 However, the impact of this problem is far greater than the data indicate. For example, 2.5 million Americans are estimated to have serious drug problems . In 1981, 443,000 (about three percent) of New York state residents experienced health problems related to drug use—not abuse; drug use. The societal cost of drug abuse has been estimated as $10 to 47 billion. The leading cause of death among teenagers and youth and young adults is unintentional injuries (previously referred to as accidents). Suicide, homicide, and unintentional injuries are in many cases linked to drug abuse. Approximately 200,000 persons received public-funded treatment for drug abuse in 1980. Workers at all levels of industry report that drug use is a problem leading to increased absenteeism, theft, dissension, unintentional injuries, and decreased productivity. Throughout this conference, emphasis has been placed on the devastating social and health problems resulting from drug abuse in the United States. These data, in fact, reflect the drug abuse problem, not the drug use problem. The data reflect the abuse of illicit drugs and the social consequences of the abuse of illicit drugs. The data do not reflect the personal, long-term, ill-health consequences on the individual from the use of caff eine, alcohol, tobacco, and other drugs that are socially acceptable. These data do not reflect the family dislocation, physical, social, psychological, or spiritual harm to families, particularly to women and children. The data do not reflect the infant mortality, the morbidity, and the subsequent childhood behavior problems. Nor do they reflect the tremendous intellectual drain on the American public that, surely, history will recount related to a generation lost to drugs. Some people suggest that drug abuse is the problem, particularly for African-Americans. However, emphasis and attention on drug abuse occurred largely as a result of the AIDS/HIV epidemic. Yet much of the HIV/AIDS problem reportedly is not related to drugs. In the 1980s, HIV and AIDS were not related to drug abuse at all. The disease was reported then to be most prevalent amongst gay white men, not heterosexuals, not among...