Heroin, drugs CDC/ Louis Alexander

Americans Spent As Much on Illegal Drugs as on Alcohol

MedicalResearch.com Interview with:

Greg Midgette, PhD Assistant Professor Department of Criminology and Criminal Justice University of Maryland

Dr. Midgette

Greg Midgette, PhD
Assistant Professor
Department of Criminology and Criminal Justice
University of Maryland

MedicalResearch.com: What is the background for this study?

Response: This report estimates marijuana, cocaine, heroin, and methamphetamine use in the U.S. between 2006 and 2016 on three dimensions: the number of past-month chronic users per year, where “chronic” has previously been defined as consuming the drug at least four days in the past month, expenditure per drug among those users, and consumption of each drug. These measures are meant to aid the public and policy makers’ understanding of changes in drug use, outcomes, and policies.  

MedicalResearch.com: What are the main findings?

Response: We found that approximately $150 billion was spent on the four drugs we studied in 2016, which is roughly equivalent to the amount spent on alcohol in the U.S. The country spent $52 billion on marijuana across 32 million past-month users in the states’ legal and illegal markets combined in 2016. Though the difference between the markets is important, we did not attempt to apportion our estimates between them for this study. Marijuana expenditure is roughly equal to the amount spent on cocaine and methamphetamine combined. We estimate that heroin consumption grew by approximately 10 percent per yer between 2010 and 2016 amid the opioid epidemic, and there were 2.3 million chronic heroin users in 2016. While data to study methamphetamine use are particularly noisy, we believe the methamphetamine market grew rapidly over the study period, driven in part by increasing drug purity and falling prices.

MedicalResearch.com: What should readers take away from your report?

Response: This report updates previous estimates published by the Office of National Drug Control Policy in 2014. In the intervening five years, the markets for these drugs have changed in important ways. More than 25% of the U.S. population now lives in now lives in states that have passed laws that allow for-profit firms to produce and sell marijuana to adults ages 21 and older. Use of opioids including heroin grew dramatically and the introduction of fentanyl into the opioid supply increased the risk of overdose among users. The rapid decline in cocaine consumption that started in 2005 appears to have ended, and methamphetamine use has surged recently. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: These estimates help provide a sense of the scale of drug use for each of the substances we studied, but the uncertainty underlying the estimates highlights the need for improved data collection and sharing among researchers and practitioners. This is a fundamental need if we hope to develop a public health and medical infrastructure to effectively respond to drug epidemics today and in the future. Our ability to generate comparable estimates to those in the report in the future is hampered by a lack of systematically reported data. There is now a void in our understanding of drug use across the country due to the elimination of key data sources including the Arrestee Drug Abuse Monitor, which provided information on drug users that are less likely to show up in a household survey or substance abuse treatment records. Researchers need to think creatively about alternative and replacement data.  

MedicalResearch.com: Is there anything else you would like to add?

Response: Our research for this project was funded by the Office of National Drug Control Policy. The views and calculations presented here and in our report only represent those of the authors.


Midgette, Gregory, Steven Davenport, Jonathan P. Caulkins, and Beau Kilmer, What America’s Users Spend on Illegal Drugs, 2006–2016. Santa Monica, CA: RAND Corporation, 2019. https://www.rand.org/pubs/research_reports/RR3140.html. Also available in print form.




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Last Updated on August 21, 2019 by Marie Benz MD FAAD