In 2018, the life expectancy in America declined for the third consecutive year, breaking a 100-year trend of growth. According to public health experts, one major crisis is to blame: drug use.

While over 29 million people around the world suffer from drug misuse and deadly drug-related disorders, the drug fatality rate across the U.S. is growing faster than ever before. In 2017, a nearly 10% annual increase in the number of drug overdoses brought the total fatality rate to more than 70,000 lives lost to substances including opioids and amphetamines.

To understand the full impact of illicit drug use in America, we took an extensive look at the newest drug trends from the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2017. Read on as we explore where drug misuse is growing, which substances are gaining in popularity, and which age groups are the most affected by this growing public health emergency.

A Growing Concern

According to SAMHSA, nearly 1 in 5 Americans aged 12 and older participated in illicit drug use within the last year at the time of their study.

Based on the SAMHSA findings, we learned nearly 1 in 10 people admitted to using marijuana illegally within the past month. At the time of this writing, 33 states and Washington, D.C., had passed legislation allowing for the legalization of marijuana, but only 10 states and Washington, D.C., had legalized marijuana for recreational use. Despite conflicting public opinion, some health advocates point to a rising trend in psychosis, suicide, and motor vehicle accidents in response to the widespread legalization of marijuana in America. In states where legalization occurred, more than 15% of adults reported using marijuana within the last month.

Like marijuana, misuse of prescription pain medication (1.18%), cocaine (0.80%), stimulants (0.67%), and tranquilizers (0.64%) accounted for the most used narcotics across the country.

Nowhere in America was illicit drug use more prevalent in 2017 than Washington, D.C. With more than 5% of the population aged 12 and older engaged in some form of illegal drug use in the past month, more residents in Washington, D.C., consumed illegal substances than in Vermont (4.71%), Oregon (4.55%), or Rhode Island (4.31%).

In Washington, D.C., specifically, the opioid epidemic has evolved to include a drastic increase in the use of synthetic drugs including fentanyl and synthetic cannabinoids. While the national rate of opioid fatalities declined, Washington, D.C., experienced multiple outbreaks of synthetic narcotics in 2018. In recent years, fentanyl (the most common and well-known synthetic opioid) has accounted for more than half of opioid overdose deaths in Washington, D.C.

Unlike other substances, synthetic drugs are inexpensive to produce and derive entirely from laboratory chemicals. These narcotics are often more difficult to control and even more difficult to predict in terms of potency or chemical composition. Because understanding what compounds have been used in the creation of synthetic drugs (including fentanyl) is challenging, users may have little to no idea how deadly these substances can be.

In 2017, states with the lowest overall drug use included Hawaii (2.67%), New Jersey (2.74%), Texas (2.81%), and Nebraska (2.87%).

Targeted Drug Use

In all 50 states, the number of drug-related fatalities is rising. The drug crisis in America is a national health concern, but drug use patterns vary between states.

In states where marijuana has been legalized for recreational use, consumption is dramatically higher than in states where marijuana remains either illegal or legal exclusively for medicinal use. More than 1 in 4 people in Oregon (26.51%) and Washington, D.C. (26.35%), used marijuana at least once in 2017 compared to roughly 1 in 10 people in states like Utah and Alabama.

As we found, states that passed legislation for medicinal or recreational marijuana had higher use rates of other illicit substances as well. In Washington, D.C., where marijuana is legal for recreational use, more than 4% of residents used cocaine within the last year, followed by 3.5% in Vermont. In Delaware, where marijuana is legal for medicinal use, 0.84% of the state population used heroin within the last year, followed by 0.70% in Connecticut. Similarly, in New Mexico, 1.19% of the state population used methamphetamine in the last year, followed by 1% of residents from Oregon.

Drug Misuse, by Demographic

Consistently since 2002, young adults between the ages of 18 and 25 have been more likely to engage in marijuana use than older adults. Since 2012, the overall use of marijuana has continued to rise across all age groups (except for adolescents between the ages of 12 and 17), perhaps in response to newly passed legislation regarding the legalization of marijuana across the country.

Cocaine saw a dramatic decrease in use after 2005 among young adults between the ages of 18 and 25. Those between the ages of 26 and 34 saw an analogous decline in cocaine use the following year 4. However, illicit cocaine use has risen among adults between the ages of 18 and 34 since 2014. Heroin use, especially, has seen a dramatic increase among adults between the ages of 26 and 34, reaching a 15-year high in 2017.

While they don’t represent the largest population of people misusing these substances, adults aged 50 and older also saw an upward trend in heroin use despite the downward momentum of slightly younger adults near their age demographic.

Conventional thought around drug addiction and misuse typically paint users as younger, including adolescents and young adults. In reality, roughly 1 million people over the age of 65 have a substance use disorder. Studies suggest that risky substance use among older adults (over the age of 50) is expected to rise to 5.7 million by 2020. Because older adults are more likely to have chronic health concerns that typically involve prescription medication, substance use can be even more dangerous.

Men and women have been found to use and respond to illicit substances differently. Between 2002 and 2017, men misused heroin, marijuana, meth, and painkillers more than women. Overall, heroin and marijuana misuse increased for both men and women, while that for painkillers decreased.

Above the National Average

In 2017, 19 states across the U.S. and Washington, D.C., ranked above the national average for the total occurrences of illicit drug disorder.

At nearly 4% of the state population, no part of America was more strongly impacted by the rapidly growing drug crisis as Washington, D.C. Vermont, Alaska, Washington, and Nevada also ranked among the highest for drug use disorder residents in 2017.

In stark contrast, Kansas, New Jersey, Texas, and Wisconsin all ranked well below the national average for occurrences in illicit drug disorders. Still plagued by the presence of opioids and heroin, Wisconsin planned to introduce new programs for medication and counseling to help reduce the record number of overdoses due to opioids across the state in 2017.

The Changing Face of Drugs in America

The drug health crisis in America isn’t new, but this analysis helps illuminate how dramatically it’s changed in recent years. As marijuana continues to experience an increasingly legalized presence across the county, states that have introduced positive marijuana legislation also rank among the highest use areas for other illicit substances including heroin, opioids, and prescription medications.

At Serenity at Summit, our mission is to help families experiencing a substance use disorder find the education and support they need to overcome it. We encourage you to visit Serenity at Summit website where you can learn more about our commitment to every stage of the treatment and recovery process.


We used data from SAMHSA’s National Survey on Drug Use and Health (NSDUH) from 2002 to 2017. We analyzed recency of use data by age, gender, and state. All use data reflects survey respondents who are 12 years and older unless otherwise indicated. SAMHSA defines illicit drug use as “the misuse of prescription psychotherapeutics or the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. Misuse of prescription psychotherapeutics is defined as use in any way not directed by a doctor, including use without a prescription of one’s own; use in greater amounts, more often, or longer than told; or use in any other way not directed by a doctor. Prescription psychotherapeutics do not include over-the-counter drugs.”

All state data reflects an average of the 2016 and 2017 NSDUH surveys. State and census region estimates are based on a survey-weighted hierarchical Bayes estimation approach and generated by Markov Chain Monte Carlo techniques. Illicit drug use disorder graphs show the percentage of respondents who have had a disorder in the past year among people aged 12 and older.

When analyzing state marijuana legalization status, we looked at the 10 states and district that had enacted recreational marijuana laws as of 2017, which were: Alaska, California, Colorado, Washington, D.C., Maine, Massachusetts, Nevada, Oregon, Washington, and Vermont. We then averaged the use rates for states with and without legalization laws.

Fair Use Statement

Are your readers interested in the changing face of the drug crisis in America? All of the analysis and graphics found within this study are available for noncommercial reuse. We encourage you to share these findings and only ask that your article includes a link back to this page.

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