Ch. 11.2: Stimulant Epidemiology

Globally, the highest prevalence of amphetamine misuse (separate from other stimulants) occurs in the United States (UNODC, 2018). In the U.S., according to the 2018 National Survey of Drug Use and Health (NSDUH; SAMHSA, 2019), 6.6% of respondents reported any use of stimulant drugs during the past year (this does not include caffeine and tobacco products). Misuse of any stimulants was reported by 1.9% of respondents for the past year (an estimated 4.7 million persons in the population) and 0.6% in the past month (an estimated 1.55 million in the population). Use of illicit stimulants figures were quite similar to the stimulant misuse figures: 1.2% in the past year and 0.4% in the past month. The chart below depicts the figures reported for specific types of stimulant substances: cocaine, crack cocaine, and methamphetamine.

Cocaine.

Among the estimated 40 million persons aged 12 and older who have used cocaine during their lifetime, men are more likely to have done so than women (18.1% versus 11.5%). Persons reporting lifetime use of cocaine are more likely to self-identify their race/ethnicity as White (17.6%) or as two or more races (17.7%) than as American Indian/Alaska Native (16.4%), Native Hawaiian/Other Pacific Islander (14.0%), Hispanic/Latino (11.1%), Black or African American (8.5%), or Asian (5.4%). Lifetime crack cocaine use, however, is more likely reported among individuals who self-identify as American Indian/Alaska Native (5.4%) and as two or more races (5.0%) than the other race categories; White (3.8%) and Black or African American (3.6%) reported rates are fairly similar.

More individuals report having used methamphetamine in their lifetime, the last year, and last month than report having used crack cocaine; however, cocaine use was far more likely to be reported than methamphetamine (crack cocaine makes up a relatively small portion of the cocaine use reported in the United States). Still, an estimated 144,000 individuals aged 18 and older engaged in daily or almost daily use of cocaine during the past year (SAMHSA, 2019). Based on the NSDUH 2018 data, an estimated 977,000 individuals aged 12 and older had a substance use disorder during the past year that involved cocaine (SAMHSA, 2019).

Methamphetamine.

Among the estimated 14.9 million persons aged 12 and older who have used methamphetamine during their lifetime, men outnumber women (6.8% versus 4.2%; SAMHSA, 2019). The race/ethnic groups most likely to report having used methamphetamine during their lifetime are those self-identifying as American Indian/Alaska Native (12.7%), followed by individuals of two or more races (8.5%) and White individuals (6.9%). Least likely are Asian (1.5%) and Black/African American (1.1%) individuals (SAMHSA, 2019). An estimated 228,000 individuals in the U.S. engaged in daily or almost daily use of methamphetamine during the past year (SAMHSA, 2019). Over 1 million individuals aged 12 and older were estimated to have a past year substance use disorder involving methamphetamine based on 2018 NSDUH data (SAMHSA, 2019).

Caffeine.

Estimates indicate that over 90% of adults in the U.S. regularly use caffeine and that average daily use exceeds 12 ounces of coffee or five 12-ounce servings of soft drinks (Meredith, Juliano, Hughes, & Griffiths, 2013). The Academy of Nutrition and Dietetics reported that an estimated 75% of children, adolescents, and young adults regularly consume caffeine (https://www.eatright.org/food/nutrition/healthy-eating/is-your-kid-over-caffeinated).They also reported that the U.S. Food and Drug Administration (FDA) does not produce recommended limits on caffeine for children (they suggest 400mg for adults), but the Canadian government recommends limits based on age:

• 45 mg for children aged 4-6 years
• 62 mg for children aged 7-9 years
• 85 mg for children aged 10-12 years

The American Academy of Pediatrics “discourages” caffeine use (and other stimulants) by children and adolescents (https://www.eatright.org/food/nutrition/healthy-eating/is-your-kid-over-caffeinated).

Tobacco/Cigarettes & Vaping

Based on the 2018 NSDUH data (SAMHSA, 2019), an estimated 168 million individuals aged 12 and over (61.5%) have used tobacco products during their lifetime; 152 million used cigarettes (55.7% of population), and almost 84 million (30.6% of population) used cigarettes on a daily basis during their lifetime.

Current tobacco use, as indicated by past month use, was estimated to occur among over 58 million (21.5%) with cigarette use accounting for almost 47 million individuals (17.2%). 

Smokers are more likely to be male, 25-64 years of age, non-Hispanic American Indian/Alaskan Natives, less educated, lower income, divorced/separated/widowed, lesbian/gay/bisexual, uninsured, disabled, with a serious psychological distress and from a Midwestern region (https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm).

Like most of the other substances we have studied, men were more likely to report use of tobacco products than were women (69.2% versus 54.2% lifetime, 33.4% versus 20.5% past year, and 26.6% versus 16.6% past month).

The race/ethnic groups reporting past month tobacco use at the highest rate self-identified as American Indian/Alaska Native (39.8%) or being of two or more races (27.1%). The following groups reported past month use at rates somewhat similar to each other: White (23.9%), Black/African American (23.0%), Native Hawaiian/Other Pacific Islander (24.9%). Study participants self-identifying as Hispanic/Latino (14.5%) and Asian (9%) reported past month use at the lowest rates.

Past month use of tobacco products had an inverse relationship to income: persons living at less than 100% of the federally defined poverty threshold reported tobacco use at the highest rate (35.3%) compared to those in the group living at 100-199% of the poverty threshold (30.3%), or those living at 200% or more than the poverty threshold (23.7%).

Perhaps the most telling statistics presented in the NSDUH 2018 data (SAMHSA, 2019) relate to nicotine dependence among persons aged 12 and older. Based on these data, an estimated 26 million experienced past month nicotine dependence. Another way of looking at the data shows that 55.7% of individuals reporting past month cigarette use experienced nicotine dependence—in other words, current use is not casual among the majority who smoke cigarettes.

With regard to vaping/e-cigarette use, we can turn to the Monitoring the Future (MTF) study results concerning 8th, 10th, and 12th graders surveyed across the United States. Between 2017 and 2019, the rate at which vaping was reported continually increased—by 9% among 8th graders, 14.8% among 10th graders, and 16.5% among 12th graders: “among the largest increases ever recorded for any substance in the 45 years that MTF has tracked adolescent drugs use” (Johnston et al, 2020). Among 12th graders, 35.5% reported engaging in this behavior and nicotine vaping “continues to rank among the lowest of all substances for perceived risk” (Johnston et al, 2020). In one study, nearly two thirds of young people were not aware that a popular e cigarette brand always contains nicotine (https://truthinitiative.org/press/press-release/juul-e-cigarettes-gain-popularity-among-youth-awareness-nicotine-presence).