Federally funded drug treatment admissions involving marijuana have increased from 418,066 in 1992 to 660,526 in 2006, an increase of 58% in 14 years. During this period, admissions involving marijuana has also increased from 27% of total admissions to 37% of total admissions. Admissions in which marijuana was the primary substance of abuse increased during this period from 92,518 (6% of total admissions) in 1992 to 289,988 (16%) in 2006.
From 1992 to 2006 the percentage of admissions referred by the criminal justice system also increased dramatically, by over 20%. For admissions involving marijuana the number referred by the criminal justice system increased from 39% in 1992 to 49% in 2006, and admissions in which marijuana was the primary substance of abuse referred by the criminal justice system increased from 48% in 1992 to 58% in 2006.
There were 1.8 million admissions for drug treatment services recorded by the TEDS program in 2006. The leading cause of drug treatment admissions, in terms of primary substance of abuse, is alcohol (39.9%), followed by marijuana (16.2%), cocaine (14.0%), heroin (13.8%), and methamphetamine (8.4%). Almost three-fifths (58%) of all admissions involving marijuana also involved alcohol, and where marijuana was the primary substance of abuse alcohol was an additional factor in 47%.
Less than half of the admissions where marijuana was the primary substance of abuse met DSM criteria for marijuana dependence. When marijuana was the primary substance of abuse 45% of the admissions met the DSM criteria for marijuana dependence and 30% met the criteria for marijuana abuse. Alcohol dependence was the diagnosis for 15% of these admissions.
Non-intensive outpatient treatment is the most likely treatment for patients in which marijuana is the primary substance of abuse, accounting for 68% of these admissions. This treatment is received by 71% of individuals referred by the criminal justice system in which marijuana is the primary substance of abuse, and 64% of the remaining admissions of this description.
Teenagers under the age of 18 account for 31% of these admissions, and adults age 18 to 24 comprise an additional 32%. Half of these admissions are white, and 29% are black. Almost three out of five (59%) have less than a high school education, 30% have a high school education, and only 10% have a college education. About one-fifth (22%) have full-time jobs, 11% have part-time jobs, 19% are students, 31% are unemployed and 13% were already institutionalized (such as in jail or prison). Educational and employment characteristics are, in part, a reflection of the relative youth of the admissions population.
Young people (age 12 to 17) account for 13% of annual marijuana users but comprise 31% of treatment admissions in which marijuana is the primary substance of abuse. The over-representation of teenagers is even more apparent with arrest demographics are taken into account. The 15-to-17 age group accounts for 11% of annual marijuana users, 14% of possession arrests, and 26% of this category of treatment admissions. The 18-to-20 age group accounts for 15% of annual marijuana users, 25% of possession arrests, and 15% of these treatment admissions.
Over one-third (36%) of admissions where marijuana was the primary substance of abuse did not use marijuana in the last 30 days. This is likely due to cessation of use while under correctional supervision or after initial acknowledgement of a problem requiring treatment. Thus approximately one-third of admissions have not used marijuana recently, 27% have used marijuana either One-to-three times in the last month or one-to-two times in the last week, and 37% have used marijuana more frequently, either three-to-six times in the last week or daily.
Data on the age of first use of marijuana among those where the drug was the primary substance of abuse indicate that 87% of admission began marijuana use while under the age of 18, and 56% began marijuana use under the age of 16. For admissions where marijuana was the primary substance of abuse and the DSM diagnosis was marijuana abuse, 84% had their first use of marijuana under the age of 18, and 48% were under the age of 15. When marijuana was the primary substance and the DSM diagnosis was marijuana dependence, 87% of admissions reported first use of marijuana while under the age of 18 and 55% reported first use while under the age of 15.
Just 19% of these admissions can provide for the payment for their treatment, 13.4% will pay out of pocket and 5.8% will cover their treatment with insurance. Overall government programs will pay for the treatment of 62% of all of these admissions where marijuana is the primary substance of abuse, and 60% of the admissions referred by the criminal justice system. Given that this data reflects approximately 58% of all treatment admissions, the government is paying for at least 35% of all treatment admissions where marijuana is the primary substance of abuse.
The top 10 states for criminal justice referrals in 2006 were Delaware (77.87%), Alabama (76.53%), Nevada (74.73%), Missouri (73.07%), Arkansas (72.18%), South Dakota (70.76%), Illinois (68.18%), North Dakota (66.83%), Florida (66.37%), and Texas (66.17%)
The largest increases from 1997 to 2006 were in Arkansas (81.04%), Oklahoma (79.75%), Nebraska (75.47%), Minnesota (37.83%), North Dakota (35.94%), Nevada (34.50%), Maine (33.53%), Washington (29.84%), New Mexico (25.43%), and Massachusetts (24.45%).
The largest average annual increases in the incidence of criminal justice referrals for treatment where marijuana was the primary substance of abuse were Arkansas (5.79%), Oklahoma (5.73%), Nebraska (4.59%), Minnesota (3.19%), Nevada (3.17%), North Dakota (3.08%), Maine (2.85%), Washington (2.80%), Kansas (2.19%), and Massachusetts (2.13%).
The trend of increasing criminal justice referrals for treatment for marijuana-related abuse and dependency is pronounced, pervasive, and nationwide. It is also exceptional. This data indicates that drugs with much more severe dependence liabilities result in drug treatment admissions without the need for criminal justice system intervention. In over half of the cases the individuals do not meet DSM criteria for dependency or abuse. In over two-thirds of the cases where marijuana is the primary substance of abuse the treatment is outpatient, without the need for confinement or detoxification. The sheer number of cases and the source of the referrals suggest that 20% or more of marijuana arrests result in referral to drug treatment.
The preponderance of available data suggests that many of these referrals take place as a condition of probation and that acceptance of treatment is part of a plea agreement in which individuals avoid incarceration. While the use of the criminal justice system to advance public health goals of discouraging and/or reducing marijuana use may provide continued justification for marijuana’s criminal status, it is a largely ineffective, expensive, and counterproductive use of public resources.