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Measuring the human costs of drug use for friends and family of drugusers. The results from a survey in four Nordic capitals

Hans Olav Melberg, Pekka Hakkarainen, Esben Houborg, Marke Jaaskelainen, AstridSkretting, Mats Ramstedt, Pia Rosenqvist

Abstract

This paper presents the results from a Nordic survey that explores different approaches toquantify the human costs related to drug use. The results show that in most Nordic capitalsmore than half of the respondents at some time have known and worried about the drug use of somebody they know personally. Moreover, while the average reported harm was about 2 ona scale from 0 to 10, a significant minority (10%) of those knowing drug users indicated thatthe harm was quite high, with females scoring higher than males. The results can be used togive a more accurate estimate of the overall cost of drugs and its distribution which in turn isimportant in the debate about how large priority the drug sector should be given and how themoney should be spent.1

Measuring the human costs of drug use for friends and family of drugusers? The results from a survey in four Nordic capitals

Introduction

Drug use is costly. It is costly for the state, for the users themselves, for friends and familyand for society in general. While costs that are covered by the state and society in generalhave received much attention and attempted quantification, relatively little has been done onthe human costs of friends and family of drug users. This study explores how populationsurveys could be used to fill this gap and reports on one such large survey in the Nordiccapitals.The quantification of human costs is important in itself, but it also has important policyimplications. The immediate consequence of leaving out human costs is to underestimate thecost of drugs use. Often studies of the social cost of drugs quantify costs born by society atlarge – health costs, crime costs, lost income - but not the human consequences felt by thosewho are close to the user (See, for instance, French and Martin, 1996, Single et al., 1998,Culyer et al., 2002). This underestimation may in turn lead to under-prioritization of the drugarea as a whole. Moreover, if the success of a policy is measured by its ability to reduce thecosts associated with drugs, then leaving out important cost categories will lead to skewed policies. We will get policies aimed at indicators that happen to be easily available, instead of policies that focus on the overall problem. For both these reasons, to avoid under- prioritization and misguided policy aims, it is important to get a better understanding of thehuman costs associated with drug use.Although important, the problem of measuring human costs could be viewed as bothredundant and impossible. Redundant in the sense that existing policy goals and indicators2

indirectly take human costs into account. Impossible in the sense that human costs are believed to be beyond quantification. We will deal with each argument in turn.The redundancy argument centers on the assumption that commonly used measures of the sizethe drug problem – like prevalence and social cost - are so strongly correlated with humancosts that there is no need to measure it separately. Although human costs are related to prevalence, Caulkins and Reuter (1997) have pointed out that use-reduction is not perfectlycorrelated with harm-reduction. There are policies, such as needle-exchange programs, whichdo not reduce drug use, but make it safer and hence reduce the harm associated with drug use(e.g. the risk of being infected with Hepatitis B). Because of the imperfect relationship between prevalence and harm it is important to avoid focusing only on prevalence goals.More generally, it illustrates that there is a need to work on alternative indicators of the size of the drug problem.Another often used indicator of the size of the drug problem is the social cost of drugs, butthis approach has both empirical and conceptual problems. Empirically it is very difficult toget precise estimates of the various cost categories. For instance, drug related health costs are based both on imprecise estimates of the costs of treating various diseases and the fraction of these costs that can be attributed to drug use. Even if precise estimates were available, there isconceptual disagreement on what kind of costs that should be included. For instance, prisoncosts could be viewed as an external cost that drug users impose on society, but it might also be viewed as a control cost which society itself has chosen to incur by making drugs illegal.Including prison costs could also create problems if policy success is judged by the degree towhich it reduces the social cost of drugs. This could create a self-reinforcing policy justification in which the high cost of drugs is used to justify tougher interventions and longer 3