245 



Drug use among the elderly also accounted for a very small percentage of the total 

 discharges, even though more than 3% of this population admit to using drugs in the last year. 

 This low number is, in part, indicative of a lack of research connecting illicit drugs with 

 disease, and does not imply that drugs present no problem for the elderly. Further, since we 

 were also unable to find sufficient data fi-om the epidemiologic literature to quantify the health 

 effects of the abuse of prescription drugs, we could not estimate the extent of that problem 

 either. Thus, our estimate of the impact of drugs--both legal and illicit~on Medicare is 

 undoubtedly low. There is clearly a need for more research to understand and quantify the 

 impact of all drugs on morbidity and cost. Since the elderly are such large users of 

 prescription drugs, this research is even more critical with respect to that population. 



In total, we found more than 60 conditions that are associated with substance abuse 

 covering virtually every major disease category (Appendix II)'. In the Medicare population, 

 more than half of the substance abuse-related hospital admissions were for cardiovascular 

 diseases, 15% for respiratory diseases, 12% for neoplasms, and 7% for bums and trauma 

 (Table 3). These results differ somewhat from the earlier Medicaid study where the adverse 

 impact on birth outcomes represented the major contributor to the costs attributable to the 

 substance abuse. Further, in comparing substance abuse problems in the Medicaid and 

 Medicare populations, the impact on Medicare was much more a result of the long-term effects 

 of smoking. More than 80% of substance abuse-related Medicare hospital costs was for 

 treating smoking-related medical conditions - from lung cancer to chronic pulmonary 



This number is lower than the 72 substance-abuse related conditions identified in the 

 Medicaid because further analysis led us to combine some specific diagnoses into broader 

 diagnostic categories. Appendix II provides an even more detailed breakdown of the substance 

 abuse-related discharges in all the conditions identified. 



