The Drug Capitals Of America

Persistent narcotics problems continue to plague American cities both large and small.

In Pictures: America's Illegal Drug Capitals

It may not be surprising that well-known urban centers like New Orleans, Baltimore, and San Francisco appear on the Forbes list of cities dealing with the worst drug problems in the nation. But some smaller communities are also facing epic battles with drugs, including tiny Española, N.M.

Española is a small city in rural Rio Arriba county, north of Santa Fe. Its population of roughly 10,000 includes a large Hispanic community, relies largely on Los Alamos National Lab for employment and struggles with a high poverty rate. This is the U.S. city that consistently ranks among the top in the nation in drug overdoses, according to federal statistics. It is tough to find another American city that records 42.5 drug-related deaths per 100,000, compared with a national average of 7.3.

Heroin is the drug of choice in Española, and local health groups are at a loss to explain the high rate of overdoses despite a longstanding public health effort. In 2001, New Mexico started distributing Narcan, a drug used to reverse the effects of overdose, and bolstered the program in 2007 by giving out Narcan nasal spray instead of needles. Also in 2007, the state passed a law granting immunity from prosecution for people in possession of illegal drugs if they call 911 to seek help for an overdose or take someone to a hospital.

"We are trying to tackle this on a number of fronts," says Deborah Busemeyer of the New Mexico Health Department. "It is certainly concerning that some of our counties are harder-hit than others."

Drug use continues to ravage cities across the nation, and for the last few years, has remained steady--with 8% of the population reporting using drugs, says the Substance Abuse & Mental Health Services Administration, a federal agency. A Zogby/Inter-American Dialogue Survey released in October 2008 shows three-fourths of Americans think the nation is losing its war on drugs.

There have been some successes, which John Walters, the U.S. drug czar under former President George W. Bush, liked to highlight, such as the decline in youth drug use during the Bush administration. Additionally, the price of a pure gram of cocaine has skyrocketed while purity has dropped.

But certain areas of the country continue to see huge drug problems for reasons that sometimes confound those trying to dam the tide. "There are different drug-use rates among the population," says John Carnevale, a public-policy consultant who served three presidents at the White House Office of National Drug Control Policy. "Some communities do get impacted more--sometimes because of location; it could be local economies; it could be all kind of things. I wish we really knew the answer, and maybe we could have a more effective strategy."

There has been little research on geographic drug-use patterns and effects in America. One of the last important federally funded studies of this sort, the Arrestee Drug Abuse Monitoring program, had its cash cut off and ceased operation. To figure out which American cities have been hit hardest by illegal drug use and trafficking, Forbes looked at available federal data and spoke with public health and law enforcement officials across the nation.

The longstanding effort to reduce the nation's drug problem would be better served if geographic drug-use patterns were better understood, says David M. Kennedy, director of the Center for Crime Prevention and Control at the John Jay College of Criminal Justice in New York. "There is no shortage of examples of weird outliers," says Kennedy. "It's not that there is one particular place that is strangely off-center, the fact is that if you look at patterns of drug use, that is a routine finding."

Some of the statistics are indeed surprising. For example, Missoula, Mont., had the highest rate of illicit drug use, according to the Substance Abuse & Mental Health Services Administration's most recent household survey. SAMHSA says averages taken in 2004, 2005 and 2006 showed 13.8% of households polled in the Missoula region reported using illicit drugs in the prior 30-day period.

Montana has been fighting a methamphetamine epidemic that accounts for 50% of the state's adult incarcerations, says the Montana Meth Project, a Missoula-based nonprofit group founded by billionaire Thomas Siebel.

Missoula's meth problem remains robust, according to local law enforcement, but cocaine and marijuana are big contributors to the overall drug problem. "Drug use and the procurement of drugs and sales impacts all of our [areas of] work here, including thefts and burglaries," says Lt. Steve Brester of the Missoula Police Department, who also runs the region's High Intensity Drug Trafficking Area program. "It's pervasive in terms of how it effects all of our department."

Even in major urban centers wrestling with drug problems, the patterns are elusive to many public-policy specialists. What could be more confusing than the situations in Baltimore and Washington D.C., two neighboring cities with longstanding but very different drug problems?

Washington D.C., had 75 cocaine overdoses in 2006, and one-third of adult arrestees tested positive for cocaine as of September 2008, according to data obtained by Erin Artigiani, deputy director for the Center For Substance Abuse Research at the University of Maryland, College Park.

The Drug Enforcement Administration reports that "cocaine and crack are the most significant drug problems in Washington, D.C." And SAMHSA reports that at 5.22%, Washington, D.C.'s 2nd Ward had the highest rate of cocaine use of any area it polled in the nation.

But just 40 miles away in Baltimore, the problem, for years, has been heroin. Public-policy pros remain baffled that the heroin problem never receded in Baltimore like it did in most other big American cities. There were 184 heroin-related overdoses in Baltimore in 2006, reports Artigiani. "Baltimore is home to higher numbers of heroin addicts and [incidents of] heroin-related crime than almost any other city in the nation," says the DEA.

There are the extremely tragic situations, like the current drug problem in New Orleans, where crack is prevalent. Drug dealers were among the first to filter in to New Orleans after Hurricane Katrina, joining some who never left at all. The result: bloody turf wars that have produced the highest murder rate in the country.

At 95 murders per 100,000 people, New Orleans led the nation in killings by a wide margin in 2007. The figures may be skewed by the city's fluid population numbers, and murders did decrease in 2008, but the link between the rampant violence and drugs is clear. "The violence rate is just astronomical because of the drug markets," says Eloise Dunlap, principal investigator for the National Development & Research Institutes, who has studied post-Katrina New Orleans drug markets. "It's just so sad."