Good News, Bad News Scenario for US Teen Drug, Alcohol Use

Caroline Cassels

December 15, 2011

December 15, 2011 — Cigarette and alcohol use by teens is at its lowest point in more than 3 decades, according to the latest results of an annual survey conducted by the National Institute on Drug Abuse (NIDA).

However, this good news is counterbalanced by a slowing rate of decline in teen smoking as well as continued high rates of abuse of other tobacco products, including hookahs, small cigars, smokeless tobacco, marijuana, and prescription drugs.

"The use of cigarettes by adolescents increases the risk of addiction to nicotine, but also there is increasing evidence that it may be priming them for the rewarding effects of other drugs of abuse, including the illicit substances," NIDA director Nora Volkow, MD, told reporters attending a press briefing.

"So the decline in cigarette smoking is likely to have [positive] downstream consequences both in medical health as well as substance use disorders. In fact, [the prevalence] of cigarette smoking is at its lowest since the inception of the survey in 1975," she added.

Dr. Volkow also noted that the survey revealed "dramatic decreases" in the prevalence of daily smoking as well as past-month smoking. For daily smoking, the rates have gone down 60% during a 15-year period, a finding that indicates that smoking prevention messages and interventions are effective.

On the other hand, she said, despite these dramatic decreases, smoking rates among teens remain high.

There is also good news on the alcohol front, with survey results indicating rates of use are the lowest level since 1996. Rates for daily drinking are 46% lower, and rates for binge drinking are 30% lower — findings that Dr. Volkow said "exemplify the concept that prevention interventions work and can have a big impact."

Shift in Perception of Harm

Overall, the annual NIDA survey, Monitoring the Future (MTF), which polled 46,773 8th, 10th, and 12th graders in the United States, showed that more teens continue to abuse marijuana than cigarettes and that alcohol remains the drug of choice. Although marijuana use declined in the late 1990s and early 2000s, 5-year trends indicate significant increases among 10th and 12th graders for current- and past- year use. In 2011, 12.5% of 8th graders, 28. 8% of 10th graders, and 36.4% of 12th graders reported past-year marijuana use.

Dr. Volkow pointed out that although there was no increase in marijuana use between 2010 and 2011, it continues to exceed cigarette use among teens. In 2011, the rate of 30-day past use of marijuana vs cigarette smoking among high school seniors was 22.6% vs 18.7%, respectively.

"We have seen trending towards increases in marijuana utilization, particularly among 10th and 12th graders," she said, adding that 6.6% of 12th graders smoke marijuana daily.

The survey also showed a decline in teens' perceived risk of harm associated with marijuana use.

"This is not a good indicator because throughout the inception of MTF, we have learned to recognize that perception of risk predicts whether kids are going to be smoking marijuana or not," Dr. Volkow said.

First Data on Synthetic Cannabis Use

This year's MTF survey captured the use of synthetic marijuana, also known as K2 or Spice, for the first time. It revealed that almost 1 in 9, or 11.4%, of high school seniors reported having used these substances in the past year.

Synthetic cannabis, explained Dr. Volkow, is mixed with plant materials to give the impression that it is a herbal product when, in fact, it is a chemical substance. A recent study presented at the American Academy of Addiction Psychiatry and reported by Medscape Medical News suggests that Spice is more potent than natural cannabis and may confer an even greater risk for psychosis than the natural product in individuals with no psychiatric history.

Gil Kerlikowske, director of the White House Office of National Drug Control Policy, told reporters that synthetic marijuana is dangerous.

"These drugs are dangerous, and you can see from calls to poison control centers and you can certainly see from the data about visits to emergency departments that these drugs can cause serious harm," he said.

Mr. Kerlikowske noted that US Drug Enforcement Agency scheduled them as an illegal substance in February. Whether this move has had an impact on the use of Spice and K2 will be revealed in next year's MTF survey.

He noted that Spice, or synthetic marijuana, is now the second most widely used illegal drug among high school seniors, second only to marijuana.

Prescription, OTC Drug Abuse

Finally, after marijuana, the illicit use of prescription and over-the-counter medications account for the majority of drug abuse by 12th graders in the past year. These include hydrocodone (Vicodin, Abbott Laboratories), racemic amphetamine (Adderall, Shire Pharmaceuticals), tranquilizers, cough medicine, sedatives, oxycodone (OxyContin, Purdue Pharma), and methylphenidate (Ritalin, Novartis).

"The use of psychotherapeutics, which we have come to recognize in the past 10 years of the survey, has become increasingly prevalent among teenagers. The pattern has shifted towards favoring this type of drug for abuse because of the misperception that they are safer than illicit substances," said Dr. Volkow.

The survey showed that 8.2% of high school seniors reported using stimulant medications such as racemic amphetamine "not just to get high but to improve cognitive performance."

To help educate teens about the dangers of prescription drug abuse, NIDA is launching an updated prescription drug section of its teen Web site, PEERx.

Dr. Volkow and Mr. Kerlikowske have disclosed no relevant financial relationships.


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