Teen Drug Use Down, but No Time for Complacency

Megan Brooks

December 13, 2016

With the exception of marijuana, use of illicit drugs among US teenagers is down, and on some measures, it is at historic lows, according to the newly released National Institute on Drug Abuse (NIDA) 2016 Monitoring the Future annual survey.

"Overall, it's very good news in terms of the patterns of drug use of teenagers in our country," Nora D. Volkow, MD, director of NIDA, told Medscape Medical News.

"We see very significant reductions across basically all of the drugs of abuse except for marijuana, which has been stable among 12th graders. But the rates of cocaine, heroin, methamphetamines and inhalants are the lowest that they have been since inception of the survey," Dr Volkow said. "Similarly, the rates of alcohol use and cigarette smoking are at the lowest they have ever been."

Dr Volkow said the reasons for the decline in drug use among US teenagers are not completely clear.

"I think that we can say unequivocally that prevention strategies that have targeted tobacco and alcohol, which have been very consistent [and] successful, are responsible for those declines in tobacco and alcohol use," she said.

"What relates to the decreases in other drugs of abuse is much less clear, because the prevention efforts haven't increased, so we can't ascribe it to that," she noted. "However, there is a domino effect on drug use, so the decrease in nicotine and alcohol, which may be acting as gateway drugs, may have had a downstream effect on other drugs of abuse."

Altogether, 45,473 students in 8th, 10th, and 12th grades from 372 public and private schools participated in NIDA's 2016 Monitoring the Future survey.

Perception That Marijuana Use Is Safe

Findings from the survey show that past-year use of any illicit drug was the lowest in the survey's history for 8th graders, whereas past-year use of illicit drugs other than marijuana is down from recent peaks among 8th, 10th, and 12th graders.

Use of marijuana in the past month among 8th graders dropped significantly this year to 5.4%, from 6.5% a year earlier. However, among high school seniors, 22.5% reported past-month marijuana use, and 6% reported daily use, about the same as in 2015. Rates of marijuana use in the past year among 10th graders also held steady compared to 2015 but are at their lowest levels in more than 20 years, the survey shows.

There continues to be a higher rate of marijuana use among 12th graders in states with medical marijuana laws, compared to states without them. For example, in 2016, 38.3% of 12th graders in states with medical marijuana laws reported past-year marijuana use, compared to 33.3% in nonmedical marijuana states.

"Of concern," said Dr Volkow, "is the fact that there is an increasing number of kids that feel that the use of marijuana is safe. That basically reflects what is happening in our country across all age groups with the whole move toward medical legalization of marijuana. The implication is that, if it is a medicine, then it cannot be so harmful. When teenagers feel that drugs are not harmful, they are more likely overall in general to try them, so that is a concern."

The survey also shows that marijuana and electronic cigarettes are now more popular among US teenagers than regular tobacco cigarettes. However, rates of past-month e-cigarette use have fallen, from 16.2% in 2015 to 12.4% in 2016.

Still, Dr Volkow said "we were surprised" at the high levels at which teenagers are using e-cigarettes. "The other thing that is interesting is that 60% of these teenagers report that they use e-cigarettes just for the flavoring and 20% report that they use it for nicotine."

e-Cigarettes a Major Concern

"There is already some longitudinal data," she added, "suggesting that users of electronic cigarettes are more likely to end up smoking combustible tobacco, so the concern is that we may lose some of the ground that we have achieved with prevention of tobacco smoking through introduction of electronic cigarettes.

"The other concern," said Dr Volkow, "is that electronic cigarette devices are new technology that allows you to administer drugs, not just nicotine, in very efficient ways that can result in very fast delivery of the drug into the brain and at high quantities, and the speed at which drugs get into the brain is a factor that determines how addictive they are."

This year's survey also shows a large drop in the use of tobacco cigarettes among teenagers, with a long-term decline from their peak use more 20 years ago. In 1991, for example, when the survey first measured cigarette smoking, 10.7% of high school seniors reported smoking a half pack or more a day. Today the rate is down to only 1.8%, reflecting the success of widespread public health antismoking campaigns and policy changes.

There has also been a decline in the use of alcohol, with the rate of teenagers reporting they have "been drunk" in the past year at the survey's lowest rates ever. For example, 37.3% of 12th graders reported that they have been drunk at least once, down from a peak of 53.2% in 2001.

And although the nonmedical use of prescription opioids remains a serious problem in adults, use of prescription opioid pain relievers is trending downward among 12th graders, with a 45% drop in past-year use compared to 5 years ago. For example, in 2016, only 2.9% of high school seniors reported past-year misuse of Vicodin (acetaminophen and hydrocodone) compared to nearly 10% a decade ago.

"Clearly our public health prevention efforts, as well as policy changes to reduce availability, are working to reduce teen drug use, especially among 8th graders," Dr Volkow said in the release. "However, when 6% of high school seniors are using marijuana daily, and new synthetics are continually flooding the illegal marketplace, we cannot be complacent."

2016 Monitoring the Future study. Full text

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