teen drug use in the US, a new survey

The National Institute on Drug Abuse at The National Institutes of Health just published their national survey results on adolescent drug use from 1975 to 2015, noting a remarkably significant decline on teen drug use, with the exception of marijuana (see http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2015.pdf ). Key findings:

-- For grades 8, 10, and 12 combined:
                -- any illicit drug use, annual prevalence: 20.2% in 1991, increasing to 31.8% in 2001 and ultimately decreasing to 26.8% in 2015
                -- any illicit drug use including inhalants, annual prevalence: 23.5% in 1991, increasing to 34.3% in 2001, then decreasing to 28.4% in 2015
                -- any illicit drug use other than marijuana, annual prevalence: 12% in 1991, increasing to 16.3% in 2001 then decreasing to 10.5% in 2015
                -- marijuana/hashish, annual prevalence: 15% in 1991, increasing to 27.5% in 2001, then remaining relatively stable and at 23.4% in 2015
                -- heroin, annual prevalence: 0.5% in 1991, 0.9% in 2001, and 0.4% in 2015 (ie, not much change)
                -- amphetamines, annual prevalence: 7.5% in 1991, increasing to 9.6% in 2001, then decreasing to 6.2% in 2015 (ie, not much change, but the second most widely used class of illicit drugs other than marijuana)
                        --nonmedical use of Adderall, in particular, has remained pretty stable at around 2% of 8^th graders, 5% of 10^th graders and 7% of 12^th graders
                -- alcohol, annual prevalence: 67.4% in 1991, decreasing to 58.2% in 2001, further decreasing to 39.9% in 2015
                -- steroids, annual prevalence: 1.2% in 1991, 2.0% in 2001, 1.0% in 2015
                -- cigarettes, daily prevalence: 12.4% in 1991 (of which 6.5% was at least ½ pack per day), 11.6% in 2001 (5.7% at least ½ ppd), and 3.2% in 2015 (1.1% being at least ½  ppd)

   --for prescription opiate pills: annual use of oxycontin use has decreased in all grades from a peak in 2009: around 5% for 10^th and 12^th graders, to around 3-4%. vicodin from around 9% to <4%.  And “use of narcotics other than heroin” overall from 9.2% to 5.4% (that data only available for 12^th graders). But around 30% thought that these pills were “fairly easy” or “very easy” to get

-- E cigarettes has made rapid inroads with adolescents, with a 30 day prevalence rate higher than that of cigarette smoking (9.5% in 8^th grade, 14.0% in 10^th grade and 16.2% in 12^th grade; more than twice the prevalence of regular cigarettes for 8^th and 10^th graders), at the same level in 2014 and 2015. And fewer students see e-cigs as being a “great health risk”. The most common reason for using them is “to see what it’s like”, and the second most common reason “because it tastes good”. Of note a small minority of 5-10% of the users stated that they used to cigarettes to stop regular cigarette smoking.

-- for 8^th  graders:

    -- the annual prevalence of any illicit drug was 14.8% in 2015 down from a peak of 23.6%

    -- the annual prevalence for any illicit drugs other than marijuana was 6.3% in 2015 down from a peak of 13.1%

    -- the annual prevalence for marijuana/hashish was 11.8% in 2015, down from a peak of 18.3%

    -- the annual prevalence of alcohol was 21.0% in 2015, down from a peak of 54.0%; the prevalence of being drunk was 7.7% in 2015, down from the peak of 19.8%

-- the sense of harmfulness of drugs as perceived by 10^th-graders has changed pretty significantly:
                -- trying marijuana was felt to be harmful by 30% in 1991, 15.8% in 2015; smoking marijuana regularly was felt to be harmful by 82.1% in 1991, but 43.2% in  2015
                -- cocaine use was felt to be harmful by about 70% throughout the time period.
                -- heroin was felt to be harmful in about 75% throughout
                -- Vicodin was felt to be harmful in around 35%, but data only dated back to 2012
                -- having one to two drinks of alcohol nearly every day was felt to be harmful in roughly 33% throughout; having five or more drinks once or twice a weekend was felt to be harmful in about 55% throughout
                -- smoking cigarettes at one or more ppd was felt to be harmful by 60% in 1991, increasing to 73% in 2015; but, of note, even smoking 1 to 5 cigarettes a day was felt to be harmful by 53% in 2015 (see blog on “light smokers”, sent out 12/12/16)

-- disapproval levels by teens have also changed:

--disapproval of marijuana in 10^th grade decreased from 75% in 1991 to 53% in 2015; and smoking marijuana regularly was disapproved by 90% in 1991 and 74% in 2015

-- heavy drinking was disapproved by approximately 75% throughout

-- smoking one ppd or more was disapproved by 79% in 1991 and 88% in 2015

commentary:
-- pretty dramatic changes over the last 25 years, with significant declines in cigarette and alcohol use as well as almost all illicit drugs other than marijuana. And, perceived risk of regular use of marijuana decreased and disapproval rates revealed much more acceptance
--cigarette smoking and alcohol use are at the lowest levels since the beginning of the surveys (about an 80% fall from the high levels of 1996, for those in 8^th and 10^th grades).  In my experience, asking teens about “smoking” is a confusing question: they are not sure whether I mean just cigarettes or if marijuana is included.  So, best to be clear: “are you smoking cigarettes, marijuana, or anything else???”
--in my pretty limited experience with teens in the clinic, the above is pretty concordant. Lots of marijuana, some cigarette smoking, fair amounts of alcohol, but not a lot of other drugs.  This is in pretty stark contrast to the number of opiate users (prescription or otherwise) that I see in older people. Perhaps reflecting a positive future trend???
--I just want to bring up one (to me) quite striking prior blog, finding that prescription opiates given to kids by 12^th grade (eg for surgery…) predicted future opioid misuse at age 23, even in the subgroup “least expected to misuse opioids” by a validated questionnaire. See http://blogs.bmj.com/ebm/2015/11/10/primary-care-corner-with-geoffrey-modest-md-prescribed-opioids-and-future-prescription-opioid-misuse-in-teens/

So, interesting and reasonably uplifting data overall.  I am still concerned about the potential long-term effects of marijuana, even the pure, unadulterated stuff: see http://blogs.bmj.com/ebm/2015/07/29/primary-care-corner-with-geoffrey-modest-md-marijuana-passing-through-the-generations/ which include possible epigenetic effects which are passed to the next generation (at least in rats); http://blogs.bmj.com/ebm/2015/07/27/primary-care-corner-with-geoffrey-modest-md-medical-use-of-marijuana/ for a review of the medial uses; http://blogs.bmj.com/ebm/2014/08/06/primary-care-corner-with-geoffrey-modest-md-marijuana-adverse-effects-review/ and http://blogs.bmj.com/ebm/2014/04/09/primary-care-corner-with-geoffrey-modest-md-marijuana-psych-effects/ for adverse psych effects

geoff