Teen substance use shows promising decline

December 13, 2016

The 2016 Monitoring the Future (MTF) annual survey results released today from the National Institutes of Health (NIH) reflect changing teen behaviors and choices in a social media-infused world. The results show a continued long-term decline in the use of many illicit substances, including marijuana, as well as alcohol, tobacco, and misuse of some prescription medications, among the nation's teens. The MTF survey measures drug use and attitudes among eighth, 10th, and 12th graders, and is funded by the National Institute on Drug Abuse (NIDA), part of the NIH.

Findings from the indicate that past year use of any illicit drug was the lowest in the survey's history for eighth graders, while past year use of illicit drugs other than marijuana is down from recent peaks in all three grades.

Marijuana use in the past month among eighth graders dropped significantly in 2016 to 5.4 percent, from 6.5 percent in 2015. Daily use among eighth graders dropped in 2016 to 0.7 percent from 1.1 percent in 2015. However, among , 22.5 percent report past month marijuana use and 6 percent report daily use; both measures remained relatively stable from last year. Similarly, rates of marijuana use in the past year among 10th graders also remained stable compared to 2015, but are at their lowest levels in over two decades.

The survey also shows that there continues to be a higher rate of marijuana use among 12th graders in states with , compared to states without them. For example, in 2016, 38.3 percent of high school seniors in states with medical marijuana laws reported past year marijuana use, compared to 33.3 percent in non-medical marijuana states, reflecting previous research that has suggested that these differences precede enactment of medical marijuana laws.

The survey indicates that marijuana and e-cigarettes are more popular than regular tobacco cigarettes. The past month rates among 12th graders are 12.4 percent for e-cigarettes and 10.5 percent for cigarettes. A large drop in the use of tobacco cigarettes was seen in all three grades, with a long-term decline from their peak use more than two decades ago. For example, in 1991, when MTF first measured cigarette smoking, 10.7 percent of high school seniors smoked a half pack or more a day. Twenty-five years later, that rate has dropped to only 1.8 percent, reflecting the success of widespread public health anti-smoking campaigns and policy changes.

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

Although non-medical use of prescription opioids remains a serious issue in the adult population, teen use of prescription opioid pain relievers is trending downwards among 12th graders with a 45 percent drop in past year use compared to five years ago. For example, only 2.9 percent of high school seniors reported past year misuse of the pain reliever Vicodin in 2016, compared to nearly 10 percent 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 eighth graders," said Nora D. Volkow, M.D., director of NIDA. "However, when 6 percent of high school seniors are using marijuana daily, and new synthetics are continually flooding the illegal marketplace, we cannot be complacent. We also need to learn more about how teens interact with each other in this social media era, and how those behaviors affect substance use rates."

"It is encouraging to see more young people making healthy choices not to use illicit substances," said National Drug Control Policy Director Michael Botticelli. "We must continue to do all we can to support young people through evidence-based prevention efforts as well as treatment for those who may develop substance use disorders. And now that Congress has acted on the President's request to provide $1 billion in new funding for prevention and treatment, we will have significant new resources to do this."

The MTF survey, the only large-scale federal youth survey on substance use that releases findings the same year the data is collected, has been conducted by researchers at the University of Michigan at Ann Arbor since 1975.

Other highlights from the 2016 survey:

Illegal and Illicit Drugs

  • Illicit Drugs other than Marijuana: Past year rates are the lowest in the history of the survey in all three grades. For example, 14.3 percent of 12th graders say they used an illicit drug (other than marijuana) compared to its recent peak of 17.8 percent in 2013.
  • Marijuana-Past year use: Past year marijuana use among eighth graders dropped significantly to 9.4 percent in 2016, from 11.8 percent last year. Past year rates were somewhat stable for sophomores at 23.9 percent, and for seniors at 35.6 percent when compared to last year. However, past year marijuana use has dropped in the last five years among eighth and 10th graders.
  • Marijuana-Daily use: Daily rates among 10th and 12th graders remained relatively stable at 2.5 percent and 6 percent for the past few years.
  • Marijuana Edibles: Teens who live in states where medical marijuana is legal report a higher use of marijuana edibles. For example, among 12th graders reporting marijuana use in the past year, 40.2 percent consumed marijuana in food in states with medical marijuana laws compared to 28.1 percent in states without such laws.
  • Synthetic Cannabinoids: Past year "synthetic marijuana" (K2/Spice) use among 10th and 12th graders dropped significantly from last year. For example, the rate for seniors fell to 3.5 percent compared to 5.2 percent in 2015, with a dramatic drop from its peak of 11.4 percent the first year it was measured in 2011.
  • Cocaine: Past year cocaine use was down among 10th graders to 1.3 percent from 1.8 percent last year. Cocaine use hit its peak in this measure at 4.9 percent in 1999.
  • Inhalants: Inhalant use, usually the only category of drugs used more by younger teens than their older counterparts, was down significantly among eighth graders compared to last year, with past year use at 3.8 percent, compared to 4.6 percent in 2015. Past year inhalant use peaked among eighth graders in 1995 at 12.8 percent.
  • MDMA (Ecstasy or "Molly"): Past year use is down among eighth graders to 1 percent, from last year's 1.4 percent. MDMA use is at its lowest point for all three grades in the history of the MTF survey.
  • Heroin: Heroin rates remain low with teens still in school. High school seniors report past year use of heroin (with a needle) at 0.3 percent, which remains unchanged from last year. In the history of the survey, heroin (with a needle) rates have never been higher than 0.7 percent among 12th graders, as seen in 2010.
  • old and Cough Medicine: Eighth graders alone reported an increase in misuse of over-the-counter cough medicine at 2.6 percent, up from 1.6 percent in 2015, but still lower than the peak of 4.2 percent when first measured in 2006.
  • Attitudes and Availability: Attitudes towards marijuana use have softened, but perception of harm is not necessarily linked to rates of use. For example, 44 percent of 10th graders perceive regular marijuana smoking as harmful ("great risk"), but only 2.5 percent of them used marijuana daily in 2016. This compares to a decade ago (2006) when 64.9 percent of 10th graders perceived marijuana as harmful and 2.8 percent of them used it daily. The number of eighth graders who say is easy to get is at its lowest in the history of the survey, at 34.6 percent.

Prescription Drugs:

  • Opioid Pain relievers (described as "Narcotics other than Heroin" in the survey): The past year rate for non-medical use of all opioid pain relievers among 12th graders is at 4.8 percent, down significantly from its peak of 9.5 percent in 2004.
  • Vicodin/OxyContin: The past year non-medical use of Vicodin among high school seniors is now lower than misuse of OxyContin (2.9 percent compared to 3.4 percent). The past year data for 12th graders 10 years ago was 9.7 percent for Vicodin and 4.3 percent for OxyContin.
  • ADHD Medicines: Past year non-medical use of Adderall is relatively stable at 6.2 percent for 12th graders; however, non-medical use of Ritalin dropped to 1.2 percent, compared to 2 percent last year, and a peak of 5.1 percent in 2004.
  • Tranquilizers: Non-medical use of this drug category, which includes benzodiazepines, has seen a general decline. For example, among 12th graders the 2016 past year rate is 4.9 percent, compared to its peak in 2002 at 7.7 percent.
  • Attitudes and Availability: The majority of teens continue to say they get most of their opioid pain relievers (for non-medical use) from friends or relatives, either taken, bought or given. The only prescription drugs seen as easier to get in 2016 than last year are tranquilizers, with 11.4 percent of eighth graders reporting they would be "fairly easy" or "very easy" to get, up from 9.8 percent in 2015. Also, when eighth graders were asked if occasional non-medical use of Adderall is harmful ("great risk"), 35.8 percent said yes, compared to 32 percent last year.

Tobacco:

  • Daily Smoking: The 2016 daily smoking rates for high school seniors was 4.8 percent compared to 22.2 percent two decades ago (1996). For 10th graders, the 2016 daily smoking rate is 1.9 percent, compared to 18.3 percent in 1996.
  • Hookah Use: For past year tobacco use with a hookah, the 2016 rate dropped to 13 percent among high school seniors, from 22.9 percent two years ago, its peak year since the survey began measuring hookah use in 2010.
  • E-Cigarettes (Vaporizers): The rate for e-cigarettes among high school seniors dropped to 12.4 percent from last year's 16.2 percent. Of note: only 24.9 percent of 12th graders report that their e-cigarettes contained nicotine (the addictive ingredient in tobacco) the last time they used, with 62.8 percent claiming they contain "just flavoring."
  • Little Cigars: The 2016 past year rate dropped to 15.6 percent among 12th graders, from a peak of 23.1 percent in 2010, when first included in the survey.
  • Attitudes and Availability: This year, more 10th graders disapprove of regular use of e-cigarettes than last year. For example, 65 percent of 10th graders say they disapprove, up from last year's 59.9 percent. In addition, more 10th graders think it is harder to get regular cigarettes than last year; 62.9 percent said they are easy to get, compared to 66.6 percent last year. This represents a dramatic shift from survey findings two decades ago, when 91.3 percent of 10th graders thought it was easy to get cigarettes.

Alcohol:

  • Past year use: More than half (55.6 percent) of 12th graders report having used alcohol in the past year, compared to the peak rate of about 75 percent in 1997. Thirty-eight percent of 10th graders and 17.6 percent of eighth graders report past year use, compared to the peaks of 65.3 percent in 2000 among 10th graders and 46.8 percent in 1994 among eighth graders.
  • Binge drinking: Among eighth graders, binge drinking (described as five or more drinks in a row in the last two weeks) continues to significantly decline, now at only 3.4 percent, the lowest rate since the survey began asking about it in 1991, down from a peak of 13.3 percent in 1996. Binge drinking among seniors is down to 15.5 percent, half its peak of 31.5 percent in 1998.
  • Been drunk: Representing a long-term downward trend, 37.3 percent of 12th graders say they have been drunk in the past year; 20.5 percent of 10th graders say they have been drunk, down from a peak of 41.6 percent in 2000. Eighth graders reported a rate of 5.7 percent, down from a peak of 19.8 percent in 1996.
  • Attitudes: Just over 71 percent of 10th graders think it is easy to get alcohol, compared to last year's rate of 74.9 percent, and down from 90.4 percent two decades ago.

Overall, 45,473 students from 372 public and private schools participated in this year's MTF survey. Since 1975, the survey has measured drug, alcohol, and cigarette use and related attitudes in 12th graders nationwide. Eighth and 10th graders were added to the survey in 1991. Lloyd D. Johnston, Ph.D., who has been the principal investigator at the University of Michigan's Institute for Social Research for all 42 years, is retiring from that position this year, but the survey of teens will continue under the leadership of Richard A. Miech, Ph.D., who is currently a member of the MTF scientific team.

"The declining use of many drugs by youth is certainly encouraging and important," said Dr. Johnston. "But we need to remember that future cohorts of young people entering adolescence also will need to know why using drugs is not a smart choice. Otherwise we risk having another resurgence of use as was seen in the 90s."

"We want to thank Dr. Johnston for his lifetime of work building this survey into the important public health tool it is today," added Dr. Volkow.

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