National leaders on Dec. 16 presented mostly encouraging survey data about trends in youth substance use, including a finding of historically low levels for both alcohol and tobacco use. A focus on one emerging pattern in the opposite direction cast the only decidedly negative perspective on the overall numbers.
“The only fly in the ointment I can see is with e-cigarettes,” said Lloyd Johnston, PhD, architect of the Monitoring the Future (MTF) survey released at the end of each calendar year. Asking 8th-, 10th- and 12th-graders about electronic cigarette use for the first time for the 2014 survey, researchers found that the not heavily researched e-cigs have already surpassed conventional cigarettes as a delivery system of choice among young people.
That has created immediate concern for anti-drug leaders who speculate based on early research that e-cigarettes may be attracting formerly low-risk youths who have never smoked but now could become susceptible to nicotine addiction. Future installments of the annual survey will begin to ask young people about their level of knowledge of the contents of e-cigarettes, and whether the delivery devices also are being used to administer other drugs such as the active ingredient in marijuana.
“Could it transition to regular smoking?” said National Institute on Drug Abuse (NIDA) director Nora Volkow, MD. “Could it influence other patterns of drug use?”
Most trends down
Overall, however, the tone of the Dec. 16 media briefing that discussed the results of the 40th NIDA-funded MTF survey was clearly upbeat. The University of Michigan's Johnston referred to the overall trends as “quite positive,” and Volkow added that declining numbers in areas such as use of prescription opioids suggest that targeted prevention initiatives have generated desired results. The prevalence of past-year use of Vicodin, for example, among 12th-graders is now half of what it was back in 2009, dropping to 4.8% in 2014 from 9.7% five years earlier.
Alcohol use continues to decline at all three grade levels examined in the annual survey, which this year encompassed more than 41,000 students from 377 public and private schools. Past-month use of alcohol among 8th-graders stood at 14.9% in 2009 and was at 9% in this year's latest survey; the corresponding percentages for 12th-graders were 43.5% in 2009 and 37.4% this year.
Marijuana use is not showing similar declines, although Volkow said the current patterns in marijuana use are not as discouraging as feared given recent developments with marijuana's legal and regulatory status at the state level and the continued drop in youths' perceived risk associated with the drug. Around 6% of 12th-graders report using marijuana daily, while 21.2% of 12th-graders report having smoked marijuana sometime in the past month (the latter figure stands at 16.6% for 10th-graders and 6.5% for 8th-graders. Use of synthetic marijuana is trending downward, as is use of other synthetic drugs such as the stimulants known as bath salts.
But researchers point out that in the growing number of states with medical marijuana laws, use of marijuana in edible products is more prevalent among youth than it is in states without such laws. This presents concerns, said Volkow, particularly because it takes upwards of an hour for marijuana in edibles to produce an effect in the brain—and therefore youths might be compelled to consume greater quantities of the edible products.
The prevalence of past-month use of e-cigarettes in 2014 stood at 8.7% among 8th-graders, 16.2% for 10th-graders, and 17.1% for 12th-graders. Among young people, “E-cigarettes now have higher use than tobacco cigarettes,” said Richard Miech, PhD, Johnston's colleague at the University of Michigan. In grades 8 and 10, “There are more than twice as many past-month users as there are of regular cigarettes,” said Miech.
With many questions still to be answered about e-cigarettes' effects and the degree to which their use might influence other substance use patterns, anti-drug leaders believe the ramifications of some youths' attraction to these devices must be looked at closely. Volkow referred to a recent Hawaii-based study that found that youths with higher-risk characteristics for substance use problems tended to use e-cigs in conjunction with conventional cigarettes, while youths with lower-risk characteristics were tending to use e-cigs alone.
In looking at this year's survey numbers as a whole, Johnston tried to place the data in the context of decades of surveys marked by wide fluctuations in use patterns. He pointed to an uptick in use in the 1990s as a sign of what can happen when parents and community leaders become complacent about prevention efforts.
“We refer to that as a generational forgetting of the hazards,” Johnston said, adding, “This is not a problem we can turn away from.”