Every year, 8th, 10th, and 12th graders at hundreds of public and private schools around the nation are surveyed anonymously about their use of illicit and prescription drugs, alcohol, and tobacco, as well as their attitudes toward substance use. Today the results of the 2017 Monitoring the Future (MTF) survey were released by NIDA-funded researchers at the University of Michigan at Ann Arbor, and overall the news is encouraging. For most substances including opioids and cigarettes, use is at lowest-ever levels. But there are a few areas of concern, including the continued popularity of e-cigarettes.
The best MTF news this year concerns the low levels of opioid use by youth. Even as the country reels from the devastating effects of the opioid crisis, misuse of prescription opioids like Vicodin and OxyContin and use of heroin are at record low levels among middle and high school students. In this year’s survey, 4.2 percent of seniors reported misusing “narcotics other than heroin” (a category for all prescription opioids) in the past year. In 2004, the peak year of opioid misuse in the MTF survey, nearly 1 in 10 teens (9.5 percent) had misused these drugs.
It may be no accident that the cohort with high opioid use rates as teens nearly a decade and a half ago are now in their early 30s, in an age bracket showing high levels of opioid addiction and opioid overdoses. The Centers for Disease Control and Prevention have reported alarming increases in opioid-related mortality for Americans age 25 to 44. It is well established that risk of addiction increases when drug use begins during adolescence or earlier. The declines in teen opioid use since its peak reflect the success of public education and prevention initiatives around prescription opioids, but it is crucial that we follow these initiatives with prevention of heroin use, which is now increasing among adults.
Questions about lifetime and past-month use of electronic vaporizers such as e-cigarettes (“vaping”) were added to the MTF survey in 2015, and this year, past-year vaping was added. Over a quarter of 12th graders (27.8%) reported vaping in the year leading up to the survey; 18.8 percent of seniors reported vaping nicotine, 9.5 percent reported vaping marijuana, and 20.6 percent reported vaping “just flavoring.” More young people use these products than smoke cigarettes.
While the potential of e-cigarettes for smoking cessation or harm reduction among adults who smoke is an active area of research, the worry among many researchers is that e-cigarettes are re-normalizing smoking behavior among youth, introducing many of them to nicotine, and thus getting them addicted. According to a new study published in Pediatrics, young people who used e-cigarettes were much more likely to later start using conventional cigarettes; the reverse relationship (starting with cigarettes and moving to e-cigarettes) was not found. Thus, the popularity of e-cigarettes has the potential of reversing the downward smoking trends that have been observed for two decades. Given the huge health benefits of not smoking, a reversal would be devastating to this generation’s future health, so this is something that we at NIDA and our colleagues at other federal agencies are watching closely.
Like cigarette use, alcohol use has declined over the past two decades in all three grades, but in this case the declines have slowed. In 2017, 16.6 percent of 12th graders reported binge drinking (consuming 5 or more drinks on a single occasion) in the previous two weeks, which was not significantly different from 2016. Previously, binge drinking had been steadily declining. This, too, is an area that researchers at NIDA and our sister Institute the National Institute on Alcohol Abuse and Alcoholism will continue to watch closely.
Since 2009, marijuana has been more widely used than cigarettes among students in the survey. Among 12th graders, 5.9 percent currently report using marijuana daily, compared to 4.2 percent who are daily cigarette smokers. Although there have been few significant increases or decreases in marijuana use since 2011, attitudes toward marijuana use continue to become less negative; every year, fewer students in any of the three grades report that they disapprove of marijuana use or perceive marijuana use as dangerous. State-level policies appear to be associated with how people are using this drug: In states with medical marijuana laws, 16.7 percent of 12th graders had consumed marijuana edibles, whereas in states without such laws, only half as many (8.3 percent) had done so.
Another indicator that has plateaued instead of showing continued decreases in the past few years is the use of inhalants—sniffing household chemicals like glues and solvents. Inhalants are unique among substances in being misused mainly by younger students: 4.7 percent 8th graders reported using an inhalant to get high in the past year. This is slightly higher than the 3.8 percent who reported using inhalants in 2016, but is still much lower than in 1995, when 12.8 percent of 8th graders reported using inhalants. Continued misuse of these potentially very dangerous chemicals shows that we cannot become complacent about preventing dangerous drug experimentation in middle school and even earlier.
It must be remembered that MTF is not a perfect cross-section of American adolescents: It only captures information from kids who regularly attend school. Today, as in 2004 (or any year), most drug use is likely to be higher among teens who have dropped out of school or among those who do not attend when the MTF survey is taken. For instance, in 2012, the Substance Abuse and Mental Health Services Administration estimated that if school dropouts were included, the percentage of people reporting that they have ever used heroin would be 1.7 times higher for those equivalent to 12th Grade in age (17-18) than what school-based surveys indicate.
But we should still take encouragement from this year’s MTF results. Most substance use by middle and high school students is the lowest it has ever been, which suggests that prevention interventions and policies continue to have the desired effect of minimizing drug experimentation and use in the population most vulnerable to the long-term effects of drugs. It is important that we study other potential factors that might have contributed to the decrease in drug use among high school students, such as access to alternative reinforcers (like video gaming) and the new ways in which teenagers interact (especially social media). There is also need to expand on prevention strategies to further reduce drug use—such as use of marijuana—and to prevent current use trends like the popularity of vaping from leading to a resurgence of cigarette smoking.
For detailed MTF 2017 data, see Monitoring the Future Study: Trends in Prevalence of Various Drugs. Also, National Drug and Alcohol Facts Week begins on January 28th, with more than 200 events for middle and high school students planned around the country. For more information, visit https://teens.drugabuse.gov/national-drug-facts-week