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Monitoring the Future: Teleconference 2014

December 18, 2014

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Dr. Nora Volkow, NIDA Director, discusses the results of the 2014 Monitoring the Future survey during a teleconference on December 16, 2014. Monitoring the Future tracks annual drug abuse trends of 8th, 10th, and 12th-grade students, including attitudes and perceived risk of specific drugs of abuse. Dr. Volkow is joined by Mary Lou Leary, Deputy Director for State Local and Travel Affairs, at the Office of National Drug Control Policy, and Lloyd D. Johnston, Ph.D., Principal Investigator, and Richard A. Miech, Ph.D., Research Professor, both from the Institute for Social Research, University of Michigan.

Welcome:

Jack Stein, Ph.D.
Director, Office of Science Policy and Communications, National Institute on Drug Abuse

Speakers:

Nora D. Volkow, M.D.
Director, National Institute on Drug Abuse

Mary Lou Leary, J.D.
Deputy Director for State Local and Travel Affairs, Office of National Drug Control Policy

Lloyd D. Johnston, Ph.D.
Principal Investigator, Institute for Social Research, University of Michigan

Richard A. Miech, Ph.D.
Research Professor, Institute for Social Research, University of Michigan

Location: Teleconference

Time: 11:00 a.m. EST
Date: Tuesday, December 16, 2014

Transcript by My Meetings by Verizon.

Coordinator: Welcome, and thank you for standing by. At this time all participants are in a listen only-mode. During the Q and A portion of the call, if you would like to ask a question, you may press star one.

Today’s conference is being recorded. If you have any objections, you may disconnect at this time. Your host of today’s call is Dr. Jack Stein. Thank you, you may begin.

Jack Stein: Well good morning everybody, this is Jack Stein. I’m the director for the office of Science Policy and Communications at the National Institute on Drug Abuse, a part of the National Institutes of Health.

We’d like to welcome you to a teleconference press briefing on the “Monitoring the Future” study. This is the 40th anniversary of this study that is supported by NIDA and conducted by the University of Michigan.

We’re delighted to host this today. And let me just quickly mention how we’ll proceed and then we’ll move right in to our briefing. Following my brief comments right now, we’ll have brief presentations by several of the principals involved or connected with this study.

First will be Dr. Nora Volkow, who is the director for the National Institute on Drug Abuse. Followed - Following that, we will have a representative, Miss Mary Lou Leary, the deputy director for state, local, and tribal affairs at the office of National Drug Control Policy. Speaking on behalf of the agency for the acting director, Michael Botticelli.

She will also be joined later by Regina Labelle, the Chief of Staff, who will be available for some questions as well. Following their comments, will be Dr Lloyd Johnston and (Richard Miech) from the University of Michigan, who have been the individuals responsible for conducting the “Monitoring the Future” study.

So with that, I’d like to turn things over to the Director of National Institute on Drug Abuse, Dr. Nora Volkow, who will have some brief comments about the study.

Nora Volkow: Well Jack, thanks very much. Good morning everybody that’s on the phone. I - for all (unintelligible) event and this particular here, where we are reporting the results for 2014 actually looks very good. Especially the (unintelligible) indicators on the consumption of drugs by teenagers that are in high school.

What we showed is significant decreases in the rate of drug use, both for illicit substances and legal ones. For most of the illicit substances, there are actually trends that (unintelligible) continue decrease that become significant if one looks over it over the past five years.

Some of these decreases are more pronounced for some of the drugs than others. Among the most notable ones are the significant decreases that we are observing in the abuse of opioid analgesics.

These are prescription medications used for the treatment of pain, which have generated a lot of concern because they can be highly addictive and because of the risk of overdoses. The rate of these drugs has been quite high among teenagers.

And we’re seeing, actually, over the past five years, significant - pretty dramatic I would almost say, reduction in the two most frequently abused drugs. One of them is Vicodin, which actually for many years, and up to 2009, remain at 9.7% use in the past year. For this year it has gone down to 4.8%.

Similarly, Oxycontin, which is the other second favored pain medication. Which has been - remain at levels around 4.5% up to 5% has now been reduced to 3.3%. And so these are very good indicators of how prevention campaigns, that have been targeted towards prescriptions, have worked.

There’s also significant reductions in the rate of the abuse of synthetic cannabinoids, which are referred to as “spice”. These, we started to record three years ago, when the numbers were around 11% past year use on 12th graders. They are currently at 5.8%.

And so we can see that in a three year period, there has been almost a 30% reduction in the use of these drugs that actually can be quite toxic. Another very notable decrease is in the rate of cigarette smoking, particularly daily smoking. Which are actually the ones associated with the worst outcomes.

Between last year and this year, in 12 graders, we’ve seen a reduction from 8.5% to 7.7%.And these are just basically the continued trend of decrease that we have seen in the past 10 years, most accentuated over the past five years. And finally alcohol. 

The decreases are not so dramatic, but are actually quite significant across all of the indicators, when you look over the past five years. Having said that, despite all of these very good news in many of the drugs, we have not been able to see decreases in the abuse of marijuana. Which continue to remain at very high levels across the 8th, 10th, and 12th graders.

For example, past year use of marijuana among 12th graders was 35%, and daily use or regular use of marijuana among 12th graders was 5.8%. This constitutes some of the highest rates that are seen among student populations in - across the country. So this is something that we need to pay attention to.

However, we have not seen increases in their use, which was something that we have been afraid would happen as the regulations change, and as there is decreasing the perception of marijuana as harmful. However what we have seen is a shift in the pattern of the way that marijuana is consumed.

And for example, we’re seeing that up to 40% of those teenagers that abused marijuana in the past year, have abused it, edibles, in those states that have medical marijuana legalized, in contrast to 26% on the states that have not medically legalized marijuana.

The other area where we have not seen an increase and we were anticipated - we were afraid that there may be, is heroin. We have seen increases in heroin use among young adults. Which has generated a lot of concern, but the rates remain very low, .6% and stable.

And finally, we have recording for the first time, numbers that are worrying us, vis a vis, the new technology utilization of E-cigarettes. With very, very high rates of use among 12th graders at 17% reported past year use. Among the 10th graders, 16% reported past month use. And finally among the eighth graders, 8% - a little bit over 8% reported past month use.

So overall, very, very good news. (unintelligible) most of the legal or illegal drugs, but we need to still be concerned about the very high rates of prevalence of substance abuse among our teenagers.

Jack Stein: Dr. Volkow thank you. Our next speaker will be Mary Lou Leary, who is the Deputy Director for State Local and Travel Affairs, at the Office of National Drug Control Policy.

Mary Leary: Thank you. And thanks to all of you for participating in this call today. Thanks to Dr. Volkow for hosting the call, and to Lloyd and to (Richard) for their research on this really important topic. Each of you plays a vital role in our effort to use science to shape national drug policy.

On behalf of the president, and acting director Botticelli, I want to thank you for your work, and for sharing these latest survey results. This year's “Monitoring the Future” data shows promising signs on the declining rates of adolescent substance abuse. They reinforce the need to continue efforts on prevention, treatment, and recovery.

The Obama Administration remains steadfast in its commitment to reduce drug use and its consequences. We all know that the best way to reduce drug use is to prevent it from ever starting. The young people represented in today’s study, are making decision that will define their future, and the future health of the next generation of American leaders, innovators, and citizens.

I encourage parents, teachers, coaches, mentors. Have a conversation with a young person in your life about making the healthy decisions that will keep them on a path toward a successful future. We all recognize the impact of drug use on America. Too many of us have been touched by a life cut short by overdose. Or a future cut down by substance dependence.

Current opioid usage rates among teens, is at one of the lowest rates we’ve seen in years. This is encouraging news at a time when thousands of people across the country die from opioid overdose every year.

And to help prevent the abuse of prescription drugs, we urge Americans to keep track of prescription medications in your home, and dispose of any unused or expired medications properly. Prevention is, and it’s always been, the best tool we have to reduce drug use among young people.

And with that, I’d like to give the floor to Dr. Lloyd Johnston, from the University of Michigan. He’s the architect of today’s study.

Jack Stein: Thank you Miss Leary. And Dr. Johnston and then Dr. (Miech), both from the University of Michigan, will be commenting.

Lloyd Johnston: Good morning all, pleased to be joining you for this release of the 40th survey in the “Monitoring the Future” series. As in most years, we surveyed 42,000 students across the country in some 377 schools.

As you’ve heard, the results are really quite positive this year. I think a couple of the most important being the continuing decline in cigarette smoking, which is at the lowest levels in all three grades we surveyed that we’ve seen in the history of the study. And the same is true for Alcohol.

Alcohol, while still at substantial levels, is at historical lows, again, in the history of the study. Still, there are a lot of kids who are using both of these substances and who will pay a price for it. And we worry about them, but progress is real and important.

Among the illicit drugs, there have been a number of drugs that are down, including Ecstasy, Salvia, over-the-counter cold medications that are used to get high. And as Dr. Volkow said, any prescription drug use is also down, and that’s an important development because the prescription drugs became a bigger part of the country’s drug problem in the late 90’s and early 2000’s.

When illicit drug began to turn around - illicit drug use, then we continue to see a rise in the use of these psychotherapeutic drugs. And probably the most important among them are the narcotic drugs. They have declined significantly this year and have been declining since about 2015. So I see those as quite important developments.

Of the drugs that didn’t show a decline, most of them, including some important ones like heroin and methamphetamine and crack, are at lower levels than they have been. So even in those cases, there has been progress, although not more progress this year.

Really, practically none of the drugs showed an increase this year, and I’m sure that’s music to the ears of the nation’s parents. The one fly in the ointment I can see, is - has to do with E-cigarettes. And my colleague (Richard Miech) is going to be speaking about those.

(Richard Miech): Thank you Lloyd. Good morning all, thank you for dialing in. I’d like to elaborate a little more on Dr. Volkow and Dr. Johnston’s comments about E-cigarettes. This is the first national study to show that, among teens, E-cigarettes are now - have higher use, than regular tobacco cigarettes.

We asked 8th, 10th, and 12th graders if they, in the past three days, had used an E-cigarette or a tobacco regular cigarette. And we found that among 8th and 10th graders, more than twice as many reported using an E-cigarette than a regular tobacco cigarette.

And among 12th graders, we find in the past 30 days, about 17% had reported using an E-cigarette, whereas only 14% had reported using a regular tobacco cigarette. So these results show that E-cigarettes have become the nicotine delivery device of choice among today’s teens.

Jack Stein: Great, thank you very much. We’re doing great on time. We’re going to be opening up the lines in one moment. Before I do so, I just want to have it recognized that supporting documents for this teleconference including press releases, visuals, and an overview of the findings can all be found on the NIDA Website at drugabuse.gov.

That’s “drug abuse dot G O V”. Simply click on “news and events” tab and then select the block specific to “MTF” to be guided to the page. The page will also have contact information for press offices, for each of today’s speakers, if you wish to set up individual interviews.

So with that, we’re now going to open up the lines to field any questions that may exist beyond the information that’s already been shared. And I will ask the operator to field any questions that may be out there.

Coordinator: Thank you. At this time, we’ll conduct the question and answer session. To ask a question, please press star one. You will be prompted to record your first and last name. To withdraw your request, press star two. Again that’s star one if you’d like to ask a question - one moment please.

Jack Stein: I believe we have a few questions that are coming in.

Coordinator: Yes. Our first question is from (Amara Omeokwe), your line is open.

(Amara Omeokwe): Hi, yes. I was wondering, regarding the E-cigarettes, if the use of E-cigarettes among adolescents hasn’t necessarily been determined to be a gateway to the use of regular tobacco cigarettes. Can you explain why this is still identified as an area of concern in the survey?

Nora Volkow: Well the E-cigarette is very new way of administering substances. They were developed initially for administration of nicotine. It enables you to vaporize it and to inhale it and deliver into the brain quite rapidly. These E-cigarettes are now being used also to administer other drugs like THC.

We - what we are seeing, and the “Monitoring the Future” survey very nicely shows, and the other investigators have started to look at this. Is that we are having many kids, actually, that are abusing both the cigarettes and the E-cigarettes - both the regular tobacco and the E-cigarettes.

And these tend to be kids that are of greater risk. What it was most worrisome, are those kids that are only using E-cigarettes because of the concern that had E-cigarettes not been available, they would never develop an addiction to nicotine.

And also the concern, which we do not have the data, since this has not been evaluated, or whether the use of E-cigarettes in those lower risk kids could then transition into regular cigarette smoking on the one hand. On the other hand, we are also anticipating that these may in turn influence the process of other drug use.

Because the research has shown in laboratory animal experiments that exposure to nicotine enhances the rewarding effects of other drugs. So that concern that there is this new route of administration for nicotine, that in turn, it may serve in a so-called gateway drug. It’s something that we need to be cautious about and evaluate whether it is true or not.

But as of now, there is very limited research on this subject.

Jack Stein: Thank you Dr. Volkow. Dr. (Miech)?

(Richard Miech): Yes, I guess I’ll quick elaborate on that a little bit more. E-cigarettes in 2011, their prevalence was about 1.1%. They’ve really taken off ever since then. They’ve doubled about every single year, and so it’s just a relatively new phenomenon.

And we can’t do a randomized control trial, we can’t give teens E-cigarettes and see if they progress to harder drugs of course. So the best we can do is follow people who have used E-cigarettes and see what happens to them as they age. And so that’s what we’re doing now with monitoring the future.

And in the coming years, we will have more definitive scientific information about whether E-Cigarette use predicts the use of harder drug use in the future.

Jack Stein: Excellent, thank you. Is there another question, operator?

Coordinator: There is. The next question’s from Rob...

((Crosstalk))

Jack Stein: I believe it’s Rob...

Coordinator: Rob Stein with NPR. Your line is open.

Rob Stein: Yes, hi. I just wondering if you could elaborate a little bit more about, if we don’t know whether E-cigarettes are or not a gateway to other drug use, what is the concern about their use?

Nora Volkow: Well, nicotine - the concern about their use among drunk people is that nicotine we know is an addictive drug, so the notion that through this delivery system, you’re actually going to end up having teenagers that can remain addicted to nicotine, which is highly addictive.

Now, the aspect of potentially also E-cigarettes having additionally toxic effect, actually it was a very nicely described on “New York Times” article this Sunday in which they were commenting that the lack of manufacturing practices, the lack of standards leads to those cigarettes that are leaking those toxics and chemicals that when inhaled can have quite adverse effects to the human body.

And so, that is that again, because these are new devices, we don’t have sufficient information yet to actually be able to ascertain their negative extent, but our concern with young people is that independent of these toxic effects of the nature of that technology of the E-cigarette, that nicotine is addictive.

And also since this is particularly relevant in adolescents whose brains are rapidly changing as they transition from childhood into adulthood, and where we know that the effects of drugs are faster acting and longer lasting consequences.

Rob Stein: And if I could just follow up with one question, which that there - some have argued that maybe kids are not using regular cigarettes because E-cigarettes are available, and so there might be a benefit in that way, it might be helping reduce the use of regular tobacco use among teenagers.

Nora Volkow: Well, a recent paper just published, actually, I think the American Academy of Pediatrics showed that they were actually evaluating teenagers, 1,000 kids, I think the site was learning how - why when they were looking at the characteristics of the kids that were just using the electronic cigarettes, versus those that were using electronic cigarettes and tobacco.

And what they found was that kids at higher risk on the basis of their characteristics, where abusing both of them, whereas kids that have low-risk characteristics as evidenced by strong support social systems, by group performance at school, by having good social skills, were predominately using the electronic cigarettes.

And so this the - these are the ones - these are the kids that formally would not have engaged in consuming nicotine, had it not been available by an E-cigarette. So the concern is, of course, that we had done incredible advances in the prevention of nicotine use among teenagers, and access to the E-cigarettes will lead us to lose some of that territory making.

Kids that otherwise wouldn’t have consumed the drug become addicted to it.

Jack Stein: Dr. (Miech), I think you can comment further on some of the data around E-cigarette use and more conventional tobacco cigarette use?

(Richard Miech): Yes, except a slight addendum to talk to Dr. Volkow’s comments. Among 12th graders, we find that about 4% of all 12th graders use E-cigarettes alone, they’ve never smoked a real cigarette in their life.

And what’s particular interesting, and perhaps troublesome about this group is that these people are more likely to be college bound than the non-college bound. And that’s unusual for cigarettes these days. And so this kind of builds on Dr. Volkow’s point that these cigarettes seem to be reaching a population that is not being reached by cigarettes.

Jack Stein: Great, we have several more calls, I know in the queue. So Operator, let’s go to our next one, please.

Coordinator: Thank you, our next question is from Alison Knopf with “Alcoholism and Drug Abuse Weekly”. Your line is open.

Alison Knopf: Yes, hi. Thank you. Dr. Volkow, heroin use is going up among young adults according to stipend providers in many states, and according to the states themselves. Why isn’t it going up among high schoolers? When does it start, or does this survey mean that the trend toward an increase in heroin use is actually reversing?

Nora Volkow: I would not say that the results from monitoring the future showing no increases in heroin in adolescence can be interpreted to say that the trend of increases in heroin in the United States is reversing.

It actually reflects the different age and demographics of those kids that are actually in their 20’s, because actually the highest risk is up here in between 25 and 29 years of age. But initially, frankly, many of them become addicted to opioid medication, and then transition into injection of heroin.

We are not seeing this pattern among adolescents, and again, this might reflect, among other factors, some of the protective environmental constraints that adolescents may have that they may not be exposed easily to heroin as much as an adult that’s 20 years old may be.

Also we are seeing definitively that the greatest prevalence or the highest prevalence for addiction to opioid medication occurs between 18 and 25 years of age, and so also these teenagers, even though they may be experimenting, their rate of drug use for Vicodin and Oxycontin may not be as frequent and as severe as you will see later on in life.

Jack Stein: Thank you.

Alison Knopf: Thank you.

Jack Stein: Thank you. Operator, I think there are several more questions in the queue.

Coordinator: Yes, and as a reminder, if you’d like to ask a question, please press star 1. Our next question is from Nancy Wride from “Elements Behavioral Health” and addiction.com. Your line is open.

Nancy Wride: Hi there. My question has to do with whether the youth surveyed were asked whether when they were using the E-cigarettes, they contained nicotine juice or not, and whether they were using the E-cigarettes to smoke marijuana. Thank you.

Jack Stein: Dr. (Miech)?

(Richard Miech): Yes, this is (Richard Miech). This is the first year that we asked about E-cigarettes, so we just included a question asking the youth if they had used an electronic cigarette, (E-cigarette). And given the results, we’ve added a lot more questions along the lines that you’re talking about that will be asked in 2015.

About whether the youth know what it is that they’re smoking, and whether they’re smoking marijuana and nicotine, and a host of other potential things that could be in their E-cigarette device.

Jack Stein: Great, thank you. I believe there’s another question?

Coordinator: Yes, our next question is from Chris Cousins with Bangor Daily News. Your line is open.

Christopher Cousins: Good morning, folks. I’m interested in the results from the survey that have to do with marijuana use in states where medical marijuana is legal. I noted the results you’ve found in relation to edibles, but wondering if you saw any other correlations.

(Richard Miech): That was really the primary factor that we looked at was how they consume marijuana, and we found that the proportion of youngsters in the medical marijuana states that consumed by eating edibles was considerably larger than in the other states.

I can’t say that I have a quick explanation for that except maybe it’s just easier to be handling marijuana and using it and cooking and so forth in those states because there’s less likelihood of being turned in. But we haven’t done an intense an intense exploration of the differences between medical marijuana states and the others.

Jack Stein: Okay, thank you. Another question, Operator?

Coordinator: Yes. Our next question is from Whitney McKnight with Frontline Medical Communications. Your line is open.

Whitney McKnight: Hi, yes. Following up on the question about cannabinoid use. I’m wondering if you have a concern over the differences between the cannabinoids in edible marijuana versus inhaled marijuana - well, in particular, on the teenage brain.

Nora Volkow: Well this is an area actually that again, is relatively new for us because until very recently, most of the prevalence of the consumption of marijuana by teenagers was by smoking. And as it was showed to us that we actually have very little information regarding, for example, the bio-availability, which means if you do consume it by the oral route, how much of it will end up in your blood?

And what are the temporals, the kinetics of that behavior? And again, when you smoke a drug, that drug gets into the brain very rapidly. And that is associated with stronger rewarding effects and more addictiveness. But it also is associated with a better control of how much you ingest.

When you are taking oral marijuana, the problem is may take 60 minutes to get actually absorbed in big concentrations. So in the mean time, you may not feel much, and that may lead you to take higher content.

And these guys have started to notice the problem because people buying edibles don’t really know how much they are consuming, and this results in very (unintelligible) effects, and ending up in the emergency room.

So one of the priorities right now identify that now is the need to develop research that can inform us in terms of number one, the bio-availability, as well as the pharmacokinetics of marijuana, THC and the other components that are in marijuana when these products are consumed by these various routes. But right now, unfortunately I do not - we do not have that data.

Whitney McKnight: Okay, thank you.

(Richard Miech): If I could just add, I think that it’s pretty obvious when people are smoking a joint, the rough quantity that they’re getting. And the feedback as Dr. Volkow said, is very quick, you know how high you’re getting. Whereas, what’s in any edible sheet of brownies, you have no idea the quantity of marijuana that’s been put in there.

And the time to get feedback as to how much to consume, as she said, is an hour. So it’s quite a different situation, and I think considerably more dangerous.

Whitney McKnight: Thank you.

Jack Stein: Thank you all. Operator, are there any more questions at this time?

Coordinator: There are no other questions at this time.

Jack Stein: Okay. Before we begin to wrap up, I’d like to invite our speakers from NITA, University of Michigan, or the Office of National Drug Control Policy for any final additional comments that they’d like to share with the - with our listeners?

Nora Volkow: I do want to highlight the point made by the Office of National Drug Control, so we see that our best strategy for controlling the problem of drugs in our country is prevention. And prevention, since the age for at which you are at greater risk for experimentation is adolescence, prevention at force need to focus on this age as well as children.

The indicators are very good, and I think that in a way, it does reflect the fact that prevention strategies that have been implemented in the United States are working. However, at the same time, I think that I want to highlight that we can not become complacent, because the rate of drug use in this nation among adolescence in the United States are among the highest in the world.

So we still have a lot to do in terms of prevention of drug use in our country.

Jack Stein: Thank you, Dr. Volkow. Dr. Johnson?

(Richard Miech): If I could add to that, when we look over the longer term history, the 40 years that we’ve covered adolescent drug abuse in the U.S. we see there are wide fluctuations over time. And one of the most serious was what I call the relapse of the 90’s. And I think that came about because the country took its eye off this problem.

We like to leave problems behind. And the adolescent drug abuse problem, I think was one that we wanted to leave behind and, everyone from the congress to parents were paying less attention to the issue of drugs, and while that was happening, a new generation of young people were entering adolescence.

And they knew less about why they shouldn’t use these drugs. They weren’t deterred from use. It’s what we call generational forgetting, the hazards that comes with generational replacement. So this is not a problem that we can turn away from, it’s one that requires continuing effort. And especially maybe in times like this when things seem to be getting better.

Jack Stein: Thank you very much. Any other additional comments before we formally conclude?

Mary Lou Leary: Leary, I would agree that these - this data for monitoring the future shows that prevention works. And this is not the time to become complacent. This is the time to redouble the prevention efforts, and particularly with parents and others who have influence on young people.

Jack Stein: Thank you, Ms. Leary. Well with that, before we do officially conclude, I would like to acknowledge Dr. Johnson’s work on this Survey. As he had been introduced, he is the architect of monitoring the future, and has been with the study for 40 years, and we want to thank him and congratulate him for an incredible 40 years of very valuable data.

And understanding the trends in youth, and how we can better inform policy and practice. So thank you for that, Dr. Johnson.

Lloyd Johnson: Thank you very much.

Jack Stein: With that, we are concluding this press event. As I noted, on drugabuse.gov, our Web site, you can find all our information related to MTF monitoring the future study, and thank you for your time today. Operator, we can officially conclude.

Coordinator: Thank you. This concludes today’s conference. Participants, you my disconnect at this time.

END

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