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Monitoring the Future: Teleconference 2015

December 18, 2015

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Dr. Nora Volkow, NIDA Director, discusses the results of the 2015 Monitoring the Future survey during a teleconference on December 16, 2015. 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 Michael Botticelli, Director,  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

Michael Botticelli
Director, 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: Wednesday, December 16, 2015

Transcript by My Meetings by Verizon.

Operator: Welcome and thank you for standing by.  At this time all participants are in a listen-only mode until the question-and-answer session of today’s call.  At that time if you’d like to ask a question, please press star one.  Today’s conference is being recorded, if you have any objections, please disconnect at this time.  I would now like to turn the meeting over to your host, Dr. Jack Stein.  You may begin.  Thank you.  

Jack Stein: 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, NIDA, which is part of the National Institute of Health.  

We’d like to welcome you to a teleconference press briefing on the Monitoring the Future study -- this is the 41st year 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 into our briefing.  

Following my brief comments, we’ll have some presentations by several of the principals involved or connected with this study.  We will begin with Dr. Nora Volkow who is the Director for the National Institute on Drug Abuse.  Following Dr. Volkow, we will have Mr. Michael Botticelli, the Director of the Office of National Drug Control Policy. 

Following his comments will be Drs. Lloyd Johnston and Richard Miech from the University of Michigan who are the individuals responsible for conducting the Monitoring the Future Study.  

I also just wanted to mention that supporting documents for this teleconference including press releases, visuals, and an overview of findings can be found on the NIDA Website at drugabuse.gov.  So with that I’d like to turn things over to the Director of the National Institute on Drug Abuse, Dr. Nora Volkow who will have some brief comments about the study.  Dr. Volkow?  

Nora Volkow: Good morning.  Thanks, Jack.  First of all, I want to welcome all of the press media that is interested in Monitoring the Future and I also want to welcome my colleagues from the Office of the National Drug Control Policy, Michael Botticelli as well as my colleagues from the University of Michigan who are responsible for the hands on work that is required by this survey.  

This year, it’s actually quite exciting to report very good news in terms of what the Monitoring the Future is telling us about the patterns of drug use among teenagers.  

We are seeing overall significant decreases in most of the illegal drugs and all of the legal drugs, tobacco and alcohol, across 8th, 10th and 12th graders.  In some instances, the rates of use of these drugs are at the lowest we’ve ever seen them as relates to the history of the survey.  

Now, most notable, I want to say is the continued decreases in cigarette smoking that we’re observing basically across all indicators -- 8th, 10th and 12th graders.  Again, with some of the lowest levels we’ve ever recorded.  Very salient also is the significant decreases that we’re observing in prescription opioid abuse particularly since we’re seeing a significant increase in prescription opioid overdoses in the United States.  

Very salient too is that that we’re seeing the lowest rates of heroin abuse among teenagers, 8th, 10th and 12th graders, despite the fact that we’re seeing significant decreases across the rest of the age population in the United States.  

There are other areas where the indicators are very, very positive.  For example, synthetic drugs, which are very harmful both because of their addictive effects, but also because of their toxicity. 

Now having said that, there are some areas that we need to be cautious about and one of them is marijuana.  Despite decreases in basically all of the indicators of drug use, we’re not seeing reductions in the pattern of use of marijuana to the extent that for the first time ever in the survey we’re seeing that the rate of smoking marijuana regularly is higher than smoking cigarettes regularly both in 12th and 10th graders.  

And, in fact, this reflects attitudes, and if you look at the number of kids that report regular use of tobacco as dangerous, 75 percent versus reporting regular use of marijuana, 34 percent of them, you can get an idea of how the norms among teenagers are with respect to how these drugs may negatively be influencing them.  

The other aspect that deserves attention on our part is that while tobacco smoking, cigarette smoking, has been going down, we’re observing an increase in the other sources of delivering of nicotine.  Most notable, electronic cigarettes, the rate of which is very high in all 8th, 10th and 12th graders; and the reality that we really do not know ultimately how the use of e-cigarettes will influence the patterned use of cigarette smoking.  

So, yes, there are some very, very good news, but at the same time, we need to take it in the context that the rate of some of these drugs, even tobacco and alcohol, are still unacceptably high, certainly those of marijuana; and that, as a country, we have one of the highest rates of drug use among teenagers in the world.  Thanks again very much for your attention.  

Jack Stein: Dr. Volkow, thank you.  Our next speaker will be Michael Botticelli who is the Director of the Office of National Drug Control Policy.  Mr. Botticelli?

Michael Botticelli: Good morning and thank you all for participating in this important call today.  I’d like to thank our colleagues at NIDA, Dr. Volkow and Dr. Stein, for hosting this call and, more importantly, for supporting this important research and work; and to Drs. Johnston and Miech for their research on this incredibly important topic.  

All of you play a vital role in our efforts to use science and data to shape our national drug control policy and on behalf of the President, I’d like to thank you for your work and for sharing these latest survey results.  

This year’s Monitoring the Future data continue the promising trends from last year with declining rates of adolescent substance use.  These trends point to the value of evidence-based prevention efforts.  The Obama Administration remains steadfast in its commitment to reduce drug use and its consequences, and we 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 decisions that will define their future and the future health of the next generation of American leaders, innovators and citizens.  We encourage parents, teachers, coaches, mentors to have a conversation with young people in their lives about making healthy decisions that will keep them on a path towards a successful life.  

We all recognize the impact of drug use on America.  Too many of us have been touched by a life cut short by overdoses or a future cut down by substance-use dependence.  Current substance use rates among teens are among the lowest we have seen in years and this is encouraging news at a time when thousands of people across the country die from opioid overdoses each year.  

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.  

Today, I am hosting a community forum in Tulsa, Oklahoma focused on best practices and evidence-based initiatives to prevent and treat prescription drug abuse and heroin use.  This is one of a series of forums across the country that will continue the conversation that President Obama began in October in West Virginia where he announced new public and private sector efforts to address the opioid overdose epidemic.  

Those announcements built upon years of work.  In 2010, the Administration released its first national drug control strategy followed up in 2011 with a prescription drug abuse prevention plan.  

Since then, the Administration has supported and expanded community-based efforts to prevent drug use, pursue smart-on-crime approaches to drug enforcement, improving prescribing practices for pain medication, increasing access to treatment, reducing overdose death and supporting the millions of Americans in recovery.  

The President’s fiscal year 2016 budget included critical investments to intensify our efforts to address the opioid epidemic, including $133 million in new funding.  

As the President has said, we’ve all got a role to play because these young people -- they remind us these are our kids, it’s not somebody’s kids, it’s our kids.  And with that, I’ll give the floor to Dr. Lloyd Johnston from the University of Michigan, the architect of today’s study.  

Lloyd Johnston: Thank you, Mr. Botticelli.  Good morning, all.  I’m pleased to share these findings this year. I think they are very encouraging.  As usual, we surveyed about 45,000 young people in nearly 400 secondary schools around the country and we’ve been doing this study, as Dr. Volkow said, since 1975.  

So, we have long-term trends on adolescent use of an ever-growing host of substances and the one prediction I can make with almost certainty is there’ll be new ones along the way.  

The unusual thing this year, really, is that we saw no substance that showed a significant increase, and that’s quite unusual.  All of them either stabilized or showed declines, and we look at some 55 different substances in sub-categories of those substances.  So, it’s impressive that there were no increases.  And, the decreases that we’ve seen, although not common to all the drugs, I think are very important.  

In particular, the decline in the use of cigarettes and alcohol...I can’t think of anything that would probably have more consequence for the health and longevity of this generation of young people; and this dramatic decline, especially in cigarette smoking, is down from the mid-90s by about three-quarters.  So, that’s a huge change in a very serious form of substance use.  

The one fly in the ointment has to do with cigarillos, which are small cigars, and my colleague, Dr. Miech, is going to say more about that.  Binge drinking is down by about half since ’97.  Again, a very important change and something that didn’t look like it was going to change for a good many years.  

And, I also want to mention for those two drugs, and also for synthetic marijuana, that I think there’s evidence in these data that efforts by communities, sometimes states, have had an effect in reducing access to some of these substances for young people.  

We see it particularly with tobacco and alcohol, a long term decline in report of availability, or access to, these substances, and I think that’s because there’s been a real change at the retail level.  With synthetic marijuana, which is also in decline, we’re seeing a similar kind of thing, a considerable drop in perceived availability. 

The findings on prescription drugs does certainly constitute another important nodule here. And, we’re seeing a decline in the proportion of young people who use any of the abusable prescription drugs; and to remind you, those include tranquilizers, sedatives, amphetamines and narcotics.  

And, that became a serious part of the problem during the late 90’s and early 2000’s. We see among the 12th graders a peak rate in about 2005 with 17 percent said in the past year they used one or more of those drugs.  That’s now down to 13 percent this year.  So, at least something that had been rising for a long time is finally turned around, and I think that’s very important.  

Sedatives, sedative use, which is only asked in 12th grade, declined this year significantly.  Amphetamine use also declined if we look at the 30- day prevalence, but still has a significant number of kids who are using the drug.  And tranquilizers declined from 2002 to 2013 by almost half, so we’re seeing some real changes there.  

The narcotic drugs are of particular importance has been mentioned -- both heroin and the other drugs -- and we’ve seen, as a nation, a serious increase in the number of emergency room admissions and deaths associated with these drugs.  

Fortunately, among the adolescents, which is not where most of heroin use is concentrated, we have seen a decline. It was significant this year for the three grades combined; and we’re down now to numbers a proportion is using that are half to one-third what they were at the beginning of the 2000’s.  

So, I’m hopeful that the change that we’re seeing among adolescents in heroin use is one that will continue to echo as they become the young adults and later in adulthood.  

And, the other part of that that’s important, I think, is that even though heroin use has been going down, the use of the other prescription narcotic drugs has not been going up.  It’s been going down as well in parallel.  The decline this year was not significant, but we’re down to 5.4 percent using any of those narcotic drugs from 9.2 percent that existed in 2009.  

Finally, let me comment on marijuana, obviously an important drug in the country at this point, and the subject of a great deal of discussion, political and other.  We saw a rise through about 2007 to 2012 in the proportion of teenagers who were using marijuana; and since then, or actually going back almost to 2010, we’ve seen a leveling off of this use.  

But, as Dr. Volkow mentioned, we’re not seeing a decline. Almost everything else is declining, marijuana is not. And, today we see the proportion who have used any marijuana in the past year is 12 percent among 8th graders, 25 percent among 10th graders, and 35 percent among 12th graders.  

So, this is clearly the most widely used of the illicit drugs and hasn’t been budging much.  Risk, perceived risk, has declined quite a bit and normally we would expect a decline in use with that.  That hasn’t been happening in the past few years and I’ll be glad to talk about that further, but first let me give the mic to my colleague Professor Richard Miech. 

Richard Miech: Thank you, Dr. Johnston, and thanks to all of you for participating, and particularly to Dr. Nora Volkow and NIDA for hosting this press conference.  I want to spend my time highlighting, and going into a little more depth, on three particular findings that have been discussed already here; and one of the them is good news and the other two are not-so-good news.  

The good news of course is the decline in cigarette smoking among teens. And, as Dr. Volkow mentioned, it’s at the lowest level we’d ever seen in the 41 years of the study. And, to put that in context among 8th -- well among 12th -- if you go back 20 years, smoking rates in the past 30 days for 12th graders were three times as high as they are now.  In 10th grade, they were four times as high; and in the 8th grade, they were five times as high.  

So, over the past 20 years we’ve seen a quite dramatic decline in cigarette smoking among U.S. teenagers.  And so the question is “Why is that?”  There have been a lot of efforts out there to reduce smoking.  These include increased taxes on tobacco products, restrictions on advertising and promotion, limiting where cigarette smoking is permitted, broad-based anti-smoking ad campaigns, educational programs in schools, removal of added flavoring to cigarettes, except menthol, and quit smoking programs and products have become more available.  

So, taken all together, these efforts have resulted in a quite a remarkable success and we should keep these efforts going. Otherwise, as we’ve seen in the past, cigarette smoking can be at much higher levels than it is now.  So, that’s the good news. 

Two not-so-good news items are one that youth, it’s important to keep in mind, are using other tobacco products as well, other than just cigarettes.  

So, if you take cigarillos into account, for example, and you ask youth, “Have you used tobacco in the past 30 days?”  If you include cigarillos in there with cigarettes, then past 30-day tobacco use increases by three-quarters for 8th and 10th graders, and by more than half for 12th graders.  

Almost all cigarillos that 87 percent of youth report using are flavored cigarillos. And, if those flavorings weren’t there, it’s quite plausible that cigarillo use would go down.  And, so we highlighted cigarillos this year as an example of alterative tobacco products are actually increasing the tobacco - well, lead to increased estimates of tobacco use.  

And, the third item I’d like to talk about today is e-cigarettes.  We know from last year’s press release that e-cigarette use is really quite substantially high among 8th and 10th graders.  More than twice as many report using e-cigarettes in the past 30 days than report using cigarettes.  

Among 12th graders, e-cigarette use rates are 50 percent higher than it is, at least 50 percent than just regular cigarettes. And this year, MTF was the first major study to ask teens why they are using e-cigarettes. It turns out only 10 percent or less report that they are using them as a way to quit cigarette smoking, which is what you would expect considering that cigarette smoking is so low in terms of its prevalence.  

More than half report that they’re using e-cigarettes as a way to satisfy their curiosity -- they want to see what it’s like -- and 40 percent or more said they like the flavors.  E-cigarettes come in flavors that can be very appealing to teens, like chocolate cream or strawberry, or flavors like that.  

So, these results suggest that e-cigarettes are not so much, at least among teens, not so much a way to end smoking, but they’re a new form for teens to use substances recreationally, which is unfortunate that they’re using it in that way.  And, with that, I will give the floor back to Jack.  

Jack Stein: Terrific.  Thank you to all of our speakers.  I will be ready to now be able to move into opening the lines for some questions from any press that are on the line.  Do we have a first question? 

Operator: Thank you.  At this time if you would like to ask a question, please unmute your line, press star one, record your first and last name when prompted.  Our first question comes from Alison Knopf of Alcoholism and Drug Abuse Weekly, your line is open.  

Alison Knopf: Thank you.  As Dr. Volkow said, there is an increase in opioid ODs.  So what does the decline in opioid use by teens mean?  Does it mean fewer ODs in future years?  Was there a correlation in previous years?  MTF is showing an increase in opioid use that then resulted in this increase in ODs, or are these just completely separate measures?  Or does it mean that the few teens who do use are the ones who end up dying?  Thank you. 

Nora Volkow: The increases in opioid overdoses are actually particularly prominent among individuals of 44 to 54 years of age.  One of the things that actually was reported for last week by CDC was their new data on the overdoses in 2014, as compared to 2013, and unfortunately, they reported 16 percent increase in the number of overdoses, but this reflects predominately an older group comparison.  

As we mentioned, among the teenagers, we are seeing the rates of opioids, whether it’s prescription or heroin, at the lowest they’ve been since the survey has been looking at them.  This reflects in part the many inventions to try to curtail the availability of opioids, including the Take Back campaign, but also strong campaigns to actually educate prescribers on the prescription of opioid medications.

And, reports have actually shown that there is that decrease in the number of prescriptions for opioids among adolescents, which, in turn, is very important, because what the survey is showing, the Monitoring the Future, is that approximately 30 percent of them are obtained in the prescription opioids for abuse from their own prescription.  

So, it is an important source for adolescents to get hands on this prescription medication.  So, I think that we’re seeing patterns that are different among teenagers than they are among the older groups.  

Jack Stein: Thank you.  Dr. Johnston.  

Lloyd Johnston: Yes.  If I may just add…the evidence from the teenagers that we have shows that they’ve seen a substantial decline in their ability to access opioids other than heroin.  So, it’s more support for what Nora was just saying -- that there’s a real change in availability.  And, I think that’s a result of a number of very intentional efforts.  

Jack Stein: Terrific.  Thank you.  Do we have another question? 

Operator: Our next question comes from John Lavitt of The Fix, your line is open.  

John Lavitt: Yes.  My question is it seems like the prevention efforts towards alcohol and cigarettes have been very effective. Do we need to use such prevention strategies towards prescription drugs and marijuana as well?  

Nora Volkow: The answer is definitely.  I think that we should learn from the big successes that have come about by the prevention efforts.  I mean the prevention efforts and the reduction of cigarette smoking has been unprecedented on any interventions that we’ve had. And, as Dr. Lloyd Johnston mentioned, this is probably one of the most salient effects to improve the outcomes of these teenagers.  

Similarly, though not as dramatic, the prevention efforts for reducing alcohol are also starting to pay off.  So, we should learn from those efforts and translating into not just prescription opioids, but other drugs of abuse. As I mentioned, even though we do have very good indicators, rates of drug use among teenagers is still among some of the highest in the world.   

And, as we are struggling with the changes in policy that relate to marijuana, making it legal for recreational purposes or more available, and it’s changing the norms of risk among population of all ages including teenagers, we need to again highlight the importance of doing prevention efforts particularly targeting adolescents.  

Jack Stein:  Either Drs. Johnston, Miech, or Mr. Botticelli would you like to add to that?  

Michael Botticelli: Sure.  This is Michael Botticelli.  You know, as Dr. Volkow talked about, as part of our national strategy, prevention becomes an important role and, you know, it clearly says that we need to try to increase our efforts particularly around raising the youth understanding around the risks around marijuana.  

I think all of us are significantly concerned about our inability to reduce underage marijuana use and particularly to push against some of the perceptions of risk, the declines in perception of risk that we’re seeing as it relates to occasional marijuana use among youth.  I think we, as a nation, have been challenged by countering the messages that youth get around legalized marijuana and what that means.  

Jack Stein: Great.  Thank you.  Dr. Johnston.  

Lloyd Johnston: Yes.  I wanted to just add that I think that an important determinant of the decline in cigarette smoke we’ve seen among young people has been price, and not only did the industry have to raise the price in order to pay for the tobacco settlement, which was I think was a quarter of a trillion dollars, but, in addition, the federal government and many states and some communities raised taxes considerably.  

That may have some implications for the marijuana policies in states that do decide to legalize marijuana because kids, in particular, are price sensitive. And so, if the price of marijuana becomes higher and more difficult for them, it may help to contain it.  

I mean obviously there will be laws that say you can’t sell it to someone who is under 18 or under 21, but we know from cigarettes and alcohol that that is not a set of policies that always works.  

Jack Stein: Okay.  Thank you.  I know we have several folks still on the line.  I’m not sure if there are any additional questions.  Operator, at this point, are there?  

Operator:  Not at this time, but once again, if you’d like to ask a question, please unmute your line, press star one, record your first and last name when prompted.  Give us a few moments please.  

Jack Stein: Okay, we’ll hold for a bit.  While we’re doing that, let me just alert everyone that we will be hosting a Twitter chat today from one to two p.m.  We have information about that which can be accessed via the NIDA Website at drugabuse.gov. And, as I said at the beginning of our teleconference, all collateral materials related to Monitoring the Future can be easily found on the NIDA Website at drugabuse.gov. 

Lloyd Johnston: Can I also add that the Monitoring the Future Website which is monitoringthefuture.org also has the press releases that come out of the study.  

Jack Stein: Terrific.  Thank you.  Operator, any more questions?  

Operator: We have no further questions at this time.  

Jack Stein: Okay.  Let me just ask our speakers if there are any final comments they’d like to make before we conclude this teleconference?  

Nora Volkow: Yes, again, I just want to thank everybody for their interest in the matter of substance use among teenagers, which is one of the most important prevention interventions that we can do because it not only influences their health but actually influences their overall outcomes.  

And, preventions work, and I think that clearly the example is shown by the dramatic reductions in alcohol and cigarette smoking among teenagers.  

Lloyd Johnston: This is Lloyd Johnston.  I’d like to add a note of caution about all the good news.  It reminds me a lot of, about 1990 when the country got substance use of most kinds, not alcohol and cigarettes, but almost all of the illegal drugs down to very low levels, and I think the country took its eye off the problem.  

The issue wasn’t in the press for four or five years, the Congress cut monies that were aimed at reducing drug use.  Perhaps parents talked to their kids less about it.  It was as if we said, well, that problem’s solved, we’ll move on to the next one.  

This is not a problem that’s ever solved.  This is like crime. You just keep working to try to minimize it, and I think that we want to be careful with this period of time where so many things are looking good that we don’t get lulled into a false complacency; because I guarantee you there will be new drugs. There’s a new generation of kids coming and they have to know why they shouldn’t be using them.  

Jack Stein: Thank you.  And Mr. Botticelli any final remarks you’d like to make before we conclude?  

Michael Botticelli: No, thank you, Dr. Stein.  I think we’re all set. 

Jack Stein: Terrific.  Well again, thank you all for participating. Our website is again drugabuse.gov. Our press office is happy to field individual questions certainly through the remainder of today and beyond.  At this note, we’d like to close this teleconference. Operator, you can officially close our lines.  

Operator: Thank you.  This now concludes today’s conference.  All lines may disconnect at this time.      

END

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