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Monitoring the Future: Teleconference 2016

December 16, 2016

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Dr. Nora Volkow, NIDA Director, discusses the results of the 2016 Monitoring the Future survey during a teleconference on December 13, 2016. 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,  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, 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 13, 2016

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 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, you may disconnect at this time. I’d now like to turn the meeting over to Dr. Jack Stein. Thank you and you may begin.

Jack Stein: Thank you and 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. Which is part of the National Institutes of Health. And we’d like to welcome you all to a teleconference press briefing on monitoring the future study. This is the 42nd year of this study, which is supported by NIDA and conducted by the University of Michigan.

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

We’ll first begin with the Director of the National Institute on Drug Abuse, and that is Dr. Nora Volkow. Following Dr. Volkow’s comments we will have Mr. Michael Botticelli, the Director of the National Drug Control Policy. Following his comments will be doctors Lloyd Johnston and Richard Miech, both from the University of Michigan. Who are individuals responsible for conducting the monitoring the future study.

I do want to mention that supporting documents for this teleconference, including press releases, visuals, and overview of findings can be found on the NIDA website at drugabuse.gov. And now 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: Yes, Dr. Stein, thanks. And first of all, I’m delighted to actually have this press release today. And I want to welcome the interest from the reporters. It’s actually a year where we’re seeing incredibly good news as it relates to the patterns of drug use among teenagers.

And this is observed across all of the (unintelligible) grades that are surveyed by monitoring the future eight, 10, and 12. And basically across most of the drugs of abuse for all of the years except more stable levels for 12 graders and marijuana.

Specifically, we have seen the lowest levels of use of heroin, methamphetamine, cocaine, ecstasy and inhalants that have been recorded since inception of monitoring the future. And this is across all ages. A more...and also, we have seen the lowest rates of drug use for the legal drugs, and that includes the lowest levels ever of nicotine and the lowest levels ever of alcohol.

In parallel, we’ve seen significant decreases in the abuse of prescription opioids, which was a big surprise because we actually are leading one of the worst epidemics in our country on the prescription diversion and abuse among the general population. And we were concerned that this will influence teenagers. But we have seen a 45% decrease in the past five years on the abuse of prescription opioids.

We were also very surprised and concern initially has been by the fact, I mean again, also we are leading an increasing the use of heroin across the adult population in the United States with these devastating consequences.

So, we were concerned that these will also translate into patterns in teenagers. And yet, we show the lowest rates of heroin use that we have recorded. So, both the prescription opioid epidemic as well as the heroin patterns in the adults are not translating into the teenagers.

The other major surprise of course was marijuana. Because we have been concerned all along with the changes in the legalization of marijuana either for medical or recreational purposes. That is also translated among the adult population in an increasing consumption of marijuana that this could also affect teenagers. And yet, we’re observing actually that there are significant decreases in marijuana consumption in eighth and tenth grade.

The levels of marijuana use among 12th grade, on the other hand, are stable. So, despite all of the decreases in all of the other drugs, marijuana use is stable among 12th graders. And these really pertains to the area of risk that we’re now identifying as it relates to marijuana where we are seeing the highest increases in those that are 18 to 24.

And similarly highlighting the importance of actually to understand how these policy issues influence patterns of marijuana use in our country. We do know the survey that marijuana use is more frequent among states that have legalized medical marijuana than those that have not.

So, these are really remarkable news and the challenge to us is of course try to understand what is driving these very significant wonderful decreases in drug consumption patterns among teenagers in our country. So that we can insure that we can strengthen them for once. But we also can sustain them.

At this point, I mean any...some of it relates of course to prevention measures. But others may relate to issues that at this point we haven’t properly investigated or clearly identified.

So, what are the areas of concern, areas of concerns is that the use of marijuana, particularly regular marijuana use which is particularly problematic for the effects in the brain and other organs are still very high among 12th graders, 6% of the 12th graders are using marijuana.

The concept that, the notion that marijuana is harmless is becoming more frequent. And we know that in turn that influences adolescence. If they think it’s not harmful, they are more likely to take marijuana. So, those are issues that we need to address.

And with that, again, I want to thank Dr. Lloyd Johnston, who is going to be retiring. This is going to be his last survey as a principal investigator. And he has been a wonderful, wonderful colleague that has allowed these (unintelligible) just to exist, but actually to flourish and to guide you in policies on how to properly prevent drug use among teenagers. With that I introduce Dr. Lloyd Johnston.

Lloyd Johnston: Actually we’re going to have...

Jack Stein: Shortly. Thank you, Dr. Volkow. We’re going to next hear from actually Mr. Michael Botticelli, the Director of National Drug Control Policy. And following that, we’ll turn things over to our investigators from University of Michigan. So, Director Botticelli.

Michael Botticelli: Great, thanks Dr. Stein. And thank you Dr. Volkow for this incredible work. Thank you everybody for being on the call. As Dr. Volkow said, the 2016 monitoring the future survey indeed includes some very, very good news. Teen tobacco and alcohol use are at record lows.

As Dr. Volkow said, are particularly important to us in light of the opioid epidemic is the dramatic decrease in prescription opioid pain reliever use among 12th graders down 45% over the past five years.

As well as the long term decline in the use of many other substances including marijuana among younger age groups is continuing. And this is all really good news. And it’s very encouraging to see more young people making healthy choices and choosing not to use substances.

We need, as Dr. Volkow said, to keep doing all we can to support young people. Through evidence based prevention efforts and treatment for those who may develop substance use disorders. And, you know, we have often said that we all have a role to play in preventing drug use.

Everybody at the community level, from police officers, healthcare providers, local leaders, public health officials, parents, teachers, faith leaders. We all have a role to play in setting community norms as it relates to substance use issues.

Prevention is a strategically important priority for our administration is the key, one of the key parts of the National Drug Control strategy. And many of you might have seen the surgeon general’s historic report on addiction released last month. Talking about the importance of evidence based prevention efforts.

You know, when we were in Atlanta this past March, President Obama talked about the need for prevention. And he said, “We have a healthcare system that too oftenly is really a disease care system. We wait until people get sick and then we treat them. And we don’t spend enough time thinking about how to keep people well and healthy and balanced and centered in the first place.

And this afternoon the president is giving us a big boost. He will sign the 21st century cures act, which authorizes $1 billion in new funding to address the opioid epidemic. As you know, he made a bold call to congress almost a year ago for this funding. And the president and his team fought to make it happen. And people effected by this epidemic made their voices heard.

And last week, congress finally acted and the bill the president will sign today includes $1 billion in new funding for treatment and prevention. And this funding couldn’t come at a moment too soon. Last week the CBC released its new mortality statistic. Tragically in 2015 91 people per day died from drug overdoses involving opioid, up from 78 in 2014.

We are pleased to see that new initiates to prescription drugs are down and that prescription drug use, misuse is down among our youngest folks. But too many people are still suffering and overdosing from opioid use disorders. We need to get this money out so we can expand access to prevention, treatment and recovery services all across this country. And this funding will help us get us there.

And now I’d like to turn it over to Dr. Lloyd Johnston from the University of Michigan. But before I do, I really want to thank him for leading this survey from it’s beginning from 1975 through today. The monitoring the future survey is one of our prime tools to look at drug use.

And these data reported by Dr. Johnston and his team as well as our colleagues at NIDA help us make sure that our policies are working to effect and reduce drug use and its consequences in the United States. And I know this survey will be in good hands, in Dr. (unintelligible) hands going forward. So, thank you Dr. Johnston and congratulations on your well-earned retirement. I’ll turn it over to you.

Man 1: Okay, we’re going to (unintelligible) here.

Jack Stein:  If I could ask folks to mute their phones who are on the line.

Man 1: (unintelligible) it’s all good.

Nora Volkow: Please, mute your phones.

Jack Stein: If ONDCP could mute their phones. We’d like to continue.

Man 2: Our line is muted. Our line...

Jack Stein: Okay, thank you.

Man 2: Yes.

Jack Stein: (Sima), I don’t know if there’s anything you can do to help reduce the...Very good, thank you. We’d like to move on now to Dr. Johnston. And a beautiful introduction from Director Botticelli. So, please proceed.

Lloyd Johnston: Let me start by thanking very much, Dr. Volkow and Mr. Botticelli, for kind remarks about the study. This is the 42nd year that we have done the national survey of young people. We didn’t start with the young, eight and tenth graders until 1991, but still a long time.

Like most years, we surveyed about 45,000 secondary school students located in some 372 public and private high schools that are nationally representative of the co-termination states. We’ve been doing this for a long time, but this is the first year that I can remember where nearly all substances are in decline, both licit and illicit.

So, we’re talking about tobacco and alcohol and many of the illicit drugs. Including some of the most widely used ones like amphetamines, which are down about half since we first, since we measured them at a peak level in 2004. Amphetamines were being used for a while by high school seniors I think to help study, much like college students. But that seems to be passing and the rates are going down.

Narcotic drugs, as you’ve heard, are extremely important because of the number of people that we’re losing to overdoses with narcotics. It doesn’t tend to be concentrated among secondary school students. But they in turn will make up much of the, those in their 20’s in the future.

And so, it’s very good to see that we’ve seen nearly a one half drop in the proportion of high school seniors who say that they have used prescription narcotics without medical supervision. And by the way, while I’m on that subject, one of the things we ask them is where do they get the drug that they’re using. And with narcotics some 40% of the high school seniors say they get them from prescriptions that they already had.

In other words, there’s a lot of leftover medication that they go back to and use for nonmedical purposes. And I think that one implication of that is that perhaps physicians and dentists should be reducing the number of doses they put in a prescription. A person can always come back and ask for more. But having that much leftover narcotic drugs in their own prescription is, it seems to be a problem.

The ecstasy, and more generally MDMA, which includes both ecstasy and molly, are down by about two thirds in the last few years. So, that’s been a big change as well. Sedatives are down by about half in terms of use outside of medical supervision.

The heroin, as you’ve heard, is down a great deal by roughly 80% from the peak levels in the late 90’s. So, these are some of the most important and prevalent of the drugs. And they’re down. The question of course is why are they down and what can we do about continuing whatever is causing them to go down? And I think there’s maybe two factors involved.

One is that many fewer young people today are using either cigarettes or alcohol, which tend to be the first drug that young people get into before they proceed onto marijuana and the various illicit drugs. And these are now, as you’ve heard, at the lowest levels that we’ve ever recorded.

Cigarette smoking, if we look at eighth graders and how many of them have tried a cigarette. If we look back in ‘96, it was 50% of the eighth graders, today it’s only 10%. So, many fewer have even initiated cigarettes, let alone currently use them.

With alcohol, use was at 56% back in ‘94, the mid ‘90’s. Today it’s down to 23%, about a 60% drop. And that’s in terms of eighth graders who’ve ever had one drink. So, what we’ve seen is a real decline in the two licit drugs. And I think it’s quite possible that that’s contributing to the number of people who then move on to the illicit.

And as you’ve heard from Dr. Volkow, there is a connection there. The other thing to mention, and it has to do with Mr. Botticelli’s urging of community action, is we’ve seen a considerable drop in availability for, particularly for alcohol and cigarettes for young people.

And the strongest drop for the youngest, eight and tenth graders, now I think that’s largely a result of efforts on the parts of states and communities and federal government to reduce access to these substances. I don’t think anyone really had in mind that they might prevent illicit drug use by doing that. But the fact is I think maybe that has been an effect.

Third thing I want to mention is that some of the newest drugs on the scene, like salvia, synthetic marijuana and bath salts have all fallen out of favor. Which is good news. One of the things we know from the study is that over the years there’s always new drugs on the horizon.

And young people have to make decisions without much information, except what they hear about the proponents. And I think that it’s very good that those things are down as well.

So, let me stop there and ask my colleague, Richard Miech to tell us more about tobacco and vaping and other forms of tobacco.

Richard Miech: Thank you, Lloyd. Good morning all. So, I want to build on Lloyd’s comment that there are always new drugs on the horizon that are coming out. There are new ways of taking drugs. And one of the most prevalent new ways of using drugs has been vaping.

So, vaping has increased at a tremendous rate from near zero prevalence in 2011 to one of the most common forms of substance use among young people in 2015. And what we find this year in 2016, for the first time since we’ve been tracking vaping is a decline in vaping use.

A significant decline among 12th graders, among tenth graders, and among eighth graders, which is all the grades that we surveyed. So, this is indeed a novel finding, the first time it’s ever happened since we’ve been tracking vaping. And we’ve also found, for the first time, that perceived risk among adolescents on vaping has gone up slightly.

So, if we ask adolescents what are the possible risks of harm to you from regular vaping, we find that more adolescents are saying there is great risk from regular vaping. And it’s gone up to where it’s now about 20% of adolescents in each grade report great risk in vaping. So, it’s not a particularly high level of risk, but it had increased.

The risk level itself probably isn’t enough to explain why vaping prevalence has declined. It could well be that the novelty of vaping has worn off. Or perhaps it’s just no longer cool anymore to date. But that will be the topic of future research.

We also find this year, for the first time, hookah use. Hookah is, well it’s a rubber...A person who’s using a hookah uses a mouthpiece attached to a rubber hose and inhales alcohol that passes through water, I’m sorry, they inhale tobacco smoke. And that tobacco smoke is just as dangerous as cigarette smoke.

And we find that hookah use has declined in 2016. That also is the first time we’ve ever seen hookah use decline. And this is in keeping with what we’ve seen, a long standing prevalence decline in cigarette smoking. So, as mentioned previously smoking levels among eighth, tenth, and 12th graders at the lowest levels we’ve ever seen. Which is indeed good news.

Jack Stein: Terrific. Thank you all for our, the comments. We’re going to be opening the lines in one moment. Before I do so, I would like to remind everyone that supporting documentation for this teleconference can be found on the NIDA website at drugabuse.gov. Website will also have contact information for press offices for each of today’s speakers if you wish to set up individual interviews.

So, now we’d like to open up the lines to field any questions that may exist beyond the information that’s already been shared. And the operator will assist me in fielding and triaging those questions that you may have. So, with that (Sima) please feel free to open up the lines for any inquiries from the press.

Coordinator: Sure. If you’d like to ask a question, please press star one. First question is from (Mike Follick), your line is now open.

(Mike Follick): Hi doctors. I wanted to ask you a couple questions. The first being, you said there’s a drop in use from teens in all these drugs for the first time ever. How is one certain that teens are not just getting better at lying to surveyors?

Nora Volkow: I think the question has to do of course, what is the credibility of a survey when you’re asking someone who wants to give you a response based on what he thinks you want the response to be. And the way that we ensure the data has credibility is we test it and compare it against some of the results that we get from completely independent surveys.

So, there are three large surveys that look at patterns of drug use among teenagers. Ours, the survey from SAMHSA and the survey from the CBC. And across these surveys we can compare whether there is consistency on the results reported. And we have...what we have found is well, the numbers in terms of absolute numbers of kids that say that they take a drug are not exactly the same, there is a high level of concordance.

And also, more importantly that the trends, that is when the drug is going up, that is identified across the three surveys consistently. And when it’s going down, it’s also identified across the three surveys. They are also done using different methodology. The monitoring the future, which is the one that we’re discussing today, is a school based survey. Whereas the other ones are homebased.

And just like we are reporting in monitoring the future, the SAMHSA survey reported a couple of months ago, also significant decreases in drug use among teenagers. So, the fact that the data is reproducible makes us think that there is a response. And this has been seen across the inception of the survey.

So, we don’t just rely on an indicator. And we also have surveys that are smaller that also allow us to test whether in fact we can corroborate the findings from this very large survey.

(Mike Follick): My other question here is about amyl nitrates, also known as poppers. I’m wondering where they actually lie in your data. And what are...how did your survey account for the fact poppers are not actually illegal in their other nitrite forms?

Nora Volkow: (unintelligible) inhalants, but it’s a type of inhalant. So, I do not know that is...I do not know if it is actually specifically identified in the questions that relate to inhalants. So, I wouldn’t be able to answer that question. But you...

Lloyd Johnston: What is an inhalant?

Nora Volkow: Inhaler.

Female: The amyl nitrates.

(Mike Follick): Amyl nitrates.

Lloyd Johnston: Amyl nitrates.

Female: He’s asking about the nitrates.

(Mike Follick): Is that actually asked?

Lloyd Johnston: Just didn’t understand the question. I don’t think we asked specifics about amyl nitrates anymore.

(Mike Follick): Sorry, could you repeat that again?

Lloyd Johnston: I don’t believe we asked specifically about amyl nitrates. We ask about a lot of things, maybe 50 classes and subclasses of drugs, but I don’t believe that’s one.

Nora Volkow: Amyl nitrates.

(Mike Follick): But nitrates are being considered to be all under illicit inhalants despite the fact that other variants of it are legal for purchase, is that what you’re saying?

Lloyd Johnston: No, we have a general question about inhalants. And it gives examples of it. But I don’t think amyl nitrates is one. But even if it is, we don’t ask separately about it.

(Mike Follick): Okay. Any reason for that? Even though they have very different effects from regular inhalants when you’re talking about, you know, a spray can or something like that.

Lloyd Johnston: I can’t give you a specific reason. I think it’s very low. I believe we used to have it and we I think dropped it because the prevalence was so low.

Nora Volkow: I think that the issue, we are touching on something that is always difficult and there is always emerging new drugs coming into the market. So, the question is at what point do they reach a threshold that we should be adding them into the survey. For example, now there’s interest of the kratoms. So, in the...

(Mike Follick): But the policy is now that you outlaw a specific chemical structure, but in fact nitrites as long as you take away the amyl part of it, it’s the same drug. But that drug isn’t illegal.

Nora Volkow: Yes, I mean again, you are bringing up a point that is important. And the point is we are unable to ask about all about the drug classes. But the question is how important, how frequent it is among teenagers.

And we certainly can survey that using other researchers that may have the capability to start to inquire. And if the rates do come to be important, if something that we always work with monitoring the future to add the important new questions. So, if it is, we will.

(Mike Follick): Okay. And last question is do you think that perhaps the large amount of opioid users dying has to do with the decrease in use?

Nora Volkow: Can you repeat it, the question?

(Mike Follick): The question is, do you think that the large amount of opioid users actually overdosing and dying has something to do with the decrease in usage?

Nora Volkow: No. In heroin, we are not seeing that. We are seeing actually that there is an increase in heroin use among adults. And it...but we’re also seeing a massive increase in people dying from heroin and from synthetic opioids like fentanyl. In teenagers, we are not seeing that problem.

(Mike Follick): Okay, thank you very much.

Jack Stein: Thank you. We have several other questions in the queue. Our next one please?

Coordinator: Sure. Next question is from (Bob Young) from Seattle Time. Your line is now open.

(Bob Young): Hello. Dr. Volkow, I would like to ask you the obvious question. And that is why is use down particularly, or not increasing marijuana use in light of legalization and perceptions of less risk?

Nora Volkow: Yes, very important question. And of course, one that we’ve been posing ourselves. As I completely agree with Dr. Lloyd that one of the factors that is likely to have decreased the consumption of all drugs and including marijuana among eighth and tenth graders is that we’ve seen a significant reduction in the consumption of tobacco.

And we now know from many epidemiological studies as well as pre-clinical studies in laboratory animals, that nicotine actually serves as a gateway drug in ways that it actually affects the biology of the reward system. Priming it to the rewarding effects of other drugs.

In other words, if you are smoking when you take another drug, you are much more likely to like the drug and to become compulsive about its consumption. So, as we decrease consumption of tobacco and nicotine specifically, we may have unbeknownst to the prevention effort, protected kids from the rewarding effects of other drugs. And that includes marijuana.

Also, the other one is alcohol. And when kids are intoxicated or any adult is intoxicated with alcohol, you’re much more likely to engage in risky behavior such as drug taking. And the reduction in alcohol by itself may have also contributed to the less likelihood that the teenager will experiment or take illicit drugs like marijuana.

But there is also the questions that’s emerging and it’s the notion that not only have drugs gone down among teenagers, but their behavior and how they interact with one another has been dramatically changed by social media. Again, we know that peer interactions are fundamental in drug taking among teenagers. And that many teenagers experiment with drugs or take them because of peer pressure.

So, the question that emerges is as more teenagers are interacting through social media, could actually this minimize the likelihood that they’ll be in situations where the peer pressure makes them take drugs. That’s a question, that’s a speculation that needs to be investigated.

Similarly, another speculation is that there’s been incredible advances on technology for videogaming. And that has resulted in videogames that can generate extraordinary compulsive behaviors. And this in turn may serve as a substitute for the effects of drugs.

So, again, speculative, we need to do research on this whole area. And those on the one hand, prevention of and diminution of drug, legal drugs may have prevented consumption of marijuana. And so, alternative is very dramatic changes on how teenagers behave and socialize with one another may have, also needs to be investigated. Be a...to see if it’s a contributing factor to the decline.

(Bob Young): Dr. Volkow, can I ask a follow up. And that is, although it’s speculation would the substitute of videogaming be considered a good thing given the violent and other disturbing facets of some videogaming?

Nora Volkow: Yes. I mean, this is a question that we can phase with any of the technologies, right? You can have a technology that may have certain positive aspects. And when we’re speaking about substitutions that come with social media and new tools, it’s also cell phone technologies and not just a very fancy videogame that may be substituting.

Some of them are very useful, but they have particularly among those that are vulnerable and among the most vulnerable are adolescents and young adults to the compulsive behavior that can emerge from some of these video games. That can actually have a pathological consequence such as decreases in social interactions, hinder performance at school, hinder performance at work, sleep deprivation. All of those factors of course are very negative.

Jack Stein: Dr. Johnston, do you have a comment?

Lloyd Johnston: Yes. I wanted to comment on the issue of declining perceived risk for marijuana not seeming to drive down or drive up the use among high school seniors. We have...actually we’re the ones who originally established the perceived risk was an important determinant.

But we’ve never asked really assertive that it’s the only determinant. And usually, it drives disapproval, but disapproval hasn’t changed a lot for seniors. And in addition, I think there may be a difference between birth cohorts as a result of the declining use of cigarettes and alcohol. And the seniors had higher uses of cigarettes and alcohol than do tenth graders or eighth graders.

So, we’ve seen less of a downward effect there and we know among the college students that actually marijuana is still rising. So, it could be a difference by age group that eventually will disappear.

(Bob Young): I’m sorry, was that Dr. Johnston?

Jack Stein: That was Dr. Johnston speaking, correct. Okay, I think there may be at least one if not several, there are at least two, three questions in the queue. Let’s continue on. (Sima), please put forth the next question.

Coordinator: Sure. And I’d like to remind all participants, please press star one if you have a question. Next question is from (Heidi Spleet) from Patriot-News. Your line is now open.

(Heidi Spleet): Hi, thank you so much for taking my question. I just wanted to follow up a little bit on the role of clinicians, pediatricians, family physicians and what they can continue to do to help support this decline. What would be there role? What’s the take home message for them?

Nora Volkow: Well, even though monitoring the future does not specifically address the role of what are the different levels at which prevention can be implemented to minimize the likelihood that teenagers get exposed to drugs. We know for example that parents play a very important role in the community.

But we also come to recognize that the healthcare system can be a very important line of defense for early detection of substance use among teenagers. And they also can be a very good line of defense from early interventions. And this has been particularly shown to be most effective for the consumption of alcohol.

And to a less extent, and there is research going on, to maximize the likelihood that an intervention from a primary care physician or pediatrician can have a positive effect. Whereas the likelihood that a teenager that has started taking drugs will change that behavior. The healthcare system is also very important because we know that teenagers that have a mental illness are at higher risk of taking drugs.

And they are at higher risk because they may be taking them (unintelligible) out the medication. And that is where the healthcare system, by doing a proper evaluation that there may be, to rule out whether in fact there is an emerging mental disorder that may be driving the substance use. Can do an intervention to prevent further escalation.

Michael Botticelli: This is Michael Botticelli. I would add to Dr. Volkow’s point, you know, healthcare practitioners have a need to play a key role in driving down the overprescribing of prescription pain medication that we see as a key driver for this opioid epidemic. And, you know, the CDC in March came out with their guideline around prescribing behavior for chronic pain.

So, we know that the opioid epidemic, you know, has its root in the overprescribing of prescription pain medication. And diversion to, particularly to youth from unused medicine, from unused medication as Dr. Johnston talked about. So, a prime part of our strategy is ensuring that every physician and healthcare provider has a minimum amount of education on taking effective opioid prescribing.

We want to make sure that we’re educating parents and others about removing unused medication from their home. Because we know that 70% of prescription drug misuse starts by people getting them free from friends and family.

So, I think they have a particular role to play as it relates to the opioid epidemic. And again, I think this is why we were very pleased to see the continued downward trend in prescription pain misuse. Particularly among a very young and vulnerable group of people.

(Heidi Spleet): Thank you.

Jack Stein: Great, thank you. Another question please?

Coordinator: (Martha Irvine), your line is now open.

(Martha Irvine): Hi, this is (Martha Irvine) from The Associated Press. I just wondered if you could elaborate whether, you just said that those with mental health issues are at greater risk of abusing drugs. Can you talk more about drug use and teenagers with mental health issues? And or who may say they use because of stress?

Nora Volkow: Yes. And that’s actually the (unintelligible) why a teenager may start taking a drug, if they have an underlying mental illness. It’s going to be dependent on the type of drug and on the type of problem.

So, for example, among teenagers that have an attention deficit hyperactivity disorder that have not been diagnosed, the consumption of nicotine has been associated with an increase capacity to sustain attention. And therefore, the importance of properly diagnosing them in order to do an intervention.

Similarly, in patients suffering an early emergence of psychotic symptoms, some of drugs may allow them, certainly nicotine, to have an improvement in cognitive performance or even an improvement in mood. Which could help explain why teenagers may have depression are much more likely to take drugs because at least temporarily the drugs will make them feel better even though of course with the repeated use it just exacerbates the symptoms.

So, this is...and this becomes particularly (unintelligible) many times is not easy to do diagnosis in its early stages. In this case, when you have a teenager that is consuming at a very young age drugs, that should alert the physician about the possibility that there is a reason why that teenager is using this drug. They are more vulnerable.

And the good news is certain that when you treat these teenagers you actually can prevent them from further consumption of these drugs. And their outcomes are much better.

Jack Stein:  Thank you, Dr. Volkow. I believe there is another question. Please put that through.

Coordinator: One moment. Next question is from (Peter) from Epic Times. Your line is now open.

(Peter): Hi. This is (Peter) from Epic Times. You mentioned that marijuana use was higher in states with medical marijuana laws. Was there any difference between states with medical marijuana and within states that have recreational marijuana laws?

Nora Volkow: Dr. Johnston will answer that question because I don’t think we have sufficient sample sizes, but...

Lloyd Johnston:          We don’t have sufficient sample sizes in the few states that have legalized recreational marijuana. So, there have been other studies in those states. Colorado studies suggested that there was an increase in marijuana use among secondary school students. But, I’m not able to speak to that from our own data.

(Peter): Right. Okay, thank you.

Jack Stein: Okay. Let’s see, if there are any more questions, operator please put them through.

Coordinator:  Sure. If you have any other questions, please press star one. I’m showing no further questions at this time.

Jack Stein: In that case, we would like to thank you all for taking the time. I’d like to...a special thanks to our, all of our presenters. And a particular special recognition of Dr. Johnston for his 42 years of passionate work on this very important survey, so thank you Dr. Johnston for that.

To remind the listeners that materials on this event are all found on the NIDA website, drugabuse.gov. And with that, we’re going to officially conclude this teleconference. Thank you for your time. And operator, we can officially conclude.

Coordinator: Thank you. This now concludes today’s conference. And all lines may disconnect at this time.

END

This page was last updated December 2016

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