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Monitoring the Future: Teleconference 2018

December 18, 2018

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Dr. Nora Volkow, NIDA Director, discusses the results of the 2018 Monitoring the Future survey during a teleconference on December 17, 2018. Monitoring the Future tracks drug use trends of 8th, 10th, and 12th-grade students, including attitudes and perceived risks of specific drugs. Dr. Volkow is joined by Richard A. Miech, Ph.D., Principal Investigator, and Lloyd D. Johnston, Ph.D., Angus Campbell Collegiate 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

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

Lloyd D. Johnston, Ph.D.
Angus Campbell Collegiate Research Professor, Institute for Social Research, University of Michigan

Location: Teleconference

Time: 11:00 a.m. EST
Date: Monday, December 17, 2018

Transcript by My Meetings by Verizon.

Dr. Jack Stein: Thank you very much. Good morning everyone. My name 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 Institutes of Health.

And we’d like to welcome you to this teleconference press briefing on the 2018 Monitoring the Future study. Monitoring the Future is a national survey that measures drug, alcohol, and cigarette use and related attitudes among 8th, 10th, and 12th graders nationwide from both public and private schools.

Survey participants report their drug use behaviors across three time periods – lifetime, past year, and past month. This is the 44th year of this study that is supported by NIDA and conducted by the University of Michigan. The survey is the only comprehensive federal government-funded survey on teen drug use and releases findings the same year the data are collected.

We’re delighted to host this event today. I will just quickly mention how we’ll proceed and then we’ll move right into our briefing. Following my comments we’ll have presentations by several of the principals involved or connected with this study.

We’ll begin with Dr. Nora Volkow who is the director of the National Institute on Drug Abuse. Following Dr. Volkow, we will have Richard Miech and Dr. Lloyd Johnston, both from the University of Michigan, who are the individuals responsible for conducting the Monitoring the Future study.

I 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 Web site at drugabuse.gov. I’d now 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.

Dr. Nora Volkow: Jack, thanks very much and good morning everybody. I do want to thank Dr. Richard Miech and Dr. Lloyd Johnston who are the principle investigators for these grants and have been providing us this extremely interesting information.

I want to start by saying I’m going to be highlighting three aspects of the results that we got this year on Monitoring the Future that to me are quite notable.

I’d like to start with good news, which is actually we are continuing to see some of the lowest rates of illicit substance use among teenagers in our country as well as some of the lowest rates of licit substance use, that is nicotine and alcohol, among teenagers.

And some of those reduction are particularly dramatic in the light of the fact that we are amidst an opioid crisis where the use and consumption of opioids is continuing to increase and yet we’re seeing some of the lowest rates of consumption of prescription opioids as well as heroin that we have seen since the survey was initiated. So that’s quite important.

Item number two though is what are the areas of concern, and you will hear further from the principle investigators the main area of concern is how rapidly teenagers have embraced the use of vaping devices to actually administer different types of drugs.

And some of these increases are actually quite dramatic. Whereas in 2017 most of the teenagers reported that they were vaping for the use of just the flavor, this year we see that most of the teenagers are reporting that they are using of nicotine.

So how large are these increases? Well in some instances they are actually more than double or more than double actually the consumption of substances through these devices.

We are seeing teenagers reporting to operators that 30% of them in the past year have vaped nicotine which is of course of great concern, due to the fact that many of the advances that have been done towards decreasing smoking among teenagers may now be - there is concern that some of them may be (unintelligible) as teenagers become addicted to nicotine they may then transition into combustible tobacco.

Similarly these vaping devices are - there’s been increased use for the consumption of (9-THC) which is the active ingredient of marijuana. More teenagers are seeing - though not as dramatic as for nicotine but 30% increases in consumption of cannabis through these devices. And this is a new technology that may in the future also be utilized to administer other types of drugs.

And then the third notable aspect in this new data is that despite also significant increases in marijuana consumption across all ages, we’re not seeing it in adolescents. And in fact the prevalence rate of smoking marijuana has been very, very stable and this year for regular marijuana is close to 6%. And it has been at that level for the past four or five years.

So even though the rest of the illicit substances are going down, we’re not seeing decreases in marijuana. But we are not seeing increases. And so there is something going on that appears to be protecting teenagers against the use of drugs, which brings me to my last point.

I mentioned that it was notable that we are seeing very low rates of opioid prescription and heroin use among teenagers. Yet if we look at the epidemiology of the utilization of these drugs in young adults, we see the highest rates of opioid utilization among those that are 18 to 24 years of age.

So we see this transition of where there’s a very low rate of use of opioids among teenagers. And then as they transition into young adults, those rates goes up, highlighting the transition from adolescence into young adulthood as one of vulnerability for opioid experimentation, misuse and also unfortunately overdoses.

So there is good news. There are worrisome news with the vaping that you will hear more details. And then there’s the recognition that while there may be something that is providing (resilience) on teenagers, this appears to be lost as they transition into young adulthood.

Dr. Jack Stein: Excellent. Thank you, Dr. Volkow. Our next speaker will be Dr. Richard Miech, the principal investigator of the Monitoring the Future survey from the University of Michigan. Dr. Miech.

Dr. Richard Miech: Thank you so much, Jack. Thank you, Nora. That was a very concise summary of the main findings this year. I’ll use my time to embellish on them a little bit and go into a little more depth.

I first want to start off with the background for Monitoring the Future. Its main strength is that it’s nationally representative. And what I mean by that is that there are more than 10 million 8th, 10th, and 12th graders in the United States. And if we did a survey of all of them, that would be very expensive and very time-consuming. So what we do is a survey.

We have a list of all the 12th, 10th, and 8th-grade schools in the United States. And we pick a random draw from that list. And we use that to invite those schools that are part of our random draw to participate in the survey. And because we do this in a particular scientific manner, we’re able to generalize our findings and say with confidence that what we found in our survey is what we would find if you had actually surveyed the more than 10 million out there.

So perhaps the main finding this year has been the startling increase in nicotine vaping. So as Nora mentioned it’s doubled in 12th grade from 11% to 21%. So that may not mean much to many people, so there’s other ways to look at that same increase.

One way to look at it is that Monitoring the Future has been in business for 43 years – 44 years, excuse me. We’ve reported increases for 43 of those years. We couldn’t report an increase the first year because there was no comparison year.

We have reported more than 1000 increases over the past 43 years on the various drugs that we survey. And this is by far the largest we’ve ever seen out of these 1000 increases that we reported for past 30-day use. In fact, the second largest increase was only half as large as what we saw in nicotine vaping this year.

The second largest increase was in marijuana use from 1975 to 1976. So this is a really big increase. It’s - well, it’s historic shift actually. It’s one of the largest we’ve ever seen in the past 43 years. So I wanted to emphasize the size, the magnitude of this increase.

Also we found that – as Nora pointed out – there was also a significant increase in marijuana vaping. So to date, marijuana vaping has been pretty rare. Maybe 4% or 5% of adolescents report that they did that in the past 30 days.

But that increased 50% in 10th grade and 12th grade to about 7%, and 8th grade is a little bit smaller. And it’s part of a general pattern where pretty much all illegal drug use among adolescents has been increasing or staying steady except if you can vape it. Anything that can be vaped – it doesn’t matter – it goes up.

So nicotine vaping went up. Marijuana vaping went up. We asked kids if they vaped just flavoring. That went up too. So something about this delivery device of vaping seems to really appeal to kids. Of course, there’s the flavors I think are a large part of that, as well the concealability.

Some of these vaping devices are shaped like flash drives and can be kept in your pocket. And you just suck on them and they start up. There’s no on and off switch. They’re very convenient. You can just use them whenever you want.

So given the ease and the concealability and the flavors, these all seem to be contributing to great popularity of vaping among adolescents today. And with that, I will pass it over to Lloyd who will talk about other findings as well.

Dr. Jack Stein: Yes, thank you. Dr. Lloyd Johnston also from the University of Michigan will now be commenting. Dr. Johnston.

Dr. Lloyd Johnston: Thank you, Jack. Good morning everyone. As you heard from Professor Miech, the key finding this year is in vaping. But there’s been some other interesting things going on. Dr. Volkow has alluded to some of those. I want to go into them a little bit.

One is that we have seen since the mid-90s a dramatic decline in cigarette smoking by adolescents. Thirty-day prevalence and daily prevalence of smoking in all three grades is down by 80% to 90%. That means that we’re going to have cohorts of young people who will have longer lives, less disease, and it’s going to hopefully transfer to future cohorts that are coming through.

Because this has happened so incrementally, I’m not sure that really the public knows about this. But we’ve made so much progress on cigarettes. Of course, that’s one of the reasons we’re concerned about vaping, because it has the potential to reverse that tremendous accomplishment.

We know that all other forms of tobacco that we’re tracking – and there are many – have edged lower this year. Most of them are down significantly over recent years but not in 2018.

But despite this, there was a considerable increase in the proportion of 12th graders who were using nicotine in the past 30 days. And that’s up as Dr. Volkow mentioned about five percentage points. So that’s almost all due to the vaping because the other - the tobacco products are all in decline.

And despite a significant increase in marijuana vaping, we’re still not seeing any increase of the proportion of people who - young people who are using marijuana at all. So it looks like at the moment most of those who have vaped marijuana have probably already been users. But that doesn’t mean that will be that way in the future.

As to alcohol, as with cigarettes, we’ve seen a long-term and very important decline in use by adolescents. Again I’m not sure this is fully recognized by the public. The only thing that continued this year was 12th grade, but all grades have shown long-term improvements, which in the lower grades halted this year.

The progress has been impressive. Since the peak rates in the late 90s (unintelligible) prevalence is down by 70% among 8th graders, by 55% among 10th graders and by 43% among 12th graders. And I expect that the 12th graders will continue to show the declines because to some degree you’re looking at cohort effects here, which moves through the ages as class cohorts do.

Binge drinking is probably the most concern of the alcohol behaviors that we looked at. And that means having five or more drinks in a row in the past two weeks at least once. And we had some pretty high rates of binge drinking among adolescents.

But now since 2005 among the 12th graders, we’ve seen a drop of about half. So again, that’s important improvements. In the lower grades it’s actually seeing declines greater than half.

We also in more recent years introduced the concept of extreme binge drinking which we meant ten or more drinks in a row in one sitting. And that’s down by about 2/3 among 12th graders from where it was, so again important improvement.

There are many illicit drugs that we looked at other than marijuana. However this year only two of them showed further declines, almost most have declined in the past. And those are tranquilizers and opiates. Tranquilizers had a modest decline this year but it continues an earlier one.

They’re down to only 3.9% of the high school seniors using tranquilizers in the past year. But you might expect to see an increase in the use of narcotics, given what we know and many of you have probably written about, which has been the rising epidemic of overdoses and fatal overdoses.

But in fact, we’re seeing a continuing and a substantial decline among adolescents in their use of opiates other than heroin. The peak rates were close to 10% back in the early 2000s, from about 2002 to 2009, which is pretty high for a drug this addictive. And, by the way, only 12th graders report this use.

But since then there’s been a steady decline in the annual prevalence of opiate use. And it’s down about 2/3 from where it was at that point. So even though there is an epidemic of overdoses going on, it’s not observed among the adolescents.

So how do we reconcile that? Well I think one way to reconcile it is to look at the fact that those cohorts back in the first decade of the 2000s who were heavy users, many of them are now in their 20s and 30s and they may be part of the overdose epidemic that we’re seeing now, given the fact that narcotics are potentially very addictive.

And there is potentially a cohort effect here where a cohort that goes through high school carries with them their heavy opiate use as they go into young adulthood. And that can both lead to an epidemic and it can lead to the end of an epidemic.

I mean, if we want to look at the positive part of this, a cohort effect of the low usage, cohorts that are now going through high school hopefully will help to bring down the amount of opiate use among people in their 20s.

Heroin has not shown an increase in this group either. Use has actually declined substantially although no further changes at this point in time. All these grades have less than a half of a percent of their respondents indicating they’ve used any opiates in the past 12 months.

Finally, I want to speak to meth and crystal meth. There’s a lot in the news, and some of you may be writing it, about the fact that meth is making a comeback. And I have no doubt that it is. But again it’s not something that’s making a comeback among adolescents. Use of meth and crystal meth have both fallen substantially since the late ‘90s. And they’re down around a half of a percent reporting any use at this point.

So it appears that adolescents are not contributing to either of these important epidemics that are happening right now, except insofar as they carry earlier heavy use into their adult years. Thank you.

Dr. Jack Stein: Okay, thank you very much to actually all of our speakers. We’re going to open the lines for questions in one moment. But before I do so, I just wanted to remind everyone that supporting documents for this teleconference including press releases, visuals, and an overview of the findings can all be found on the NIDA Web site at drugabuse.gov.

The Web site will also have contact information for press offices for each of today’s speakers if you wish to set up individual interviews. And with that we’re now going to open the lines for any questions that may exist beyond the information that’s already been shared. The operator will assist me in fielding any questions that you may have.

Coordinator: Thank you Dr. Stein. At this time if you would like to ask a question, please take yourself off mute and record your name and media outlet when prompted to be introduced. Once again it is Star 1 and please record your name and media outlet to be introduced for your question. Please stand by for questions.

One moment for our first question. Our first question is from Alison Knopf with Alcoholism & Drug Abuse Weekly. Ma’am your line is open.

Alison Knopf: Thank you. This question is for Dr. Volkow. What about the 6% of daily marijuana users, 12th graders? What are the effects on their health? I know that this number has been stable year after year. What are their prospects for the future? Are they addicted and what can be done to help them if they need help as they grow into a world of legalized recreational marijuana? Thank you.

Dr. Nora Volkow: You know, thanks for the question. And there are two aspects that one needs to consider where taking into account that 6% of 12th graders are smoking marijuana regularly. One of them is the fact that the current marijuana leaf has a much higher content of (9-THC) that they’ve had it in the past.

So if we want to actually compare values of what may be the consequences of regular marijuana use today from those that we had in the past, we have to realize that we have a much more addictive and therefore much more potent drug. And this is likely to then influence the likelihood that it may have negative effects.

So what are the negative effects? And this comes to your question. What are the concerns? The concerns that with regular marijuana use you’re much more likely to become addicted. And this particularly true if you are a teenager.

So the younger you start and initiate marijuana use, the greater the likelihood that you will become addicted to it and as a result of that more likely that you will therefore have adverse consequences for an addiction and the other adverse consequences that have actually been reported by multiple independent studies which is regular marijuana use is associated with greater dropout from school.

So when we’re discussing the fact that we have teenagers still in school that are taking marijuana, we know that this is going to interfere with their capacity to learn and memorize, that it will increase that risk that they will drop out of school. And as they increase their risk of dropping out of school, of course, they will jeopardize their ability ultimately to fulfill an education.

And this is without considering the other aspect regarding the potential negative effects that the consumption of regular marijuana may have on the developing human brain. We now know again from multiple studies in humans that the human brain does not fully develop until it’s in the mid-20s.

And drugs are actually particularly effective in modifying the trajectories of brain development and in particular for example cannabinoids which we are actually – we produce in our brain – one of its functions during childhood and adolescence is to participate in the orchestration of the developing brain.

And therefore the concern that if you are consuming marijuana you’re going to be interfering with these regulatory process. So that’s the main issues as it relates to why we are so concerned about relatively high rates of marijuana use. Even though they haven’t gone up, they are actually at fairly high levels.

Alison Knopf: Thank you.

Coordinator: Thank you. Once again if you would like to ask a question please press Star 1. Unmute your line and record your name and media affiliation to be introduced. We have a question from Heidi Splete with Internal Medicine News. Your line is open.

Heidi Splete: Hi, thank you for taking my call. This is for any of the three speakers who’d like to weigh in on it. What would be the take-home message for clinicians, for family practice and for primary care, for pediatricians who are seeing kids as far as the vaping in particular?

Dr. Nora Volkow: Richard?

Dr. Richard Miech: This is Richard Miech. Thank you for the question. One thing that I think is important to emphasize is that vaping is not innocuous. It’s not harmless, which I think a lot of students and a lot of parents seem to believe. One particular risk factor of concern is that vaping seems to increase the risk that kids will later go on to smoke cigarettes.

So I can think of at least 20 studies now that have followed kids at baseline, kids who have never smoked a cigarette in their life. Some of those kids are vaping. Some of those aren’t. And you follow up with those kids a year later, and the kids who were vaping are about five times more likely to have smoked a cigarette in the past year.

So that is one particular concern I think for everybody. As well vaping also contains some of the same toxicants, not to the same degree, but some toxicants that are also found in cigarette smoke. So kids who are vaping are in some ways acting like guinea pigs. And we will find out in the future what the long-term consequences to that will be.

Dr. Nora Volkow: Yeah, and I want to add a couple of things because actually in terms of why this is of concern. As Dr. Miech said very clearly the concern that they could transition into combustible tobacco is something that the data at least in the adults seems to indicate that this is a real concern.

Plus the other potentially harmful effects associated with irritants that are in - are used to actually put the flavors or the chemicals that actually sneak out of these devices since there’s no quality control.

And there’s also the effect of the temperature of these vapors that actually produces irritation into the pulmonary respiratory tract, particularly when you do it regularly.

But then we also have to pay attention about what is it that this device is doing. And these vaping devices are actually manufactured to ultimately deliver drugs into your lungs. And the lung is this organ that is (unintelligible). I mean, there are thousands of capillaries that ultimately absorb the drug directly from the pulmonary space into the circulation and deliver it at very high concentrations into the brain.

So this route of administration, vaping, is associated with characteristics that increase the likelihood of these drugs to be addictive. Just like smoking delivers the drugs very rapidly into the brain, so does vaping. And as a result of that, the devices themselves are actually one of the reasons why it’s not surprising and now being utilized to administer other types of drugs.

But then there’s the third concern that’s related to nicotine. Nicotine is addictive and actually it is highly addictive. And the younger you start nicotine, just like for marijuana, the higher the likelihood that you will become addicted.

But there’s compound into nicotine that has been shown actually both in laboratory experiments in animals as well as from epidemiological data which is that nicotine can actually prime an individual for the reinforcement effects of other drugs of abuse.

And as a result of that, if you’re exposed to nicotine when you take another drug, the other drug will be more rewarding and it will increase the likelihood that ultimately you will take it again and repeatedly you could become addicted.

So this is another concern with respect to teenagers getting exposed and addicted to nicotine that by its priming the brain for the rewarding effects of other drugs that it may also increase the vulnerability for addiction to other substances.

Heidi Splete: Thank you.

Coordinator: Once again if you wish to ask a question please press Star 1 on your touch tone phone. Please record your name and media affiliation to be introduced. Once again it is Star 1 at this time. Please stand by. At this time Dr. Stein I show no further questions.

Dr. Jack Stein: Okay well we want to thank you for helping facilitate today’s meeting. And for those of you who have joined us, very much appreciate it. We will be concluding the press conference. Once again all materials related to this release of the survey can be found on the NIDA Web site at drugabuse.gov.

And again we’re happy to set up individual interviews as requested through our press office. So I want to thank our three presenters today and for all of you to be listening today. And we’re - at this point we can adjourn our press conference, so thank you very much.

Coordinator: That does conclude today’s conference call. We thank you all for participating. You may now disconnect and have a great rest of your day. Happy holidays everyone.

Dr. Nora Volkow: Happy holidays.

END

This page was last updated December 2018

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