Monitoring the Future Survey 2016

Dr. Nora Volkow: What we are seeing this year which we saw last year, is significant decreases in the patterns of illicit substances across all ages, 8th, 10th, and 12th.

Except, actually the use of marijuana among 12th graders, where the levels are being stable as it relates to the yearly, the monthly, and the regular use.

Those have not changed.

But in 8th graders, the marijuana has gone down and some of the indicators of 10th graders have also gone down.

We've also seen a significant decrease in the abuse of opioid prescriptions, and that immediately jumps to mind Vicodin which has actually at its lowest it has ever been.

In fact, this year, the prevalence of Vicodin is even lower than Oxycontin.

In past years and this year, we have started to see that the regular of marijuana superseded the regular use of smoking, cigarette smoking and it is not because marijuana has gone up.

It is because cigarette smoking has continued to go down in the regular pattern, which is very, very good.

The same thing with alcohol.

Alcohol has been going down slower than tobacco, but none the less those significant decreases actually continued and pertain to several perimeters.

Not just occasional use of alcohol, but even binge drinking, which is the most dangerous pattern of alcohol use among teenagers, and again we are seeing for 8th, 10th, and 12thgraders.

The patterns of use for e-cigarettes is lower this year than it was last year.

Also, in the survey we are asking the teenagers, the teenagers are being asked whether when they use the e-cigarette, do they use it for nicotine, do they use it just for flavor or just use or marijuana, for THC.

60% of them say they, whether it is 8th, 10th, or 12th grade, it is for the flavor.

And more or less,  approximately 20% use it for nicotine and less than 10% use it for THC.

Dr. Volkow: The way that teenagers are communicating has changed dramatically over the past 10 to 15 years, and it has been accelerated as of the past five years.

Social media has permeated the life of all teenagers and we now know that teenagers spend much more time with these devices and in front of the computer that they had ever, ever done before and that they are communicating much more electronically done in our face-to-face perspective.

We knew from all of the epidemiological studied and the studies and lessons that mirror the behavior of observing other teenagers and the dynamic that exists on peer pressure when you are with other teenagers contributes significantly to the initiation and repeated drug use among adolescents among teenagers…a very powerful driver.

So the question that emerges, and we don't have answers because this has not been investigated but the question comes to mind could these changes in interaction be playing a role on that decreasing consumption of drugs by teenagers?

Because the probability of them being in the physical presence of other teenagers has been decreased by the fact that now they are more interacting through the web than in person, that's one. 

I also think that we need to do research in terms of understanding how other types of reinforcers that teenagers are picking up that did not exist to the same extent amongst teenagers are actually substituting for the culture of taking drugs.

And in particular, for example, the use of video games which have actually just skyrocketed in terms of technology and the power and drive they have to capture the behavior of teenagers to the point that in certain countries like China, Taiwan, Korea…they have established clinics for treating addiction to these video games among teenagers.

Cause teenagers get compulsive about it and they relinquish their school activity their social life and they stopped sleeping and then it can be quite harmful.

So you are changing the pattern of requiring compulsive options to teenagers that were not there in the past.

Dr. Compton: Monitoring the Future has been documenting for the last three years that more youth use e-cigarettes than use traditional cigarettes.

That really is a surprise to many people that teenagers are using e-cigarettes even though they never used another form of tobacco first.

This may be what they're beginning to experiment with.

What we have seen some positive developments in the 2016 data we see a slight decline in the number of youth that are reporting e-cigarettes.

We already know that the youth that are taking up e-cigarettes are more likely to make that transition to traditional combustible tobacco than don’t use e-cigarettes.

So, those that start with e-cigarettes make that transition to combustible tobacco more readily.

We know that from some longitudinal studies that NIDA has supported.

What we don't know is necessarily is this due to the nicotine, or is it due to the learned behavior.

What's in these products?

So, there's some very basic information that's missing.

What's in the e-cigarette products?

So what are youth exposed to on a regular basis?

When they're trying these new devices.

Hookahs became extremely popular just a few years ago we started seeing hookah bars for young adults, or older adults and teenagers are not immune from that.

They're curious about the same things that they see young adults and others using so we saw a surprising number close to twenty percent using hookah just a couple of years ago.

We do see some improvements in the 2016 data that there are fewer using these hookah forms of tobacco in the 2016 data.

Dr. Volkow: There are no words to actually, thank him for how important his work has been and I realized that he is stepping down as a PI, but I also know his passion for this topic and I know he will continue to be involved.

So, I look forward to many more years of interaction with Lloyd. 

I mean, I always learn something from him.

Dr. Compton: I, personally have been a fan of Monitoring the Future since long before I came to the NIH.

I think it's been a remarkable resource to understand drug use trends in the United States and that's really because of Dr. Johnston's consistency in how he asks the questions.

So, he doesn't respond if fads or major changes but he makes sure that he's able to connect the dots in terms of look at rates of drug use year after year by measuring this phenomenon reasonably consistently.

Of course, there had to be some changes over time, but I'm very appreciative of his ability to do this in a remarkably even and consistent way.

Monitoring the Future is an annual survey of 8th, 10th, and 12th graders conducted by researchers at the University of Michigan, Ann Arbor, under a grant from the National Institute on Drug Abuse, part of the National Institutes of Health. Since 1975, the survey has measured drug, alcohol, and cigarette use and related attitudes in 12th graders nationwide; 8th and 10th graders were added to the survey in 1991.

45,473 students from 372 public and private schools participated in the 2016 survey.

Figure 1: Past-Month Marijuana Use Mostly Steady
From 1996 to 2016, past-month marijuana use was mostly steady among 8th, 10th, and 12th graders.

In 2016, past-month use for each grade was:

12th grade: 22.5%
10th grade: 14.0%
8th grade: 5.4%

68.9 percent of high school seniors do not view regular marijuana smoking as harmful, but 68.5 percent say they disapprove of regular marijuana smoking.

Figure 2: Past-Month Alcohol Use Continues Steady Decline
From 1996 to 2016, there was a steady decline in past-month alcohol use among 8th, 10th, and 12th graders.

In 2016, past-month use for each grade was:

12th grade: 33.2%
10th grade: 19.9%
8th grade: 7.3%

Figure 3: Past-Month Cigarette Use Continues Steady Decline
From 1996 to 2016, there was a steady decline in past-month cigarette use among 8th, 10th, and 12th graders.

In 2016, past-month use for each grade was:

12th grade: 10.5%
10th grade: 4.9%
8th grade: 2.6%

Figure 4: Teens More Likely to Use E-Cigarettes than Cigarettes
Past-month e-cigarette versus cigarette use for each grade was:

8th grade:

• cigarette use: 2.6%
• e-cigarette use: 6.2%

10th grade:

• cigarette use: 4.9%
• e-cigarette use: 11.0%

12th grade:

• cigarette use: 10.5%
• e-cigarette use: 12.5%

What did 12th graders think was in the mist they inhaled from an e-cigarette?

• 62.8 percent thought they were inhaling flavoring.
• 24.9 percent thought they were inhaling nicotine.
• 6.8 percent thought they were inhaling marijuana or hash oil.
• 5.6 percent said they didn't know what they were inhaling.

Despite the belief that the liquid used in e-cigs contains only flavoring, it also might contain nicotine.

Figure 5: Prescription/Over-the-Counter vs. Illicit Drugs

Past-year misuse of Vicodin® among 12th graders has dropped dramatically in the past 5 years, from 7.5 percent in 2012 to 2.9 percent in 2016. So has misuse of all prescription opioids among 12th graders despite high opioid overdose rates among adults.

Past-year misuse of prescription/OTC drugs among 12th graders in 2016 were:

• amphetamines: 6.7%
• tranquilizers: 4.9%
• opioids other than heroin: 4.8%
• cough medicine: 4.0%
• sedatives: 3.0%

Past-year use of illicit drugs among 12th graders in 2016 were:

• marijuana/hash: 35.6%
• hallucinogens: 4.3%
• synthetic marijuana: 3.5%
• MDMA (Ecstasy): 2.7%
• cocaine (any form): 2.3%
• salvia: 1.8%
• inhalants: 1.7%

Students Report Lowest Rates Since Start of the Survey

Across all grades, past-year use of inhalants, heroin, methamphetamine, alcohol, cigarettes, and synthetic cannabinoids are at their lowest by many measures.