Dr. Nora Volkow, NIDA Director, discusses the results of the 2019 Monitoring the Future survey during a teleconference on December 18, 2019. 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, from the Institute for Social Research, University of Michigan.
Jack Stein, Ph.D.
Director, Office of Science Policy and Communications, National Institute on Drug Abuse
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
Time: 1:00 p.m. – 2:00 p.m. EST
Date: Wednesday, December 18, 2019
Transcript by My Meetings by Verizon.
Dr. Jack Stein: Thank you very much. Good afternoon, everyone. My name is Dr. Jack Stein. I'm the Chief of Staff and Director of the Office of Science Policy and Communications here at the National Institute on Drug Abuse which we call NIDA. And it's part of the National Institute of Health.
We'd like to welcome you to this teleconference press briefing on the 2019 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 behavior across three time periods; lifetime, past year and past month.
This is the 45th 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 that 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 the principals involved or connected with this study. We will begin with Dr. Nora Volkow who is the Director of the National Institute on Drug Abuse. Following Dr. Volkow, we will have Richard Miech from the University of Michigan who is the principal investigator responsible for conducting the monitoring the future study.
I just want 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 like to now turn things over to the Director of the National Institute on Drug Abuse, Dr. Nora Volkow will have some brief comments about the study and with that, Dr. Volkow.
Dr. Nora Volkow: Jack, thanks very much. And good afternoon, everybody. This is a very important event because it gives us a perspective on what are the trends of drug use among teenagers as it relates to what are the drugs that they are favoring. How frequently are they using it? What are the concerns about these drugs and how they - I mean how do they believe their ability - how (unintelligible) their availabilities for them?
What this survey is telling us in I would say the past two years which we have been doing for 45 years is that there is a clear shift in the pattern of drug-taking among adolescents. Last year we reported that there was almost a doubling in vaping of nicotine among teenagers. And this year we're reporting that there's almost a doubling in vaping of marijuana. And this is occurring amidst overall trends that we have observed for the past five years. Insignificant reductions in tobacco smoking, alcohol drinking, heroin consumption, cocaine use, methamphetamine use, prescription opioid use whether it is Vicodin or Oxycontin and there's also a significant reduction in the use of stimulant drug Adderall or amphetamine.
This, of course, this indicator, these past indicators are very good. But it is very unfortunate that we're not seeing a very steep rise in embracing by teenagers of the use of vaping devices. Vaping devices are new technologies which we did not monitor in the past. And in 2017 we started to specifically ask questions about how they are using these devices which are very appealing to teenagers for the consumption of nicotine or marijuana.
And we rapidly saw within one year period almost a doubling in the use of nicotine last year. And this year we're seeing almost a doubling in the use of these devices for vaping. Now, why is this concerning? It is concerning because vaping devices deliver drugs at very high concentrations. And in general, what we're observing when someone smokes cigarettes for example, it takes a certain period of time for the individual to start to increase the doses that they are consuming.
With vaping devices, this is much easier. It's made easier in part by the fact that you're not inhaling these very (unintelligible) compounds when you burn tobacco. But also it's facilitated by the use of flavors which actually appear many of them to be engineered to target adolescents. And the result is the numbers that you are observing. Thirty-five percent of 12th graders, 30% of 10th graders have reported that in the past year they have vaped nicotine. And again I'm going to emphasize, it is being vaped by a very high content of nicotine that actually can result in toxicity and significantly increases the risk for addiction.
Similarly, the very significant rise in vaping of marijuana which went from 7.5% to 14% in the past month for 12th graders and a significant increase in 8, 10 or 12th graders for the past two years in terms of vaping of marijuana. This is concerning. On the one hand, we're seeing how vaping of marijuana is associated with acute lung injury and death. And on the other side, there is increasing evidence that consumption of high content THC particularly regularly is associated with a significant risk of psychosis.
And (unintelligible) we do know that the higher the content of THC and the earlier the age of initiation, and the pattern of use, a regular pattern of use being particularly problematic is associated with a very high risk of addiction. And this is why the current findings are very concerning because they are actually pointing to a very fast increase in the consumption of drugs in teenagers at the time we have made major advances in preventing drug utilization and experimentations by teenagers.
And therefore, what the data is telling us that there is an urgency to provide interventions to be able to protect teenagers against vaping as well as measures and policies that will decrease their consumption overall. And with that, I want to actually now, it's an honor for me to introduce the principal investigator of Monitoring the Future and as we said, this is a study being done at the University of Michigan by Dr. Richard Miech and his team. Richard?
Dr. Richard Miech: Thank you so much, Nora. And thank you all in the audience for your attention and interest in the topic. And I also want to thank first and foremost all the teachers, the school district personnel, the counselors, and everybody who has allowed us to come in and survey the kids in these different schools throughout the country that allow us to look at the trends in substance use among teens. Without the voluntary participation of these principals and teachers and school district personnel, we would not be able to do what we do. So I'd like to start off thanking all those people.
I'd like to echo part of what Nora has said that the topline finding in 2019 for Monitoring the Future is marijuana vaping which has increased significantly among 12th and 10th graders, one in five. One in five has reported that they vaped marijuana in the past year. So it's quite substantial. A typical class might have 30 kids in it. So we're talking maybe five to six kids in every class will have vaped marijuana on average.
At the same time, and this is kind of an interesting result, we find that overall marijuana prevalence did not increase. It's the same as it has been in 2019 as it was in 2018. So that raises an interesting question. How could it be that marijuana vaping overall prevalence using any particular methods, smoking or eating or vaping, how could that be the same while marijuana vaping is increasing?
And there are basically two hypotheses. One would be the substitution hypothesis. Maybe kids who previously were smoking marijuana are now vaping it. That's Hypothesis Number 1. And Hypothesis Number 2 is what I call a supplemental hypothesis. Maybe vaping is supplementing marijuana use among kids who are smoking it. So maybe in addition to smoking it, now they can vape it as well.
What we find this year in addition to the big increase in marijuana vaping is that daily marijuana use among kids significantly increased in 8th grade and in 10th grade, and 12th grade it also increased, although not significantly so. And that finding to me lends support to the supplement hypothesis. That these kids who in the past were just smoking it, now they can vape it as well. And we see a more intensity of marijuana use which is going to have effects on the developing brain of teenagers if they use it in higher intensity now than they did in the past.
So definitely marijuana vaping it's the top line story of 2019. It's almost old news that nicotine vaping has increased so much, doesn't mean that it's not important. As Nora pointed out, we saw very big increases in nicotine vaping last year. In fact, of all the substances that we've measured over the past 45 years, and we measure about 50, but last year of nicotine vaping what's the largest increase with ever seen for any substance. And this year, the increase in marijuana vaping is the second-largest increase we've ever seen. So these are very alarming increases in teen substance use. As Nora pointed out, we've made a lot of progress over the past two decades and reducing teen substance use.
Cigarette smoking, for example, has declined about 90% that's the year 2000. And unfortunately, this new mode of delivery for substance use is really end-roads among teens. The policies and rules at schools and other institutions that house teens that put into place to try to prevent drug use, they're easily defeated by vaping devices. A teen can have a vaping device in his or her pocket and they can take a hit on it and very discreetly and then put it back in their pocket. Difficult to come up with a rule to prevent that from happening.
That being said, I'd like to point out that Monitoring the Future is nationally representative, so we have a list of every single school in the United States both public and private and we take a random draw from that list. The schools that are selected are the ones that we go out and we survey. This year we surveyed 45,000 - I'm sorry, 42,000 adolescents and 8th, 10th and 12th grades throughout the United States and our results generalized to the general population of all 16 million 8th, 10th, and 12th graders in the United States.
In other words, come away with the same results you would get if you surveyed all 16 million of them. Ours might be off by a percentage point or two, but that's it. So this is a very efficient way with our surveys of 45,000 or 42,000 to find out what substances kids are using and the United States and how those have changed from year to year.
We asked not only about marijuana vaping, but as Nora mentioned, we asked about a whole host of other drugs as well. I'm happy to report that teenage cigarette smoking has continued to decline as it has since the year 2000. Opioid use among teens it peaked at around 2007 non-medical and it's been going down ever since and it continued to decline in 2019 significantly so among 12th graders. So and alcohol use is also at some of the lowest levels we've ever seen and the history of the survey over the past 45 years.
So there's both good news and there's bad news. The good news is that smoking, and alcohol is down. The bad news is that vaping is up and the consequences of this are not known. And it's going to require renewed effort for us to reduce teen vaping in the future.
With that, I'll hand it back over to Jack.
Dr. Jack Stein: Great, thank you, Drs. Volkow and Miech. We're going to be opening the lines for questions in one moment. Before I do so, I just want 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 are going to open the lines for any questions that may exist beyond the information that's already been shared. The operator will assist in fielding any questions that you may have.
Coordinator: Thank you. We will now begin the question and answer session. If you would like to ask a question, please press star 1. You will be prompted to record your name. To withdraw your question, you may press star 2. Again, press star 1 to ask a question. And just a few minutes for our first question. Again, just press star 1 to ask a question. And one moment, please.
And our first question comes from John Daly with Colorado Public Radio. Your line is open. You may ask your question.
John Daly: Hi, so I'm wondering if either of you has any insights into whether vaping is a gateway for marijuana use or whether marijuana use is a gateway for vaping? You may be aware that Colorado is the Number 1 state for teen vaping. But we haven't seen the same rise in marijuana vaping, at least not yet in the data. Maybe that will be confirmed when, you know, more data comes out which I think is expected in the summer. But in general, I don't know if you have any insights or if the data that you've collected here tells you anything about the relationship between vaping and using that delivery system and marijuana consumption.
Dr. Nora Volkow: We've been doing studies, of course. This is relatively new for us since vaping is such a new technology. But what we do know is consumption of THC which is the active ingredient of marijuana or the same thing is true with nicotine can prime the brain to the rewarding is (unintelligible). And to the extent that you actually get exposed to these drugs early on, it will make you more vulnerable not just to the consumption of that drug in the future and more vulnerable to addiction. But also the reinforcing and addictive effects of other drugs of abuse.
So in that context, to the extent that vaping marijuana is going to be delivering a higher content of (unintelligible) THC, one can predict that it is likely to actually increase the likelihood of taking not just marijuana but other drugs. From the survey, Dr. Miech said, based on the data, it appears that overall it is those teenagers that were smoking marijuana, the ones that are vaping THC. And that's where he comes up with the two potential hypotheses as opposed to saying they start with vaping of THC and then go into smoking marijuana.
That does not appear to be the case for marijuana. However, that may be very much the case of vaping nicotine where we don't see actually where we see teenagers starting with vaping nicotine that has never been exposed to tobacco. And with perspective stories of what some of them are showing is that these teenagers or (unintelligible), they must have been done in young people, are at higher risk of then going into combustible tobacco.
Dr. Richard Miech: If I could, just a simple observation to the extent that your question was does vaping nicotine perhaps lead people to vape marijuana, because they already have a vaping device and maybe it's just a simple switch, a cartridge, right? I will point out that vaping nicotine increased substantially last year in terms of the (unintelligible) sequence and marijuana increased this year. So it could be the case. It's consistent with the idea that kids start vaping nicotine first and then it's a very easy switch to transition to marijuana vaping. But it's all very new material for us. It's a whole new territory. And I don't have any definitive answer for you on that yet.
John Daly: And then just to follow, so you're saying that because the devices can be used for a variety of different substances, that once you’ve started using it with one thing, then there's nothing to really stop you from switching and using it for other kinds of substances, even beyond nicotine or THC, I guess, potentially.
Dr. Richard Miech: Yes, it seems like it would be very convenient to switch from one to the other.
Dr. Nora Volkow: Yes, in fact, one of the things that were very interesting in 2017 when they actually started to ask the question about whether it was vaping flavors or vaping nicotine or vaping marijuana. Is that we have seen a transition for why teens are using these vaping devices. Initially was predominantly at least they believed they were using it for flavoring which actually corresponds also their answers when asked why do you use these vaping devices. The second most frequently cited answer is because they like the flavors.
But then subsequent to that year, we've seen more and more teens actually explicitly stating that they seek it for nicotine. Vaping nicotine is the most frequent reason for using it and the second one is vaping marijuana whereas vaping for flavors has gone down, just for flavors. So to the extent that we see this progression, you can see how if you start with just vaping flavors and you feel comfortable, then the transition into behavior that does have the drug could be easier to do.
John Daly: Okay, great, thank you very much.
Dr. Jack Stein: Thank you. Operator, any other questions?
Coordinator: Yes, again if you'd like to ask a question, just press star 1. Our next question comes from Heidi Splee from Pediatric News. Your line is open. You may ask your question.
Heidi Splee: Hi, thank you for taking my question. I was wondering what would be a take-home message for clinicians or family practice physicians or doctors who see teenagers as far as addressing this issue of the vaping of marijuana? What might they look for or what might they say or counsel teens and parents?
Dr. Nora Volkow: Well that's an extremely important question. I'm glad you are making it. Because it does highlight the responsibility that physicians have toward screening and evaluating for the use of vaping among teenagers. And also for parents to be able very early on to communicate with their children in ways that are salient to them about the dangers of vaping.
We heard Dr. Miech say that one of the reasons why probably they are favoring it because you can take them, for example, at school without necessarily being actually identified as taking a drug. But as importantly you probably can take it at home without parents noticing it because there's no smell. Whereas if you smoke marijuana it basically stinks the whole house. The opportunity to do it in situations that otherwise will not be available is very high. It's increased. And makes it much easier. So parents to having an open policy of an open behavior of discussing with their children why drugs are harmful could make a big impact.
No similarly, in the school system to have educational teenagers about what we know about the delivery system and why they are so dangerous as well as what we know about the (unintelligible) effects of nicotine and marijuana to the growing brain would be important points to make. And certainly, physicians are in a unique position to actually communicate with their young patients and encourage them. Do interventions to encourage them to stop if they started to experiment. Or importantly, refer them to treatment if they have become addicted to the drug.
Heidi Splee: Thank you.
Dr. Jack Stein: Thank you.
Coordinator: Thank you. Again, just press Star 1 to ask a question. Our next question comes from Andrew Lansarud. You may ask your question. That's with (unintelligible) news.
Andrew Lansarud: Hi, I was wondering if you notice or if you recorded any difference between states that legalized marijuana and in states that had not or partially legalized medical (unintelligible), things like that. Does that make it more accessible or is it -is there no real effect or is there some other effect?
Dr. Richard Miech: Yes, that's an excellent question. So Monitoring the Future is assigned to be nationally representative. It's not designed to be a state representative which would be a much more expensive proposition. We would have to hit at least 50 schools in each state, I think, as a benchmark. And in some of the states like Wyoming we're lucky to get one school. So we're not really set up for state-level comparisons.
That being said, there are some circumstances where we can do such comparisons with medical marijuana, for example, that's about 50/50 now among the states. This is a nice distribution so we can feel pretty confident that our results are valid and that they're robust. And so we have looked at teen marijuana use among states with and without medical marijuana laws. And we find no difference which has also been found in other datasets as well. That we were expecting there might be an increase in marijuana use because perhaps the perceived risk of marijuana use among teens went down, but that did not occur.
Right now, the number of states that have legalized marijuana is growing from strictly cold science - cold-hearted scientific perspective. It would be great if half the schools and half the states legalized and the other half didn't, because that would be very good for us for scientific analysis. And we're getting there, but at this point, we don't have enough states yet that have legalized marijuana use to do - to feel confident to that type of state-level analysis.
Andrew Lansarud: Okay, if you don't mind a slightly unrelated follow-up question. I was wondering if talking about vaping and especially talking about e-cigarettes and (unintelligible) and sort the pod things. But I know that there are other products on the market that let you vape pretty much marijuana buds. Do you know anything about the hardware these kids are using or are there some - is there a trend in that regard?
Dr. Richard Miech: Yes, I have no idea to tell you the truth. We are tracking overall levels of use of marijuana use and vaping and smoking. But we have not gotten into the particular hardware the kids are using at this point.
Dr. Nora Volkow: And I think that one of the things about Monitoring the Future is we don't know how things are going to be changing into the future. And so we are very alert of questions like this that suggest that there is a new route of administration for a drug or a new drug that is being favored by teenagers. So that we can start surveying it as soon as possible. But and in this case, if it does become are regular use, certainly, we will be adding questions that pertain to it.
Andrew Lansarud: Okay, well thank you very much.
Coordinator: Thank you. Again, if you'd like to ask a question, just press star 1 at this time. And one moment, please while we check for further questions. And at this time, I'm showing no further questions.
Dr. Jack Stein: Okay, operator thank you very much. Thank you for everyone who has participated or remained on the lines. We will b concluding this press teleconference at this time. We do refer you back to the NIDA Web site at drugabuse.gov for any further questions as well as contact information. With that, thank you for your time and operator, we can officially conclude.
Coordinator: Thank you, and this does conclude today's conference. We thank you for your participation. At this time, you may disconnect your lines.