IBH President Robert L. DuPont, MD presented his book at The Heritage Foundation hosted by Senior Research Fellow Paul Larkin. Following Dr. DuPont’s remarks which focus on the state of the nation’s drug epidemic, the future of prevention and addiction treatment, he answers questions from the audience.
ADDICTION POLICY FORUM RELEASES YOUTH DRUG PREVENTION TOOLKIT
OP-ED: WE CANNOT LET E-CIGARETTES BECOME AN ON-RAMP FOR TEENAGE ADDICTION
An op-ed in The Washington Post from Alex M. Azar, Secretary of Health and Human Services (HHS) and Scott Gottlieb, Commissioner of the Food and Drug Administration (FDA), brings much-needed attention to the growing problem of youth use of nicotine through e-cigarettes: In one year fom 2017 to 2018, “the number of high-school-age children reporting use of e-cigarettes rose by more than 75 percent. Use among middle-schoolers also increased nearly 50 percent. That is an epidemic… The surge in e-cigarette use by teenagers is alarming because nicotine is highly addictive and can harm brain development, which continues into young adulthood. Worse, kids who start on e-cigarettes are actually more likely than non-user peers to migrate to smoking tobacco…” Read more.
IBH promotes the prevention goal for youth under age 21 as One Choice: no use of any alcohol, nicotine, marijuana or other drugs for reasons of health. Read more about One Choice Prevention.
7 REASONS WHY I THOUGHT AA WASN'T FOR "SOMEONE LIKE ME"
The Fix features a powerful statement of a person struggling recovery who unexpectedly found recovery support in Alcoholics Anonymous. “As time went on, I quickly realized that the reasons I believed that AA wasn’t for me weren’t just misguided, they were completely wrong. While I wish I’d had these realizations sooner, I’m grateful now for the fellowship I found when I was finally able to open my heart and mind.” Read more.
OP-ED: IT’S HIGH TIME WE TOOK A BREATH FROM MARIJUANA COMMERCIALIZATION
The Denver Post published a remarkable op-ed from Colorado US Attorney Bob Troyer urging Colorado and other states considering marijuana legalization to pause and assess the results of this policy experiment. Among the highlights he mentions:
Colorado's youth use marijuana at a rate 85 percent higher than the national average
Marijuana-related traffic fatalities are up by 151 percent
70 percent of 400 licensed pot shops surveyed recommend that pregnant women use marijuana to treat morning sickness
Colorado has a booming black market exploiting our permissive regulatory system
Marijuana tax revenue adds less than one percent to Colorado's coffers, which is more than washed out by the public health, public safety, and regulatory costs of commercialization
Colorado's alcohol consumption has steadily climbed since marijuana commercialization
He wisely says, “We should pause and catch our breath before racing off again at the industry's urging.” Read more.
MARIJUANA USE AMONG COLLEGE STUDENTS AT HIGHEST LEVEL IN 30 YEARS
New data from the nationally representative Monitoring the Future survey show marijuana use among college students has reached the highest levels in three decades. Notable, in 2017 4.4% of college students reported daily or near-daily marijuana use in the past month while 13.7% of same-age non-college students were daily users, a number that has doubled since 2006. Principal investigator John Schulenberg noted, “The brain is still growing in the early 20s, and the scientific evidence indicates that heavy marijuana use can be detrimental to cognitive functioning and mental health… Getting a foothold on the roles and responsibilities of adulthood may be all the more difficult for these one-in-eight noncollege youth who use marijuana on a daily or near daily basis. As for college students, we know from our research and that of others that heavy marijuana use is associated with poor academic performance and dropping out of college.” Read more.
CHEMICAL SLAVERY NOW AVAILABLE
At a time when the nation is searching for ways to save lives from opioid and other drug overdoses as well as how to reduce the burden of addiction on individuals, families and communities, IBH President Robert L. DuPont, MD has written Chemical Slavery: Understanding Addiction and Stopping the Drug Epidemic, for parents, teachers, physicians and for everyone afflicted by addiction. The book also guides leaders in public policy and planning positions, as well as drug abuse treatment. Chemical Slavery covers two crucial topics: First, the national drug epidemic including an understanding of its evolution to become a national emergency, and the science of addiction and recovery. Second, Dr. DuPont presents his experience-based guide to the intimate, day-to-day struggle with the disease of addiction from prevention to lasting recovery. This book shows the ways in which these two domains of addiction, the national and the personal, are intertwined and can be both understood and managed. Read more.
BLEAK NEW ESTIMATES IN DRUG EPIDEMIC
The New York Times reports a record number of overdose deaths in 2017, reaching 72,000. Reflecting a 10% increase in deaths from 2016, the overdose epidemic shows little sign of slowing down. "According to the CDC estimates, overdose deaths involving synthetic opioids rose sharply, while deaths from heroin, prescription opioid pills and methadone fell."
"Strong synthetic opioids like fentanyl and its analogues have become mixed into black-market supplies of heroin, cocaine, methamphetamine and the class of anti-anxiety medicines known as benzodiazepines. Unlike heroin, which is derived from poppy plants, fentanyl can be manufactured in a laboratory, and it is often easier to transport because it is more concentrated." Read more.
Copyright New York Times
MORE IN US SAY DRUG ABUSE HAS CAUSED FAMILY TROUBLE
A new Gallup poll shows 30% of Americans report drug abuse has caused trouble in their families, up from 22% in 2015, "a signal that the nation's opioid epidemic, which has worsened in recent years, is taking a toll." A total of 37% of Americans report their families are negatively effected by alcohol, similar to past years, and 43% report smoking has caused health problems in their families. Read more.
REDUCING FUTURE RATES OF ADULT ADDICTION MUST BEGIN WITH YOUTH PREVENTION
Click here to download a PDF version of this commentary
Reducing Future Rates of Adult Addiction Must Begin with Youth Prevention
The United States is confronting a public health crisis of rising adult drug addiction, most visibly documented by an unprecedented number of opioid overdose deaths.1 Most of these overdose deaths are not from the use of a single substance – opioids – but rather are underreported polysubstance deaths.2 This is happening in the context of a swelling national interest in legalizing marijuana use for recreational and/or medical use. As these two epic drug policy developments roil the nation, there is an opportunity to embrace a powerful initiative. Ninety percent of all adult substance use disorders trace back to origins in adolescence.3,a New prevention efforts are needed that inform young people, the age group most at-risk for the onset of substance use problems, of the dangerous minefield of substance use that could have a profound negative impact on their future plans and dreams.
Moving Beyond a Substance-Specific Approach to Youth Prevention
The adolescent brain is uniquely vulnerable to developing substance use disorders because it is actively and rapidly developing until about age 25. This biological fact means that the earlier substance use is initiated the more likely an individual is to develop addiction. Preventing or delaying all adolescent substance use reduces the risk of developing later addiction.
Nationally representative data from the National Survey on Drug Use and Health shows that alcohol, tobacco and marijuana are by far the most widely used drugs among teens. This is no surprise because of the legal status of these entry level, or gateway, drugs for adultsb and because of their wide availability. Importantly, among American teens age 12 to 17, the use of any one of these three substances is highly correlated with the use of the other two and with the use of other illegal drugs. 4 Similarly for youth, not using any one substance is highly correlated with not using the other two or other illegal drugs.
For example, as shown in Figure 1, teen marijuana users compared to their non-marijuana using peers, are 8.9 times more likely to report smoking cigarettes, 5.6, 7.9 and 15.8 times more likely to report using alcohol, binge drink, and drink heavily, respectively, and 9.9 times more likely to report using other illicit drugs, including opioids. There are similar data for youth who use any alcohol or any cigarettes showing that youth who do not use those drugs are unlikely to use the other two drugs. Together, these data show how closely linked is the use by youth of all three of these commonly used drugs.
aAmong Americans age 12 and older who meet criteria for substance use disorders specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). bMarijuana remains illegal under federal law but is legal in some states for recreational use the legal age is 21, and in some states for medical use, the legal age is 18. Nationally the legal age for tobacco products is 18 and for alcohol it is 21.
Figure 1. Past Month Use of Other Drugs, if Marijuana is Used, Ages 12-17
These findings show that prevention messaging targeting youth must address all of these three substances specifically. Most current prevention efforts are specific to individual substances or kinds and amounts of use of individual drugs (e.g., cigarette smoking, binge drinking, drunk driving, etc.), all of which have value, but miss a vital broader prevention message. What is needed, based on these new data showing the linkage of all drug use by youth, is a comprehensive drug prevention message: One Choice: no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health. 5,6,7 This no use prevention message provides clarity for young people, parents, physicians, educators, communities and for policymakers. It is not intended to replace public health prevention messages on specific substances, but enhances them with a clear focus on youth.
Some claim adolescent use of alcohol, cigarettes and marijuana is inevitable, a goal of no use of any drug as unrealistic and that the appropriate goal of youth prevention is to prevent the progression of experimentation to later heavy use or problem-generating use. These opinions are misleading and reflect a poor understanding of neurodevelopment that underpins drug use. Teens are driven to seek new and exciting behaviors which can include substance use if the culture makes them available and promotes them. This need not be the case. New data in Figure 2 show over the last four decades, the percentage of American high school seniors who do not use any alcohol, cigarettes, marijuana or other drugs has increased steadily. In 2014, 52% of high school seniors had not used any alcohol, cigarettes, marijuana or other drugs in the past month and 26% had not used any alcohol, cigarettes, marijuana or other drugs in their lifetimes.8 Clearly making the choice of no use of any substances is indeed possible – and growing.
Figure 2. Past Month Trends among High School Seniors in Abstaining from Alcohol, Cigarettes, Marijuana and Other Illicit Drugs
Key lessons for the future of youth prevention can be learned from the past. Substance use peaked among high school seniors in 1978 when 72% used alcohol, 37% used cigarettes, and 37% used marijuana in the past month.9 These figures have since dropped significantly (see Figure 3). In 2016, 33% of high school seniors used alcohol, 10% used cigarettes and 22% used marijuana in the past month. This impressive public health achievement is largely unrecognized.
Figure 3. Percentage of US High School Seniors Reporting Past Month Substance Use, 1975-2016
Although the use of all substances has declined over the last four decades, their use has not fallen uniformly. The prevalence of alcohol use, illicit drug use and marijuana use took similar trajectories, declining from 1978 to 1992. During this time a grassroots effort known as the Parents’ Movement changed the nation’s thinking about youth marijuana use10 with the result that youth drug use declined a remarkable 63%. Rates of adolescent alcohol use have continued to decline dramatically as have rates of adolescent cigarette use. Campaigns and corresponding policies focused on reducing alcohol use by teens seem to have made an impact on adolescent drinking behavior. The impressive decline in youth tobacco use has largely been influenced by the Tobacco Master Settlement Agreement which provided funding to anti-smoking advocacy groups and the highly-respected Truth media campaign. The good news from these long-term trends is that alcohol and tobacco use by adolescents now are at historic lows.
It is regrettable but understandable that youth marijuana use, as well as use of the other drugs, has risen since 1991 and now has plateaued. The divergence of marijuana trends from those for alcohol and cigarettes began around the time of the collapse of the Parents’ Movement and the birth of a massive, increasingly well-funded marijuana industry promoting marijuana use. Shifting national attitudes to favor legalizing marijuana sale and use for adults both for medical and for recreational use now are at their highest level11 and contribute to the use by adolescents. Although overall the national rate of marijuana use for Americans age 12 and older has declined since the late seventies, a greater segment of marijuana users are heavy users (see Figure 4). Notably, from 1992 to 2014, the number of daily or near-daily marijuana uses increased 772%.12 This trend is particularly ominous considering the breathtaking increase in the potency of today’s marijuana compared to the product consumed in earlier decades. 13,14,15 These two factors – higher potency products and more daily use – plus the greater social tolerance of marijuana use make the current marijuana scene far more threatening than was the case four decades ago.
Figure 4. Millions of Americans Reporting Marijuana Use, by Number of Days of Use Reported in the Past Month
Through the Parents’ Movement, the nation united in its opposition to adolescent marijuana use, driving down the use of all youth drug use. Now is the time for a new movement backed by all concerned citizens to call for One Choice: no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health. This campaign would not be a second iteration of the earlier “Just Say No” campaign. This new no-use message focuses on all of the big three drugs together, not singly and only in certain circumstances such as driving.
We are at a bitterly contentious time in US drug policy, with front page headlines and back page articles about the impact of the rising death rate from opioids, the human impact of these deaths and the addiction itself.16 At the same time there are frequent heated debates about legalizing adult marijuana and other drug use. Opposing youth substance use as a separate issue is supported by new scientific evidence about the vulnerability of the adolescent brain and is noncontroversial. Even the Drug Policy Alliance, a leading pro-marijuana legalization organization, states “the safest path for teens is to avoid drugs, including alcohol, cigarettes, and prescription drugs outside of a doctor’s recommendations.” 17
This rare commonality of opinion in an otherwise perfect storm of disagreement provides an opportunity to protect adolescent health and thereby reduce future adult addiction. Young people who do not use substances in their teens are much less likely to use them or other drugs in later decades. The nation is searching for policies to reduce the burden of addiction on our nation’s families, communities and health systems, as well as how to save lives from opioid and other drug overdoses.18 Now is precisely the time to unite in developing strong, clear public health prevention efforts based on the steady, sound message of no use of any alcohol, nicotine, marijuana or other drugs for youth under age 21 for reasons of health.
Robert L. DuPont, MD, President, Institute for Behavior and Health, Inc.
www.PreventTeenDrugUse.org / www.OneChoicePrevention.org
[1] Hedegaard, M., Warner, M., & Minino, A. M. (2017, December). Overdose deaths in the United States, 1999-2016. NCHS Data Brief, 294. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Available: https://www.cdc.gov/nchs/data/databriefs/db294.pdf
[2] Florida Drug-Related Outcomes Surveillance and Tracking System (FROST), University of Florida College of Medicine. http://frost.med.ufl.edu/frost/
[3] The National Center on Addiction and Substance Abuse at Columbia University. (2011). Adolescent Substance Use: America’s #1 Public Health Problem. New York, NY: Author. Available: https://www.centeronaddiction.org/addiction-research/reports/adolescent-substance-use-america%E2%80%99s-1-public-health-problem
[4] DuPont, R. L., Han, B., Shea, C. L., & Madras, B. K. (2018). Drug use among youth: national survey data support a common liability of all drug use. Preventive Medicine, 113, 68-73.
[5] DuPont, R. L. (2015). It’s time to re-think prevention: increasing percentages of adolescents understand they should not use any addicting substances. Rockville, MD: Institute for Behavior and Health, Inc.
[6] DuPont, R. L. (2017, October 23). For a healthy brain teens make “One Choice”. Rockville, MD: Institute for Behavior and Health, Inc. Available: https://www.preventteendruguse.org/s/IBH_Commentary_One_Choice_10-23-17.pdf
[7] Chadi, N., & Levy, S. (2017). Understanding the highs and lows of adolescent marijuana use. Pediatrics, 140(6). Available: http://pediatrics.aappublications.org/content/pediatrics/early/2017/11/02/peds.2017-3164.full.pdf
[8] Levy, S., Campbell, M. C., Shea, C. L., & DuPont, R. L. (2018). Trends in abstaining from substance use in adolescents: 1975-2014. Pediatrics, doi: 10.1542/peds.2017-3498.
[9] Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2017). Monitoring the Future national survey results on drug use, 1975–2016: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan. Available at http://monitoringthefuture.org/pubs.html#monographs
[10] Dufton, E. (2017). Grass Roots: The Rise and Fall of Marijuana. New York, NY: Basic Books.
[11] Geiger, A. (2018, January 5). About six-in-ten Americans support marijuana legalization. Washington, DC: Pew Research Center. Available: http://www.pewresearch.org/fact-tank/2018/01/05/americans-support-marijuana-legalization/
[12] Caulkins, J. (2017, November 7). Psychoactive drugs in light of libertarian principles. Law and Liberty. Available: http://www.libertylawsite.org/liberty-forum/psychoactive-drugs-in-light-of-libertarian-principles/
[13] ElSohly, M. A., Mehmedic, Z., Foster, S., Gon, C., Chandra, S., & Church, J. C. (2016). Changes in cannabis potency over the last 2 decades (1995-2014): Analysis of current data in the United States. Biological Psychiatry, 79(7), 613-619.
[14] World Health Organization. (2016). The Health and Social Effects of Nonmedical Cannabis Use. Geneva, Switzerland: Author. Available: http://www.who.int/substance_abuse/publications/cannabis/en/
[15] Rocky Mountain High Intensity Drug Trafficking Area. (2017, October). The Legalization of Marijuana in Colorado: The Impact, Volume 5. Denver, CO: Author. Available: https://rmhidta.org/files/D2DF/2017%20Legalization%20of%20Marijuana%20in%20Colorado%20The%20Impact2.pdf
[16] E.g., Sanger-Katz, M. (2018, August 16). Bleak new estimates in drug epidemic: a record 72,000 overdose deaths in 2017. The New York Times, p. A1. Available: https://www.nytimes.com/2018/08/15/upshot/opioids-overdose-deaths-rising-fentanyl.html; Seelve, K. Q. (2018, January 21). One son. Four overdoses. Six hours. A family’s anguish. New York Times, p. A1. Available: https://www.nytimes.com/2018/01/21/us/opioid-addiction-treatment-families.html
[17] Drug Policy Alliance. (2018). Real drug education. New York, NY: Author. Available: http://www.drugpolicy.org/issues/real-drug-education
[18] The President’s Commission on Combatting Drug Addiction and the Opioid Crisis. (2017). Final Draft Report. Available: https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-15-2017.pdf