Psychiatr News July 4, 2008
Volume 43, Number 13, page 4
© 2008 American Psychiatric Association
Diverging Trends Characterize Age-Related Illicit Drug Use
Jun Yan
While substance use is showing signs of decline among youth, it appears to
be rising in some segments of the population. Meanwhile, the amphetamine
epidemic is abating in Western states.
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Moira O'Brien, M.Phil., tells annual meeting attendees that the overall
trend of illicit substance use among youth is improving as attitudes change
toward substances commonly abused. However, substance abuse is increasing
among older Americans.
Credit: David Hathcox
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There appears to be a decline in the use of some illicit substances in
certain populations but an increase of such use among people in their early
50s, according to national survey data presented at APA's annual meeting in
May.
By collecting data from various sources, public health officials can
monitor substance use trends, predict use patterns in the near future, and
take steps to stem rising tides of risky behavior.
According to the most recent National Survey on Drug Use and Health
(NSDUH), presented by Moira O'Brien, M.Phil., health scientist administrator
at the Division of Epidemiology Services and Prevention Research at the
National Institute on Drug Abuse (NIDA), an estimated 20.4 million people aged
12 and older were projected to be using illicit drugs nationwide in 2006, not
including tobacco and alcohol.
The NSDUH, an annual survey sponsored by the Substance Abuse and Mental
Health Services Administration, also found that the substances most frequently
used by people aged 12 and over were marijuana (14.8 million people) and
psychotherapeutics for nonmedical reasons (7 million), with cocaine (2.4
million) a distant third. Psychotherapeutics refer to painkillers,
tranquilizers, stimulants, and sedatives.
Substance use by teenagers has been in slow decline for the past several
years, as shown by data from the NIDA-sponsored Monitoring the Future survey,
an annual school-based survey of substance use patterns in youth.
"The overall trend in recent years is good news," said O'Brien.
"The overall rate of illicit drug use in students in the eighth, 10th,
and 12th grades has declined significantly, by 24 percent from 2001 to
2007."
"Attitude is a good predictor of future use trends," she noted.
For example, while the growing rate of disapproval of marijuana among eighth
to 12th graders is a good sign that use of this substance may lessen,
youth—especially eighth graders—now perceive ecstasy use as less
risky than their older counterparts do. Thus, ecstasy use is expected to
increase, and more public health education and interventions may be needed
with regard to this drug, she said.
Although substance use trends among youth have captured much public
attention, a notable problem revealed by the NSDUH data is "a
significant increase of illicit drug use for those aged 50 to 54 from 2002 to
2006," O'Brien pointed out. "These are people who grew up in
1960s, when drug use became common." She advised clinicians to be aware
of substance use problems in this often-overlooked population. In contrast,
the rates in the 55 to 59 age group showed no significant difference between
2002 and 2006.
"The baby-boom generation had an exposure to growing substance use in
[the] '60s and '70s," Timothy Condon, Ph.D., deputy director of NIDA,
explained. A large proportion of them have less aversion to drug use than
their parents, he said. Adding to the change of attitude toward substance use
is the increased availability and social acceptance of prescription drugs,
including psychoactive medications, in the past several decades. "This
is going to be a serious problem in the future when [they have] more leisure
time," Condon said.
A number of other sources provide different perspectives on substance use
in the general population that cannot be captured by large-scale surveys, such
as new substances being abused or early signs of a local epidemic.
"Electronic media are changing the dissemination of information about
substance abuse," Edward Boyer, M.D., an assistant professor of
emergency medicine at the University of Massachusetts Medical School, told the
audience.
He pointed to two major Web sites as sources on which to monitor substance
use trends:
<www.erowid.org>,
a massive online encyclopedia of legal and illegal substances; and
<www.drugbuyers.com>,
an aggregator of Internet pharmacy data popular among buyers of analgesics.
The former site contains firsthand accounts of drug "trips" and
pharmacological data on unusual substances. The latter site reflects market
shifts (including the black market) in the availability and prices of opiates
and psychotherapeutic agents.
NIDA also collects data from sources such as state and local public health
departments, poison centers, drug abuse treatment centers, law enforcement and
medical examiners' databases, and other surveillance efforts. The Community
Epidemiology Work Group (CEWG), a network of public-health representatives
from major metropolitan areas and some states across the country, has been
meeting semiannually to exchange intelligence and monitor regional convergence
and variations in drug abuse trends.
Findings reported at the January CEWG meeting, for example, indicated that
the rise of methamphetamine use in Western regions in previous years may be
leveling off or in decline, according to O'Brien. She also noted that in the
past decade, data from Florida and the Detroit area showed decreasing numbers
of heroin-related deaths and a parallel increase in prescription
opiate-related deaths from methadone, hydrocodone, and oxycodone. 
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