Methamphetamine Use in U.S. Continues Slide

WASHINGTON — The past-month methamphetamine use dipped sharply from 529,000 in 2007 to 314,000 in 2008 in people aged 12 years and older, according to data from the 2008 National Survey on Drug Use and Health.

That represents a decline of past-month meth use by almost half since 2006, when that number was 731,000.

One possible reason for the decrease could be the effect of the Combat Methamphetamine Epidemic Act (CMEA), which was enacted in 2006 to regulate sales of over-the-counter medications that could be used in manufacturing methamphetamine, said Dr. Carl C. Bell, director of public and community psychiatry at the University of Illinois at Chicago.

Under the CMEA, the medications were taken off the shelf, certain limits placed on their purchase, customer ID was required, and sales were tracked—making it easier to find methamphetamine labs and close them down, said Dr. Bell, also with Community Mental Health Council Inc. and the Institute for the Prevention of Violence, both in Chicago.

However, Lloyd Johnston, Ph.D., principal investigator of the Monitoring the Future study, which tracks drug use among 8th, 10th, and 12th graders, said in an interview that he and his colleagues have been reporting a steady drop in methamphetamine use in that population since they started monitoring it in 1999 when past-year use was 4.1%, compared with 1.3% in 2008.

“The drop in meth use among teens and young adults has been occurring since the turn of the decade,” said Dr. Johnston, who is also a professor at the University of Michigan's Institute for Social Research in Ann Arbor. “We don't have the relevant perceived risk measure for meth, but I think that the tremendous amount of bad publicity that meth use and local meth production received in earlier years led young people to see it as more dangerous and less glamorous than they had previously.”

The NSDUH study found that misuse of prescription drugs also decreased significantly between 2007 and 2008 among individuals aged 12 years and over—including adolescents—and that there has been progress in containing other types of illicit drug use, though the data showed that the overall national past-month users of illicit drugs has remained level at about 20 million (8%) since 2002. (Illicit drugs include marijuana/hashish, cocaine/crack, heroin, hallucinogens, inhalants, and prescription psychotropics that are used nonmedically.)

“We are seeing the benefits of a public effort that accepts that addiction is treatable and therapy works,” said Eric B. Broderick, D.D.S., the acting administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), which sponsored the study and presented the report at a press conference. “It's important to get [our] message out.”

Marijuana was the most commonly used illicit drug, though again, 2008 levels of use remained steady compared with the previous year. The drug was used by 15.2 million or just under 75.7% of current illicit drug users, and 57.3% of all users used only marijuana.

In the 12- to 17-year-old group, 9.3% used illicit drugs, of whom 6.7% used marijuana (8% in 2007) and 2.9% used nonmedical prescription drugs. The remainder used inhalants and hallucinogens (1% each) and cocaine (0.4%).

Within this group, types of drugs used in the previous month varied by age: in the 12- to 13-year group, 1.5% had used prescription drugs nonmedically and 1% had used marijuana; in the 14- to 15-year group, almost 5.7% had used marijuana and 3.0% nonmedical prescription drugs; and among 16- to 17-year-olds, 12.7% had used marijuana and 4.0% hallucinogens.

Overall illicit drug use and use of specific drugs in this group held steady between 2007 and 2008, though there was an increase in the past-month rate of hallucinogen use (1.0% in 2008 vs. 0.7% in 2007) because of an increase in Ecstasy use (0.3% in 2007 vs. 0.4% in 2008), and a decline in the nonmedical use of prescription drugs (2.9% in 2008 vs. 3.3% in 2007) that was driven by a slowdown in nonmedical pain reliever use.

Past-year use of Ecstasy was 1.4% for 2008, which was significantly lower than 2002's level of 2.2%, but higher than the lowest level of 1.0% in 2005. Similar use of LSD also showed an upward trend to 0.7% last year, compared with 1.3% in 2002 and the highest rate of 0.4% in 2006.

Dr. Johnston said that data from the MTF study had shown that “Ecstasy use had dropped dramatically after 2001 as teens came to see it as more dangerous than they previously had [however,] more recent cohorts of teens are now seeing Ecstasy use as considerably less dangerous than teens did just 3-5 years go, making them more vulnerable to a rebound in use.”

He said that he and his colleagues had found that LSD use in teens had bottomed out in 2002, probably because of a drop in availability rather than an increase in perceived risk of the drug. However, there has been a “slight bounce” back in recent years, and of concern is that the decline in perceived risk and disapproval of the drug, might make this group vulnerable to LSD use if supply increases, he noted.

“This erosion in perceived risk is something that we believe happens as new cohorts of young people age enter adolescence and don't know what their predecessors learned about the drug. We call it ‘generational forgetting,’” Dr. Johnston said.

The NSDUH study showed that current illicit drug use was higher among young adults aged 18 to 25 years (20%) than it was in youths aged 12-17 (9%) and those aged over 26 (6%). However, the 2008 and 2007 rates remained steady.

Among those aged 50-59 years—the baby boomers—past-month use increased from 2.7% in 2002 to 4.6% in 2008. In the 50- to 54-year group, that rate went from 3.4% in 2002, to 6.0% in 2006, and 4.3% in 2008; and in the 55- to 59-year group, the levels were 1.9% in 2002 and 5.0% in 2008. The investigators suggest this increase might be a result of the aging boomers' higher lifetime rates of illicit drug use.

Among the continuing concerns is that of the 23.1 million people who need treatment for illicit drug use, only 2.3 million (about 10%) receive treatment. Gil Kerlikowske, director of the National Drug Control Policy, emphasized the importance of addressing these treatment disparities. “Health care costs can be contained” with effective care and treatment, he said, adding that “treatment is half the cost of incarceration.”

Dr. Broderick underscored the importance of health reform in this new approach. “Of those Americans who made an effort to get treatment but did not receive it, the top reason was [that they had] no health coverage and could not afford the cost,” he said.

Mr. Kerlikowske's contention that he had “ended the war with drug users” and that the new focus should be on “prevention, treatment, and recovery in a holistic way”— drew praise from Dr. Bell and Dr. Johnston.

“Thank God someone with sense is in the national drug control policy area. This is a shift we have been pushing in the Institute of Medicine's 2009 report,” Dr. Bell said.

Dr. Johnston said he had long been a proponent of demand-side action in dealing with drug use. “[I have] argued to the Congress and elsewhere that the supply-side strategy is flawed by the simple economic reality that there will be an endless supply of suppliers. There is good evidence from our studies that demand-side factors have reduced drug use substantially at times,” he said.

In response to an attendee's question about how to shift current levels from “steady” to “declining,” Dr. Broderick said there was a need to continue raising awareness about importance of addiction therapy, to work harder in targeting difficult-to-reach populations such as 18- to 25-year-olds, and to address use among older persons.

Dr. H. Westley Clark, director of SAMHSA's Center for Substance Abuse Treatment, echoed that sentiment, saying that collaboration between the criminal justice, welfare, and public health and safety systems was also key in thwarting substance abuse, with about one-third of referrals for drug treatment coming from the criminal justice sector. “It's not about abstinence; it's about recovery,” he said, adding that “recovery is a process [that] involves many different people.”

The National Survey on Drug Use and Health, formerly known as the National Household Survey on Drug Abuse, interviews about 67,500 individuals in the general U.S. population aged 12 years and older. Each respondent who completes the interview receives $30. Military personnel, inmates, inpatients, and homeless persons who do not live in a shelter are excluded.