December 14, 2011


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Dr. Nora Volkow, NIDA Director, discusses the results of the 2011 Monitoring the Future survey at a press conference from the National Press Club on December 14, 2011. Monitoring the Future tracks annual drug abuse trends of 8th, 10th, and 12th-grade students, including attitudes and perceived risk of specific illicit drugs. Dr. Volkow is joined by joined by Howard Koh, M.D., M.P.H, HHS Assistant Secretary for Health; R. Gil Kerlikowske, Director, Office of National Drug Control Policy; and Lloyd D. Johnston, Ph.D., Principal Investigator, Institute for Social Research, University of Michigan.


Susan Weiss,
Acting Chief, Office of Science Policy and Communications,
National Institute on Drug Abuse

Carol Krause,
Communications Director,
National Institute on Drug Abuse


Dr. Nora Volkow,
National Institute on Drug Abuse

Dr. Harold Koh,
Assistant Secretary for Health,
U.S. Department of Health and Human Services

Gil Kerlikowske,
Office of National Drug Control Policy

Lloyd Johnston,
Principal Investigator, Institute for Social Research,
University of Michigan

Location: Washington, D.C.
Time: 10:00 a.m.
Date: Wednesday, December 14, 2011

Transcript by Federal News Service, Washington, D.C.

CAROL KRAUSE: Good morning. My name is Carol Krause. I'm the communications director at the National Institute on Drug Abuse. It's nice to see you all again, and thank you so much for coming this morning.

The Monitoring the Future Survey is well known to many of us. It measures drug use in several different ways: lifetime, past year and past month, and in some cases daily use.

In 2011, 46,773 students in the 8th, 10th and 12th grade were interviewed. We're happy to have some guests with us today who are going to be speaking, and then we'll open it up for questions. And I also want to add that we have this live streaming and we have some reporters who are also watching this and will be able to ask some questions themselves.

We're happy to have with us today Dr. Howard Koh, assistant secretary for health in the Department of Health and Human Services- honored guest today. Thanks for coming.

HOWARD KOH: Thank you.

MS. KRAUSE: Director Gil Kerlikowske, the White House Office of National Drug Control Policy. And we have Dr. Lloyd Johnston, the University of Michigan, to tell us about his 37th Monitoring the Future Survey. Did I get that right this year? Thank you. (Chuckles.)

We have some other guests that we would like to mention who are in the audience today. We have some guests from the Drug Enforcement Administration: Deb Augustine and Sigrid Melus. Thanks for coming. And Richard Lucey, Center for Substance Abuse and Prevention at SAMHSA.

So we'd like to get started. I'd like to introduce NIDA director, Dr. Nora Volkow.

NORA VOLKOW: Good morning. I want to welcome you all to the 37th Monitoring the Future Survey press conference.

The Monitoring the Future was started in 1975 and has been led by Dr. Lloyd Johnston since then. And it's an extremely important survey for us in terms of public health because it enables us, by surveying annually the prevalence rates of drug use in this country, to identify new emerging areas as well as to evaluate whether the prevention interventions that we're targeting towards substance use are actually being effective.

This year, as we look through the results that we're obtaining, several things emerge on the one hand that have good news, and on the other hand that are not so good news. And I'm going to emphasize specifically those findings as it relates to the trends that have been occurring in our country as oppose to just focusing on the differences between 2010 and 2011, but you'll be hearing from that from Dr. Johnston.

What is remarkable, in my perspective, from what we are observing on Monitoring the Future, is that there is a significant decrease in the use of cigarette smoking among teenagers, 8th and 12th graders.

That's actually quite important because cigarette smoking of course has very adverse medical consequences, but also the use of cigarettes by adolescents increases the risk to addiction to nicotine on the one hand, but also there is increasing evidence that it may be priming them for the rewarding effects of other drugs of abuse, including daily substances.

So the decline in cigarette smoking is likely to have downstream consequences, both in medical health as well as substance use disorders. And in fact, cigarette smoking as at its lowest since the inception of the survey in 1975, and we're seeing actually quite, to me, also extremely remarkable, the dramatic decreases in the prevalence rates of daily smoking as well as past-month smoking, that have gone down for daily smoking more than 60 percent over a 15-year period, which highlights the importance of prevention messages and prevention interventions as effective.

On the other hand, we cannot be complacent because the rates are still very high despite these dramatic decreases. And we're also seeing the emergence of use of tobacco products, other tobacco products. For example, smokeless tobacco is actually, among the 12th graders in the past month, is 8.2 percent, which is actually quite high. And there are other tobacco products like cigarettes- cigars, that are being used by young people, highlighting the importance of prevention strategies to go after these products.

Good news also comes on the alcohol indicators, which also show they are at the low end since 1996. And for daily alcohol drinking, that is 46 percent lower than they were in 1996. And for binge drinking, which is also very problematic, it's 30 percent lower. And again, these exemplify the concept that prevention interventions work and can have a big impact.

On the other hand, on the negative side of things, in the arena of marijuana, over the past five years we have seen trending towards increases on marijuana utilization, particularly among 10th and 12th graders.

This is, of the indicators, the one that actually highlighted in my brain as one that tells us that we cannot become complacent about it, is that we have the highest rates on every day marijuana smoking among 12th graders since 1981. Six-point-six percent of 12th graders are smoking marijuana daily, regularly. And considering the adverse effects of marijuana on memory and learning, that of course can- we can predict where the consequences are going in terms of educational achievement.

The other issue that is problematic- and it's the first time we're actually surveying- is the emergence- which caught the attention in 2008 in the European countries- of synthetic cannabinoids, which are mixed with plants in order to make believe that these are legal highs or herbal highs.

Well, they are not herbal high; they're chemical highs. They are cannabinoids. And the survey, for the first time, evaluated it, and to my surprise, it's extremely high. Among 12th graders, past-year use of these synthetic cannabinoids is 11.3 percent. That is 1 in 9 teenagers- 12th graders have tried these synthetic cannabinoids in the past year, so highlighting the need to actually do interventions to not just go in terms of the adverse effects of marijuana search but the synthetic cannabinoids.

Bad news also is that indicators of perception of risk, which continue to do down: Less kids view smoking marijuana regularly as having any harmful effects. This actually is not a good indicator because throughout the inception of the Monitoring the Future, we have learned to recognize that the perception of risk predicts whether kids are going to be smoking marijuana or not. So either we do an intervention to change that or we can predict that use of marijuana is going to increase.

And, finally, the other indicator that we are paying a lot of attention to is the use of psychotherapeutics, which we have come to recognize in the past 10 years of the survey have become increasingly prevalent among teenagers, and it has shifted the pattern towards favoring this type of drug for abuse because of the misperception that they are safer than illicit substance, and maintaining very high levels of abuse of these types of drugs.

Eight-point-two percent of 12th graders admit to the use of Vicodin, which is a pain medication containing opiates in the past year; 8.1 percent- 8.3 percent admit to the use of amphetamines, which is a stimulant medication regularly used for the treatment of ADHD that has been diverted not just to get high but actually to improve cognitive performance.

So we have been faced, and continue to be faced, with very high levels of the abuse of psychotherapeutics. We have seen some declines in some, but very steady high levels. So as a strategy, what NIDA is doing is relaunching an updated version of its website for own prescription, targeted towards teenagers to provide information, PEERx, to actually expand the knowledge about what we know on the adverse effects of psychotherapeutics.

And with that I want to now welcome my colleague, Dr. Howard Koh, who is the assistant director for the Health Services.


HOWARD KOH: Thank you very much, Dr. Volkow, and I appreciate so much being part of this critical press conference. And first I want to thank you for your passion and leadership in this important area for so long. (Applause.) We love spontaneity.


Monitoring the Future is truly a time-honored public health resource and one that I've respected for decades as a physician, researcher, professor, former state health commissioner, and now assistant secretary.

So Dr. Johnston, congratulations. It's great to meet you finally and to thank you for your decades of contributions to the country. And of course it's also great to be here with my wonderful colleague, Director Gil Kerlikowske, who you'll be hearing from in just a second.

And I want to extend my thanks to my colleagues from Health and Human Services, Sarah Wattenberg, Kirby Bumpus and Jenny Rosenberg, who have helped so tremendously with today's presentation.

I'm going to speak specifically to the results related to tobacco and alcohol and put these data into context. And let me start with tobacco, the leading preventable cause of death and suffering worldwide.

We know that half of all lifetime smokers die prematurely from their dependence, so as a nation, our goal for kids in the next generation is to have them live tobacco free. Yet, despite the data you are hearing today, every day in the United States, more than 3,800 young people under age 18 smoke their first cigarette.

More than a thousand youth under age 18 become daily cigarette smokers. And we also know that more than 80 percent of adult smokers began smoking before age 18. So the actual rate of decline being reported today is relatively small compared to the sharp declines we witnessed in the late '90s, and we have much more work to do.

We know what works for youth and tobacco. We know that policies that are effective include 100 percent smoke-free policies in public places, higher cigarette prices, use of media and counteradvertising, access to cessation services and treatments, and, very importantly, well-funded state-based tobacco control programs. So we need to accelerate, not slow the declines in youth cigarette use.

What is complicating this picture even further is the growing public health concern about the use of other tobacco products by youth, particularly hookah water pipes and small cigars. And the data being presented today suggests that a considerable amount of experimental use of hookahs and more than a quarter of 12th graders who are boys are using small cigars.

We need to stress today that these products are not safe alternatives to cigarettes, and in fact, collectively they represent yet another gateway to addiction. So we must scale up our tobacco control efforts to address this growing portfolio of changes, and one way we can do that is to do that through robust FDA regulatory action.

I want to remind this audience that in 2009, the Family Smoking Prevention and Tobacco Control Act was signed by the president. It provides the FDA with the authority to regulate cigarettes, roll your own tobacco and smokeless tobacco.

And so the rule, among other things, prohibits sale of cigarettes and smokeless tobacco to kids younger than 18, prohibits the sale of cigarette packs with fewer than 20 cigarettes, prohibits distribution or free samples of cigarettes, and prohibits tobacco brand name sponsorship of any athletic, musical or other social or cultural event.

And, very importantly for this presentation, the law also permits the FDA to issue regulation to extend its jurisdiction over other tobacco products, a process called deeming. In the spring of this year, 2011, the FDA announced their intention to exercise this authority by issuing a regulation to extend its jurisdiction over other tobacco products, including little cigars, pipe tobacco, hookah water pipes, dissolvables and e-cigarettes. So we look forward to more progress in that area.

Turning to underage drinking, we know this is a leading contributor to death, caused by injuries. The data now showed that some 5,000 people under the age of 21 die each year from alcohol-related injuries as a result of underage drinking. It also contributes to terrible outcomes such as violence and sexual assault, among other things. And we also understand that underage drinking can have lifelong effects on the developing brain, which does not mature until a person reaches his or her mid-to-late 20s.

So even though there has been progress in alcohol use, that Dr. Volkow has mentioned, alcohol remains the drug of choice for the nation's youth. And these rates remain unacceptably high.

Nearly two-thirds of 12th graders, just over one-quarter of 8th graders illegally drink alcohol. And with respect to binge drinking, a critical public health challenge, some 21.6 percent of 12th graders still binge drink, defined as four drinks on one occasion by women and five drinks or more in men.

I am very, very grateful to many community leaders, some of whom are in the audience today who have dedicated their lives to work with vulnerable youth and government leaders and others to increase awareness about the problem of underage drinking.

And those groups and others have helped to promote policies to address minors' possession of alcohol, underage drinking and driving, the practices of alcohol suppliers, and other strategies. Because of their work we are seeing some progress, and we're seeing prevention working to some degree, but we need to do more.

As I close, I want to stress that the National Institute for Alcohol and Alcohol Abuse just released a very important short screening instrument for health care providers to help detect underage drinking among kids and help them get the treatment they need and deserve. And for adults, there have been and will continue to be reimbursable evidence-based screening and referral practices that can provide important opportunities for early detection, intervention and treatment.

So in summary, we are heartened by some of the results that we are sharing today, but there is much more work to do. We must accelerate all our efforts to protect our kids from harm from tobacco and alcohol in the future.

And with that, it is my great honor to introduce and turn the program over to my colleague, Dr. Gil- or, rather, Director Gil Kerlikowske. Mr. Kerlikowske is the director of the White House Office of National Drug Control Policy.

GIL KERLIKOWSKE: Thank you. So I'm not a doctor. (Laughter.) I'm the only one up here that actually is not a doctor.

But I'm very honored to be here with Dr. Volkow, who's been a good friend and a good colleague on these issues for me in the two and a half years that I've been here, and certainly to my friend and colleague, Dr. Howard Koh, who has shown such leadership in this particular area. And then, as many people have been talking about, Dr. Lloyd Johnson and his many decades- I know after a while I hear that too- many decades of effort in this.

This is an important survey. I think from our standpoint, from the standpoint of the White House, I think the information that's provided is so critical because it really keeps us connected with the future of this country, and the future of this country is certainly in our teenagers, those kids that we want to see highly educated and want to see working and want to see performing well to all of their potential. And that's why every year when this information comes out it is of great value and great assistance to policymakers.

You know, the perspective is that it's not all bad news oftentimes in this area, and that is that over 30 years we've actually seen historic decreases and improvements in reducing drug use. And despite the increases in drug use over the past several years, over the long term the rates of drug use among youth today are lower than they were at that time, those decades ago. But we can do a lot more.

The president has already noted that we have changed attitudes in this country regarding the rates of smoking. Many of those things were highlighted by Dr. Koh and Dr. Volkow. And we've changed perceptions in the way- again, in partnership with a lot of other people- the way we look at drunk driving or alcohol-impaired driving in this country. We can do the same thing when it comes to drug use.

Well, it's no surprise to the people in this room that these consequences have substantial impact on the future of this country. It impairs the ability of many of our citizens to reach their full potential. Drug problems hit young people particularly hard, and they are at a vulnerable stage of their development. They deserve our support and they deserve our protection.

Monitoring the Future gives us that kind of information as policymakers. The good news is that today's results show that, again, we're not really powerless against teen drug use. Dr. Volkow talked about smoking and drinking now at historic lows.

And although we have all mentioned that more work has to be done, that these efforts have to be accelerated, that it is too high, it shows that when we put our shoulder to the wheel, we actually can make a difference, not just as government but also government in partnership with the private sector and partnership with communities.

And the progress doesn't happen overnight. You don't turn this around overnight. And, you know, it doesn't happen in a vacuum. Over the past several decades, parents, the private sector, public health institutions approaching it from a public education standpoint, they have mounted the sustained, comprehensive and very balanced efforts to protect teens from alcohol and cigarettes. And Dr. Koh mentioned a number of the specific steps that have been taken.

But I have some very real concerns that came out in this, and that's the use of marijuana. It's not changed. It didn't increase statistically in a significant way from last year, but it is up significantly from the past several years. And to make matters worse, as has been mentioned, young people's perception of harm regarding marijuana use is declining.

And for the first time, this reveals some very surprising information regarding synthetics. And we have read and heard and talked about synthetics anecdotally. Thanks to the work of Dr. Johnston and this survey, we actually have the information that shows 1 in 9 12th graders in America have used synthetic marijuana in the last year. Spice and K2, we've heard all the different terms for this, now rank as the second most frequently used illegal drug among high school seniors, second only to marijuana.

Well, these drugs are dangerous, and you can see from calls to poison control centers, and you can certainly see from the data of visits to emergency departments, that these things can cause serious harm. Poison control center information receive daily calls about this. And if you look at those increases on the charts, you can really tell that this has entered the American vocabulary, but not to the level that it should, and I want to mention that in just a minute.

A few months ago, DEA used its emergency scheduling authority to ban the sale of the chemicals used to manufacture K2 and Spice. We have convened several working groups at the federal level, working with our colleagues on Capitol Hill to also- we could not be more proud that the House of Representatives, I believe last week, passed legislation to ban this. It will now be in front of the Senate. And I think there is strong support to get these things off the market.

And many states- I believe 38 states- have taken action already because the states can move quickly on these kinds of issues. And I think when I look at a long career and a long history in law enforcement and I see at times when we were behind on these issues, it took us a long time to catch up, particularly with synthetics right now.

The synthetic marijuana- I think both the federal government, the state government but also health and education groups are moving much more rapidly. And that's what it takes in this age in which the information is spread so instantaneously through the Internet. Well, let me show you what it looks like. This was purchased recently by the Drug Enforcement Administration.

It's about $13. Inside it would be a packet really no larger than this, and it's been sprinkled on tobacco and then ingested or used or smoked by young people. And of course, the result is what happens when it comes to either calls to poison control centers or visits to the emergency department. You, parents, and that's who we're speaking to right now, really they're the most powerful voice.

Too often I think people say, gee, teenagers don't listen to parents. The research is very clear. Actually teenagers do listen to their parents. This type of a problem isn't really in that discussion that parents often have. They talk about the problem involving marijuana with their young people, with their kids, these caregivers. They talk about the problem involving alcohol. But this really hasn't been on their radar screen.

And with your help today and discussing it today, we'll make sure that this is on their radar screen so that they can have that important conversation. Using illegal drugs isn't a normal part of everyday life in this country. And too often, whether it's through popular media or other discussions, we have this idea that normalizing drug use, this is just a part of American life. It's a rite of passage among young people.

Actually it's not and I've seen young people wearing T-shirts that talk about 77 percent, meaning they're the 77 percent that don't use any drugs. So whenever you listen to some of the people say, well you know, everyone does it. Quite frankly, in this country, everyone doesn't do it, whether they're younger or whether they're older. We have to give kids the right message. Well, it's no surprise we have an election coming up next year.

There's going to be millions of dollars spent by political operatives to deliver messages that seep into the consciousness of young people, whether it's on legalizing marijuana or other areas. And these campaigns are grounded purely in political advocacy. They're not grounded in science. They're not grounded in research. They're grounded in politics.

And instead of a concern for public health because these really are dangerous, as the data shows us, that is absolutely the wrong message to be giving to young people. And the research is already beginning to become clear that medical states that have passed medical marijuana laws may be linked to higher overall use and abuse of drugs than states that don't have medical marijuana laws.

And this comes at a time when parents are unbelievably heightened about the awareness of drug abuse. According to the University of Michigan C.S. Mott Children's Hospital survey released in August, parents consider drug use as the top concern and African-American and Hispanic parents consider youth drug use as their top worry for their young people.

Well, parents are facing enough challenges right now in this country trying to raise healthy and smart kids who are going to be great achievers. We have to be clear about our messages. Smoked marijuana is not an FDA-approved medicine. The National Institutes of Health have long documented the harms of marijuana use. Science shows it can be addictive, and research shows that it impairs driving.

And the studies relating it to the degradation of academic performance are also clear. We're going to continue to examine the effect of marijuana advocacy campaigns that they have on drug use, but in the meantime making parents more aware of these issues and making sure that they have the right tools that are available to them to have that important discussion with their young people is critical.

We remain concerned and we've talked last year and the year before- at least I did- on these prescription drug abuse problems and that is something that's very high of concern among my colleagues here and many others in the federal government. But we are making some progress on that.

We couldn't be more proud of the Drug Enforcement Administration and their coordination of drug take-back days because these are drugs that are coming right out of the medicine cabinet, and that's where they need to be stopped. And the surveys show that young people that do abuse prescription drugs about 70 percent of them get them from a friend or a relative.

And so the support of drug take-back legislation, using all of the other tools that are in the president's outline released in April with Dr. Koh and Dr. Volkow on prescription drug abuse is actually going to show some real progress. And I'm very optimistic on that. So we've made headway in a lot of areas. We have a lot more work to do that's been echoed by all of my colleagues.

But the fact that we have this data and we have this information is particularly helpful and important. And with that, I have a great honor of introducing the principal investigator for Monitoring the Future, Dr. Lloyd Johnston. And I won't talk about how many years Dr. Johnston. (Applause.)

LLOYD JOHNSTON: Thank you, and good morning. Appreciate you all coming this morning. I see many familiar faces of leadership in the field, folks who've come a number of years to see what we've got to say. And I appreciate that we have the audience. It's a pleasure to join Assistant Secretary Koh, Director Kerlikowske and NIDA Director Volkow in presenting the results of this, the 37th survey in the Monitoring the Future series.

As in most years, we surveyed about 47,000 students. They are in three grades- 8, 10 and 12. And they are representative samples of students in each of those grades in the coterminous United States. We continue to study what I call an ever expanding list of both licit and illicit substances used by American adolescents.

Among those added to the study this year are synthetic marijuana, energy drinks, snus- which is a new form of smokeless tobacco- and other forms of tobacco. This actually has become a bit of a problem for the study because there's been such a growth in substances that American young people know about and abuse that we're actually running out of questionnaire space to deal with all of them.

But that's a problem we'll have to solve. There's one that you may want to ask about and that's called bath salts, a fairly new substance on the scene. Unfortunately, we didn't include it in this year's survey. It will be in next year's which starts in just a couple of months. So we hope to be able to report on that rather dangerous substance soon.

But the main story this year actually isn't the new drugs so much. Three of the long-term leading substances of abuse, as you've heard: tobacco, alcohol and marijuana. Cigarette smoking among young people peaked about '96, '97. There was a sharp decline thereafter for five or six years and then a decelerating decline.

And in fact we were worried last year, as you may recall, that the decline in smoking among teens had actually ended and possibly begun to reverse. But I'm happy to say that this year we've actually observed continuing decline in all three grades. One that is statistically significant- and if I average across the three grades, we've gone from 13 percent indicating smoking in the past month down to 12 (percent).

And with these size samples, that's a very statistically significant change. And it brings their smoking rates in all three grades to historic lows within the life of the study. So I think that's a very important development and I can't even begin to tell you how many premature deaths have been prevented by this substantial decline in smoking and how many serious diseases like lung cancer and heart disease have been prevented.

So I think it's a very, very important development both that there has been this large decline and that it's still continuing because we were fearful that it may not. Still, we have on the order of 19 percent of our high school seniors indicating that in the past month they have smoked cigarettes to some degree.

And that, as Dr. Koh suggests, is still not an acceptable level for a behavior that we know has the personal and social costs of cigarette smoking. So there's still much to be done. It's also a good thing, I think, that perceived risk of smoking resumed its longer term rise this year. And that usually is indicative of future changes to come.

The alcohol news is also very encouraging. There's been a long-term decline. But because it's been gradual I think it really hasn't been widely recognized in alcohol consumption by adolescents but it actually goes back to the early '80s.

There's been a fairly steady decline since then with one major exception and that was in the early '90s, the first half of the '90s when illicit drug use went up. So did alcohol. But before that and after that we've seen a continuing decline in alcohol use, a gradual one but an important one, of considerable magnitude.

So for example, binge drinking among 12th graders is down from 41 percent in the class of 1981 30 years go to 22 percent in the class of 2011- nearly a one-half drop in a very powerful and acculturated behavior that leads to a lot of death and dysfunction or a lot of kids and other people too. But with that of course drunk driving has also gone down dramatically in these age groups.

So today, alcohol is at a historic low in the life of the study in all three grades, again. The proportion using alcohol in the past 30 days among eighth graders is 13 percent, among 10th graders, 27 percent and among 12th graders, 40 percent.

So the majority of even 12th graders are not actively drinking, which I think is a good, good thing and good for them to know because sometimes the kids who are doing the deviant things are the ones who overestimated in the population because somehow they're more visible.

Another thing to mention on alcohol is that availability or perceived availability has been in decline since the late '90s and especially among the younger teens. So I think a number of things that states are doing to reduce access have helped to contribute to the progress that we've seen.

Now, the third drug is marijuana. And on the other hand, this is not a good news story. It's been moving in the wrong direction, gradually so for four years after a decade of fairly constant decline in use.

The annual prevalence in the three grades combined has grown gradually. In 2007, it was 21.4 percent. In 2010, it was 24.5 percent. In 2011, it was 25 percent. So the increase this year was not of such a magnitude that it was statistically significant but my interpretation of looking at the charts is that the increase at least continues in the upper grades and I won't be at all to see it continue in the eighth grade as well, although it didn't this year.

Probably the most important part of the story is the daily use of marijuana is rising, which probably has the greatest consequence for the kids. It's up significantly in the past two years in all three grades.

It went up significantly last year in all three grades and this year up some more in all three but not significantly so that today we have 6.6 percent of our high school seniors say that in the past two weeks- sorry, in the past 30 days they have used marijuana on 20 or more occasions- pretty heavy rate of use. We call it daily or near daily use. And that's one in every 15 high school seniors.

If you're looking out at a classroom of 30 kids, on average, two of them are current pot smokers on a daily basis. That's the highest it's been since 1981. Perceived risk from marijuana is down sharply in the last few years, as Dr. Volkow mentioned.

And I think that's one of the reasons we're seeing this rising use. And one can speculate as to why that's happening. As often is the case, when perceived risk goes down, peer norms against abuse also weaken, and we've seen that in the last three or four years.

One of the developments that began in the mid-'90s was the expanding use or really misuse of prescription-type drugs- psychoactive drugs used outside a medical regimen. These include the narcotics, sedatives, tranquilizers and amphetamines.

These drugs kept rising after many of the illegal drugs in the late '90s and beginning of 2000s turned around. And so as a result, during this past decade, they really became a more important part of America's drug problem. A substantial proportion of kids were using these drugs without doctor's orders.

While it's still a serious problem, I'm glad to report that this unwelcomed development seems to have leveled off. About 15 percent of 12th graders today indicate that in the past year they've used one of these medicinal drugs outside of medical supervision. And that's about where it was in the last couple of years. So that's stabilized. Amphetamine use fell some in the early 2000s and slowly in the lower grades since.

Sedative and tranquilizer use are both gradually reducing. But they certainly have reached a peak. And the narcotic drugs, after holding level at 9.2 percent of several years, are down some. They went down to 8.7 percent last year and held there this year. So it looks at least like the rise in use of other narcotics is not continuing.

And I think that's a very important part of the equation. Prevalence among 12th graders for most of the 2000s declined some, to 8.7 percent, as I mentioned. But these are still disturbingly high levels of use of these drugs, in particular the narcotic drugs with their particular addiction potential. But at least these problems have leveled off. But one of the things I've learned is there's always something new coming around the corner.

And synthetic marijuana is one marvelous example, as you've heard. It was added to the survey just in 2011- K2, spice, herbal incense, whatever you want to call it. Mr. Kerlikowske has shown you what some of it looks like.

Until very recently, it was sold legally in head shops and gas stations and various other - all nine as well - various other outlets. And it's meant to mimic the effects of marijuana because it's using cannabinoids that are slightly altered formulation from actual Delta-9-THC. And that way they avoided the DEA prohibition on the sale of these drugs.

But the DEA did schedule it in February 2011 and we see a prevalence rate among the 12th graders of 11.4 percent, a pretty high number. But the change in the rules occurred in February and the kids were answering about the previous 12 months. So I think that these numbers reflect more of what was going on before the change in the law than after.

But our next survey next year should tell us how effective this has been to schedule these drugs. We have looked some at what kinds of kids are using these. We find them to be heavily involved in other drug use. Ninety-four percent have used- reported using the year.

Over 30 percent reported using marijuana daily in the year. And roughly 60 percent of them have used other illicit drugs than marijuana. So they're quite a drug-experienced group probably looking around for a cheaper alternative to get a marijuana high.

Now, a number of drugs showed some decline this year in addition to alcohol and tobacco - inhalants, cocaine powder, crack, which are at quite low levels, Vicodin - it's a narcotic analgesic but it's still at 8.1 percent in 12th grade. So it's still a widely used drug. Adderall, an amphetamine used for the treatment of ADHD- for the three grades combined, it went down from 4.5 to 4.1 percent which is significant.

Sedatives, tranquilizers, cough and cold medicines, all of these have shown some decline this year. When I say cough and cold medicines, of course I'm talking about their use for getting a high, not for their use for coughs and colds.

When kids want to get high with them, they take excessive doses of drugs like Robitussin that contain dextromethorphan. A number of other drugs held steady, including the proportion of kids who used any drug other than marijuana. That is flat.

LSD, which is at very low levels but held steady, and other hallucinogen- salvia, a drug in the mint family, fairly recent on the scene- it's not a scheduled drug. It's used for its short-acting dissociative effects, a hallucinogen, if you want. And its use is not expanding but we still do see 2 percent of eighth graders, 4 percent of 10th graders and 6 percent of 12th graders who say in the past year they've used salvia.

Heroin, which is a very important drug, is below 1 percent fortunately in all grades. Other narcotics than heroin, taken as a class, as I said, the level has been level. Oxycontin also has been level. It hasn't changed beery much in the years that we've been measuring it. Amphetamines remained level. They declined considerably earlier in the decade of the 2000s. Ritalin is level after declining.

Crystal meth, a drug of great public concern a little while ago, is at low levels- 1.2 percent annual use in 12th grade, and that hasn't changed. And the so-called club drugs- GHB, Ketamine, Rohypnol- all of those are at low levels and holding. And anabolic steroids, which we don't hear much about any more- we did for quite a while when they were getting kicked around politically- are at quite low rates, half of what they were in 2002.

They haven't changed much but they're around a percent at each of the grade levels. So to summarize, cigarettes and alcohol use are declining and are at historically low levels. A number of illicit drugs are also declining gradually, including cocaine and Vicodin and sedatives and tranquilizers.

The misuse of prescription drugs remains high overall but level and some of them are actually showing some decline. And marijuana use is increasing with daily use at the highest level we've seen in 30 years among the 12th graders. Thank you.

MS. WEISS: Thank you. I wanted to mention one thing. Dr. Volkow mentioned the new teen website called PEERx- that's R-X at the end- for teens, interactive videos and a lot of information and it's all in your press kit. OK, let's open it up for questions. We're running a little bit late but we will be able to take a few questions. And please identify yourself.

Q: Donna Leinwand Leger, with USA Today- several administrations now have tried aggressive campaigns to curb marijuana use that involved advertising and websites and all kinds of other things, and clearly they haven't gained traction. Anyone have an explanation as to why and have you thought of any other alternative approaches?

MR. JOHNSTON: I think a couple things come to mind, Donna. One is that we haven't done as good a job giving parents the tools that they need to have that discussion about marijuana. Just recently, I think a number of efforts have come forward to give parents a better handle on this, especially if they were past marijuana users themselves at a younger age, that they would feel comfortable being able to talk about it.

And it's a good opportunity to mention the partnership at right here for the work that they do in getting these tools in the hands of young people. I also think that we face a very difficult message as adults when we tell- but when we see marijuana being advertised as medicine, when it has not been through the FDA process, when we say it's being given to patients by caregivers and out of dispensaries.

And of course we know from now volumes of research that the people that are utilizing it through those medical marijuana gateways are not people that are chronically or critically ill. And so I think we do a huge disservice to young people as adults who really are trusted messengers by giving them that message, which is false.

MS WEISS: More questions? All right, these folks will stay around a little bit if you want to ask them one-on-one question and you can always come and talk to me to arrange future interviews. Thank you so much, everybody, for coming. (Applause.)