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December 14, 2017


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Dr. Nora Volkow, NIDA Director, discusses the results of the 2017 Monitoring the Future survey during a teleconference on December 14, 2017. 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, and Lloyd D. Johnston, Ph.D., Angus Campbell Collegiate Research Professor, both 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

Lloyd D. Johnston, Ph.D.
Angus Campbell Collegiate Research Professor, Institute for Social Research, University of Michigan

Location: Teleconference

Time: 11:00 a.m. EST
Date: Thursday, December 14, 2017

Transcript by My Meetings by Verizon.

Coordinator: Welcome and thank you for standing by. All participants will be able to listen only until the question and answer portion of today’s conference. To ask a question, please press star 1. Today’s conference is being recorded. If you have any objections, please disconnect at this time. I would now like to turn your conference over to Dr. Jack Stein. Sir, you may begin.

Dr. Jack Stein: Thank you very much and good morning everybody. This is Dr. Jack Stein. I’m the Director of the Office of Science Policy and Communications at the National Institute on Drug Abuse, which is part of the National Institutes of Health. We’d like to welcome you to this teleconference press briefing on the Monitoring the Future study. Monitoring the Future is a national study that measures drug alcohol and cigarettes 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 43rd year of this study that is supported by NIDA and conducted by the University of Michigan. This survey is the only large scale federal government survey, that releases findings the same year the data are collected. We’re delighted to host this today and 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 several of the principles involved or connected with this study. We’ll begin with Dr. Nora Volkow, who is the Director of the National Institute on Drug Abuse.

Following Dr. Volkow, we will have Richard Miech and Dr. Lloyd Johnston, both from the University of Michigan, who are the individuals responsible for conducting the Monitoring the Future study. I just want to mention that supporting documentation for this teleconference, including press releases, visuals and an overview of findings, can be found on the NIDA Web site at Now I’d like to turn things over to the Director of the National Institute on Drug Abuse, Dr. Nora Volkow, who will have some brief comments about the study. And Dr. Volkow?

Dr. Nora Volkow: Jack, thank you very much and good morning to everybody. It’s a pleasure to be here with you, and actually it’s always a pleasure particularly when the Monitoring the Future survey is actually giving us good news. And this is very relevant because this represents a pulse in terms of the temperature on the pattern of drug use among teenagers in our country. And this is extremely relevant because we know that kids that start taking drugs during adolescents are at much greater risk of them going into problematic drug use.

They’re also in much greater risk of all of the adverse consequences that we saw from addiction. So the good news from that survey, the very good news, is that basically for most of the drugs, both legal and illegal, we’re seeing some of the lowest numbers that we have been recording for many years. In some instances, these are the lowest numbers that have been recorded since the inception of the survey. Know that the survey was started in 1979 by the University of Michigan, and it’s representative of 44,000 children in schools throughout the United States. So what are those good news?

I would say perhaps, the most dramatic decreases have been observed in the pattern of smoking cigarettes among teenagers. And here we’re seeing the lowest rates ever recorded by the survey. Indeed, for example, tobacco smoking regular use, daily smoking of seniors is at the low of 4.6% and that’s significantly lower than daily use of marijuana. And that gives you an idea that now among teenagers, it’s much more frequent to any serious tobacco - marijuana smoking, than cigarette smoking.

Also very good news, as it relates to alcohol, even though this year per se, the levels do not differ from those of last year, we have seen over the past few years, significant decreases in the pattern of alcohol use across all ages. Particularly notable, is the reductions in regular drug - alcohol use as it relates to a high quantity of use, such as bingeing. And again, these are the lowest that we have seen last year and this year, among teenagers. Very important also because of the crisis that is occurring in the rest of the United States with respect to the opioids and the overdose fatalities and the other consequences, the use of opioids among teenagers is at the lowest it’s ever been.

And for example, opioid prescriptions - the reductions have been quite dramatic. In 2003, the level of use, prevalence use/misuse of Vicodin which is an opioid medication, was at 10.5% for past year use in seniors. Now in 2017 it’s 2%, so you can see 10.5% to 2%. Similarly, Oxycontin has also shown significant reductions. And when it comes to Heroin where we are also seeing significant increases in the adult population, we’re seeing also some of the lowest levels, and that’s less than 0.5% of teenagers are using Heroin.

Similarly, with synthetic (unintelligible), the levels are much, much lower than we have seen when we first started tracing them. It’s less than half, much less than half. And that’s why overall, we are very excited about the (sign)s. Now why would we be excited? We would be excited because the adolescent brain is rapidly developing and the use of drugs in these teenagers actually is a predicter of adverse outcomes, including addictions.

Now what other areas where we are concerned or where the news are not so good? And there I want to highlight marijuana. Because marijuana use in our country, while in teenagers has been going down, in the adult population it has been going significantly up. But what is interesting with monitoring the future is of all of the drug abuse that we have been following for many, many years, the only one that is not going down is marijuana. It’s not going up, but the levels are remaining at steady levels of high frequency of use.

And I mentioned, particularly worrisome, is regular patterns of use, which in the seniors are at 5.9% of them report regular marijuana use, which is basically daily use. Why is this of concern? Because they are in school and they are supposed to be learning and memorizing. And this pattern of use has been shown to be associated with impairment in educational achievement and with very significant levels of dropout.

Another area where we have concern is vaping. Vaping is a new technology that enables teenagers or any adults for that matter, to consume a drug in a very efficient route of administration. You keep the extract and you can deliver the drug at high concentrations, very rapidly into the lungs, which is actually a route of administration that is very rewarding. We know that one out of three seniors has used, in the past year - has vaped. And many of them don’t know what they are vaping.

Around 20% of seniors are reporting that they are vaping nicotine and 10% are reporting that approximately vaping the active ingredient of marijuana. Now why is this worrisome? It is worrisome because nicotine is an addictive drug and studies have started to emerge that shows that kids that start vaping nicotine are at much greater risk in subsequent years, to actually start smoking cigarettes. So there is concern that all of the advances or many of the advances that we have done with the prevention campaigns for nicotine, may be lost, and we will start to get increases in use of nicotine.

Just to make you aware of it, while among the use of nicotine - yearly use or monthly use of nicotine is 9.5%, we’re seeing that the levels of vaping are almost 50% to 60% higher than the levels of cigarette smoking. So it may be a way of entering into it. And with respect to (NI) THC is relevant because when you vape (NI) THC, you can actually vape at a very high concentration. And the higher the concentration of THC, the higher the likelihood of addiction and adverse medical consequences. And those - it is important that we recognize that wide use of these new technologies for administering drugs may result in the future years, in an uptake of drugs that otherwise kids would have not done it.

So overall, they are very, very good news and what they - at the same time, we have to recognize that even in those good news, we still see, even though they are going down, just the patterns of drug use in teenagers are still unacceptably high. So there is a lot of work to be done, but I do recognize that these are very important advances. Thanks very much.

Dr. Jack Stein: Thank you Dr. Volkow. Our next speaker will be Dr. Richard Miech, the principle investigator for the Monitoring the Future survey from the University of Michigan. Dr. Miech?

Dr. Richard Miech: Thank you so much. Thank you Nora. That was a very good summary of the main points, many of the main points that come from this year’s survey. Today I’d like to discuss two issues. First, I’d like to point out that the results from Monitoring the Future, generalized for the entire population of 8th, 10th and 12th grade students. So what I mean by this is that we could, in theory, survey every single 8th, 10th and 12th grade student in the United States.

And if we did, then the results we get from such a survey, would be the same, give or take a percentage point or two, as what we found in this year’s survey. We are able to make this claim because Monitoring the Future is a national probability sample. we have a list of all of the secondary schools in the United States, and we draw a random sample of schools from this list that we then recruit to participate in our survey.

Every year we hire a professional sampling statistician, to aid us with this sampling procedure. Drawing the sample in this way is much more time consuming and complicated than running say an internet survey, which collects answers from whoever receives the invitation to participate and then decides to do so. But because we have a probability sample, we know that our results generalized to the US population of the same age.

While the size of the sample is large, with more than 40,000 surveys this year in 2017, it is not sample size that distinguishes Monitoring the Future from many other drug surveys, is it’s a process through which we draw the sample that leads many in the field to treat results from Monitoring the Future, as the gold standard. Often, others use our results to see how their school, city or state, compares to the national norms that we provide. And others may use Monitoring the Future, to see how well their sampling method compares to a national probability sample.

So as you listen to the results today, I hope that you will see that - or interpret them as this is what we’re seeing among all of the 8th, 10th and 12th graders in the United States. I’d also like to discuss vaping and provide some background on the measures that Nora discussed today. Vaping is a very fast moving field. And as the field has changed, so have our measures of it. Ground Zero for the vaping phenomenon in the United States, can be traced to 2006, which is when we have the first custom records of E-Cigarettes being imported to the United States.

At that time, E-Cigarettes were specifically designed to mimic cigarettes and the smoking experience as close as possible. They were intended to be cigarette substitutes for people who wanted to try to quit smoking, or cigarette replacements for those who wanted an alternative to cigarettes. For many of years, use of E-Cigarettes among adolescents, was extremely low. We’ve learned from others in the field that its use was picking up, so in 2014 we first asked questions about E-Cigarettes.

We found out among 12th grade students, 17% reported using E-Cigarettes in the past 30 days, which is quite high. Use of E-Cigarettes then, was more common than use of regular cigarettes as we see today. At that time, it was (fair) to assume that anybody who used E-Cigarettes, was inhaling nicotine. In 2015 we decided to look at this assumption more closely. And we asked youth about the substance they inhaled the last time they vaped. We were surprised to learn that in all grades, the majority of kids who vaped, said that they had last vaped just flavoring and not nicotine.

Some also reported vaping marijuana. This led us to conclude that if we want to know what substances youth are using, we should ask more than just whether they are using E-Cigarettes, but also what it is that they are vaping. This finding also led us to the conclusion that vaping was evolving and moving away from its roots as solely a new type of cigarette that delivers nicotine. Around this time, a stream of new vaping devices also entered the market. These included tanks and mods, and they allowed users to vape without using E-Cigarettes.

Also, many of these bore little resemblance to cigarettes and were not marketed as cigarette like products. Increasingly, vaping has become a new way of using substances that does not necessarily indicate nicotine use. Given all of these considerations, by 2017 we have moved away from asking about the specific device of E-Cigarettes and instead we use the more general umbrella term of vaping.

In addition, we asked about vaping of specific substances like nicotine, marijuana and just flavoring. Another innovation is that in 2017 we formalized the way we asked about vaping of different substances. Before 2017 we asked only what youth had last vaped. This year we asked vaping of specific substances like nicotine and marijuana and flavoring, in the same way we ask youth about other substances - number of times vaped in the past 30 days, past year, and over the lifetime.

To our knowledge, these are the first ever estimates of vaping in the standardized fashion. And these estimates allow direct comparison with all other drug measures in Monitoring the Future and indeed, most of the drug measures in other surveys. The vaping field is moving quickly and as it is changing, so too are our measures. Thank you.

Dr. Jack Stein: Terrific. Thank you so much Dr. Miech. I’d now like to turn things over to Dr. Lloyd Johnston, who is also from the University of Michigan, who will be commenting. Dr. Johnston was the previous principle investigator of this survey for 42 years. Dr. Johnston?

Dr. Nora Volkow: Isn’t he the father?

Dr. Jack Stein: He is the father of Monitoring the Future. Yes. Dr. Johnston?

Dr. Lloyd Johnston: Thank you. (Unintelligible). Okay. Here we go. Well good morning. It’s a pleasure to be back with you. I’m going to address two areas of legal drug use that we look at in the study. One is alcohol and the other is tobacco products generally. And the story as Nora has already suggested, is a quite positive one. In fact, I think the cigarette story long term, is a very exciting one. We’ve seen a tremendous decline in the proportion of young people in the country, who are using cigarettes. And that cigarette smoking has been the most prevalent behavior that leads to death and disease, preventable death and disease in the country.

So the changes that we’re seeing are every large and very important. The percent of kids for example, based on the three grades combined, who say that they have ever smoked a cigarette, is down by over 70%. That’s a tremendous change. And that’s since the mid ‘90s when there was a peak in cigarette smoking. In fact this study was the one that drew the nation’s attention to the fact that cigarette smoking among American adolescents was rising rapidly.

The daily prevalence is down by 86% and the number of kids who smoke half a pack or more of cigarettes, what we normally think of as a regular smoker, is down by 91%. That’s a huge improvement and I think one that is a wonderful development for the health and longevity of this generation of American young people. Today of the 8th graders, only 2/10 of 1% have smoked half a pack in the last month, half a pack a day, only 7/10 of 1% of the 10th graders, and only 1.7% of the 12th graders. That’s really a very dramatic change. So you see there’s not only a decline in how many use at all, but an even greater decline in the proportion who use regularly.

The other tobacco products, some of which have emerged in recent years, have been a concern to the public health community lest they offset the improvements Dr. Volkow has mentioned, in cigarette smoking. Smokeless tobacco has been around for a long time. I’m (desired) to say that it has been in decline in recent years, actually since 1992. And the 30 day prevalence among the three grades, is down by 2/3 from what it was at that time. AS you may know, smokeless is the source of various kinds of mouth and throat cancers.

Hookah pipe smoking - we only ask in the 12th grade. And it did make quite a large intrusion into the adolescent population. And it peaked in 2014 when virtually a quarter of our young people said that in the past year they had used a hookah pipe once or more. That is now down to 10%. So a more than 50% decline in the number who are using hookah. So I think that’s maybe a flash in the popularity pan so to speak.

Little cigars are potentially of more concern because they’re very much like cigarettes, except that they’re wrapped in tobacco. And that - their use is in the three grades combined, is down some since 2014 when we first asked, but not a great deal. So that’s something we have to keep an eye on. The little cigars are taxed at a lower rate than cigarettes, so in a way, that makes it more attractive to adolescents who are very price sensitive, in their use of drugs. And further, the use of little cigars has leveled off now in - this year. There was no further decline in 2017. So that’s an issue I think, to be followed.

Vaping though, as you’ve heard, is probably the most important of the methods of taking nicotine and remains of concern. I’m not going to address that further. The other class of (vice) I wanted to talk about is alcohol. The use of alcohol by adolescents, has actually been trending down since the ‘80s, with a short interruption during the - what we call a drug relapse, in the ‘90s. And it continues down, at least through 2016, last year. and we saw from the mid - peaks in the mid ‘90s, through 2016. We saw about a 4/10 drop in the number of kids who said they used it in their life or in the past year.

A drop of half in the number who say they’ve had any alcohol in the past 30 days and daily use is down by 2/3. So again, we’re seeing on a highly ingrained behavior in the culture, some important improvements that have many consequences which I don’t need to repeat for you. Also, the indications of heavy use are down by even more, much like as we see with cigarettes, with binge and extreme drinking - extreme binge drinking down by about half from what it was, and reported - self-reported drunkenness down by half.

So those are probably little recognized but substantial improvements in the situation. Needless to say, alcohol remains an important problem for adolescents and also for college students. But at least the situation has improved. Unfortunately, all of these improvements in alcohol halted in 2017. Virtually all the measures we have stopped declining and so today we have maybe 4% of the 8th graders who say they’ve been binge drinking in the past two weeks, 8% of the 10th graders, and 17% of the 12th graders.

So this filled a significant course of kids who are drinking to excess. Since 1997 there’s been very little change in the perceived risk of heavy drinking, which I think contributed in earlier years, to the downturn. There’s been a considerable decline however, in availability, although it leveled in ‘17. So that suggests to me that the efforts of the federal, state and local governments to make access more difficult for youngsters for underage, have been successful and considerably spent. It’s harder for kids to get alcohol (unintelligible).

They’ve been summarized in the disapproval of heavy drinking, but that also leveled in ‘17. So all of these findings in combination, may herald the end of the long term decline in adolescent alcohol use, and that’s the other side of the coin, which isn’t as pretty.

Dr. Jack Stein: Thank you Dr. Johnston. So I’ll thank you all very much. We’re going to be opening the lines for questions in one moment. Before I do so, I just wanted to remind everyone that supporting documents for this teleconference, including press releases, visuals, other overviews of findings, can all be found on the NIDA Web site at 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.

So with that, we’re now going to open up the lines for any questions that may exist beyond the information that’s already been shared. The operator will assist me in fielding any of the questions that you may have. So with that, if I may, we can - (Julie), you can help us open up the lines so we can begin to field any questions that may exist.

Coordinator: Certainly. Thank you. If you would like to ask a question, please press star 1. And you will be prompted to record your first and your last name. please unmute your phone when recording your name. And to withdraw your question, press star 2. One omen please for the first question.

Dr. Jack Stein: Thank you very much.

Coordinator: Okay. Our first question comes from (Janelle Miller). Your line is open.

(Janelle Miller): Thank you for taking my question. I did see how - and I heard, how you had said that teens are misusing opioid pain medications less frequently than a decade ago. However, across the population as a whole, it does seem that opioid use may be increasing. So can you discuss this disparity a bit, between the teens and the larger population?

Dr. Nora Volkow: Yes. And that is an important question because it is actually what we’re observing vis-à-vis the patterns of drug use with respect to the opioid prescriptions, are basically opposite to what we’re seeing in the adult population, where we have seen over the past close to two decades, significant increases in the abuse of prescription opioids that then have translated into a significant increase into Heroin and synthetic opioids. While initially at the beginning of 2003, 2004 we were seeing very, very high rates of abusing teenagers, those have been going down. And our question actually pertains to what is responsible for those decreases in opioid prescriptions?

And I would say that they are a result of a very aggressive campaign towards trying to make access to these medications much harder for teenagers to (divert) and abuse. And for example, that takeback program from the VA, that actually removes the access, availability of pills, maybe have been one of the important contributions to these decreases. Also, for example, from the survey, as well as the SAMHSA survey, we know that many of these teenagers get their opioid prescriptions from friends who have gotten the prescriptions or from relatives or they’re stealing them from their bathroom cabinets.

So to the extent that there has been a very aggressive campaign to number 1, decrease prescriptions of opioids among teenagers, but also limit the amount of opioids that are prescribed for a given adult patient when they go to the doctor, is likely to also have decreased the availability of these drugs and they have had a large impact. And we know that it’s a very large impact on the availability in adults, so we can presume the same thing in adolescents. Because what - a consequence that some have described on it, is that some individuals becoming addicted to opioid prescriptions then changer to Heroin because it’s much easier to get and less expensive.

But in that context it’s also very notable that teenagers in the survey, are reporting very, very low levels of Heroin use, despite the fact that Heroin use is widely available in the nation, as very, very low prices. Which indicates that the systems that they are on the prevention campaign, may actually have been able to protect them about - against the consumption of these drugs. However, we also have to contend that there may be other factors that are influencing the decreases in drug use across all of teenagers that are indirectly contributing to also the lower rates of abuse of prescription of opioids and that are responsible for general patterns of decline.

We don’t know what those other factors are, but as of last year, we were discussing the possibility that as more kids interact, have less chance of having face to face interactions, because they rely on social media. These may actually result in less likelihood of them getting exposed to drugs. Similarly, one of the points that have been made by Dr. Lloyd Johnston for many, many years, he has said, you know, these decreases in nicotine that we’re seeing in addiction to cigarette smoking, may have as an unintended great consequence, a decrease followed by a decrease in drug use for other substances and why is that so? Because nicotine can act as a gateway drug.

And we know that when an individual is exposed to nicotine and then they get exposed to another drug that drug will be more rewarding. So those are two of the factors that are likely to also be contributing. But maybe since we have here Dr. Johnston, he may want to comment on these issues, since he was the first one to bring it up.

Dr. Lloyd Johnston: Yes. Thank you. It is the case that there has been a dramatic drop in the perceived availability of these narcotic drugs as reported by the students, in all age groups, but particularly among the older ones, the seniors. It had been my prior hypothesis, other than the cigarette hypothesis, that all of the attention that narcotics have gotten, would have caused an increase in the perceived risk or dangers of using narcotics.

But we’ve measured that now since about 2010 and perceived risk has actually been fairly level. It’s surprising to me that that’s the case, because certainly the adult population knows a lot about the epidemic. But we’ve seen a substantial decline that began in 2008 and continue through including this year in the proportion of high school seniors who are reporting narcotics use. It looks to me like it’s about more than a 50% decline. So that is particularly good news.

(Janelle Miller): Is it a surprise to you that it’s different than the population as a whole?

Dr. Lloyd Johnston: Well we’ve tried to address that at various times. It was a surprise initially and I think what we’re seeing is that this class of behaviors is more serious of people in their 20s and their 30s. The people who are now in their 20s, were part of the cohort, the birth cohorts that we studied back in the late ‘90s, who had a big increase in their use of narcotics, even in adolescents. And we think that maybe there’s what we call a cohort effect going on where those birth cohorts or class cohorts, moved into later ages than we’re already familiar with the use of narcotics and were therefore more susceptible.

It’s very rewarding to see that in the past engine that’s reversed and we hope that there’ll be a cohort effect there too in that the teenagers we’ve been measuring in the last ten years, will move into the 20s and be less likely to use narcotics, simply because they don’t have the experience.

Dr. Jack Stein: I know we have at least one more call, but (doc) let me ask you, are we okay? Why don’t we take our next call and then if we have some additional commentary we can do so. So (Julie), we can take another call - question.

Coordinator: Thank you. Our next question comes from Sarah Slobin with Quartz Atlantic Media. Your line is open.

Sarah Slobin: Is it possible to get the breakdown of what teens are vaping? Because I don’t see any of those data out on the most recent release. But also, are you saying that this is the first year that you’re asking specifically for the breakdown of what they’re vaping? Or when did that start?

Dr. Richard Miech: Yes. This is Richard. And so in the past two years we asked kids what did you vape when you last vaped. So this is the first year where we asked did you vape nicotine in the past 30 days or the past year or in your lifetime? And did you vape marijuana in those same periods as well as just flavoring? And all that information is available on - it’s available on the press release, the NIDA press release for the past month, the breakdown of vaping by different substances. It’s also available on the MTF Web site.

Sarah Slobin: Okay. And so what you’re telling me is that, essentially vaping started back in 2006, right? And so it’s now 2017 and you’re just - or 2016 rather, and you’re just deciding to ask what specifically is in the pipe. I mean is that not somewhat just like not asking what’s in the rolling papers?

Dr. Richard Miech: Well the prevalence was very low in 2006 until about 2011. So that’s why we didn’t ask about it before. And actually we were one of the first projects to ask what it was kids were vaping. It was largely assumed that everybody who was vaping was vaping nicotine. And in fact, one of the names in the field for E-Cigarettes were ENDS, which stands for electronic nicotine delivery system. And because their origin was as substitutes for cigarettes, it was largely assumed, because it was true at first, that E-Cigarettes were only delivering nicotine. But they’ve evolved since then.

So I wouldn’t say that it was immediately obvious, because particularly at the beginning when E-Cigarettes first came, they were only nicotine and this process has been happening gradually.

Sarah Slobin: Okay. And one other quick question - in terms of this hypothesis you have about having less interactions because it’s (unintelligible).

Dr. Richard Miech: You’re breaking up.

Sarah Slobin: I’m sorry. Let me get rid of the headset. In terms of the other factors, kids - that you’re discussing about kids having less interactions because of social media and they’re maybe less exposed to drugs, I mean are they also not, you know, does the isolation also network both ways? They’re also less exposed to parents and they tend to be more isolated so that opens up the door for them to be doing different drugs? I’ll put myself on mute. Thank you.

Dr. Nora Volkow: Yes, no. And we have not seen an uptick of - as you see from the Monitoring the Future, which is very, very comprehensive, an uptick of drug use or even the newer drugs that are emerging, like the synthetic (unintelligible). In fact they are going down. So we do not think that the social media per se, overall as a population level, is having a negative influence in the rate of use of drugs by teenagers. It is likely, yes, and this has been brought up as a concern that excessive use of social media is decreasing the positive interactions between teenagers, including that of parents, but also are positive human relationships.

So it is likely and it is possible, that there could be negative effects from excessive social media that has been described some of the scientists in this whole area. But it’s also possible that a side effect and again, this is at this point, speculative because the studies have not been done. And this is an area that we’re interested at NIDA, for researchers to start to actually collect the data that would enable us to understand if effectively the use of social media results in less opportunities for drug taking, and therefore less peer pressure for taking drugs and being exposed to them, than they would if they did not have access to it and they would interact on the face to face meeting.

So this is at this point, speculative. But it is also speculative the extent to which social media may put these kinds at greater risk for inability to form strong social relationships. So I think that these are - is very new into how it has changed the behaviors of teenagers. And therefore, it’s something that we need to look at and investigate and understand.

Dr. Jack Stein: Terrific. Thank you all. Let’s see (Julie), any other questions in the queue?

Coordinator: Thank you. If you’d like to ask a question, please press star 1 and you will be prompted to record your first and last name. please unmute your phone when recording your name. One moment. You do have another question with Bethany Brookshire with Science News for Students. Your line is open.

Bethany Brookshire: Hi. I was looking at some of the numbers for marijuana and I’ve noticed that you’ve got separate numbers for vaping with vaping marijuana versus general use of marijuana. And I was wondering how much of marijuana use is specifically vaping. Is that number known? And what about the percentage of smoking marijuana versus vaping versus edibles?

Dr. Lloyd Johnston: I can start with the first question, which is a very good question, which is asked by some of my colleagues. And just to paraphrase it - of overall marijuana use, how much of that is due to just vaping? I think that addresses one of your questions.

Bethany Brookshire: Yes.

Dr. Lloyd Johnston: The answer is clearly about 20%, about - in each of the grades, about 20% total marijuana use is driven by people who only vape marijuana and don’t use it in any other way. Yes?

Dr. Nora Volkow: Yes. And that compares to - for the same indicators of past year use of marijuana to 37.1% of seniors actually reporting that they are using marijuana. So vaping (NI) THC which is the active ingredient, is less frequent than the consumption of combustible marijuana. But I mean within that context, that issue that is very relevant, is again the one that I noted. When you have a very potent marijuana that is and that’s described as marijuana having a very high content of (NI) THC, that may be 12%, 14%. And that is associated with a much greater likelihood of adverse consequences, including an acute psychotic episode.

When you are vaping marijuana in the case, you can put almost 100% pure (NI) THC so you are delivering a very, very high dose and therefore, are likely to be linked with much worse adverse events than in just smoking marijuana. So that is one of the issues of concern.

Dr. Jack Stein: Thank you.

Bethany Brookshire: And is there data on the percentage that is edibles?

Dr. Richard Miech: We do have information - we collect information on edibles. I haven’t calculated the percentage, but feel free to email me and I can get you that information.


Dr. Nora Volkow: I recall, because you sent those data where it shows the comparison of the use of edibles on states that have legalized marijuana, which was approximately 16.5% versus those of edibles in non-legal marijuana, and it was half. It was something like 8.2%. So if you address both of them, we may see that edibles are probably being used around 10%, 11%. But there is a significant difference between the states.

Dr. Richard Miech: So does this answer your question?

Bethany Brookshire: Yes. Thank you.

Dr. Jack Stein: Thank you very much. We have several more questions in the queue and we are doing okay on time. So let’s take the next one (Julie).

Coordinator: Thank you. Our next question comes from Joel Wolfram with WHYY.

Joel Wolfram: Hi. Thank you. I was wondering about - if you could talk about some of the limitations of the study. I know this is the gold standard survey of teen drug use in the country. But what are kind of some inherent limitations of doing a study like this, including, you know, are teens always honest when they’re answering surveys like this?

Dr. Lloyd Johnston: Well we’ve - this is Lloyd Johnston. We’ve addressed this over the years and tried to look at various angles that would tell us that let’s say kids are telling us less than what they’re really doing. One of the most convincing things I think is that what they say about their friends who are unnamed, but they are asked questions about their friends collectively, corresponds very closely to what they say themselves. And I think that that has to do with the fact that we provide extensive protections for them and try to make that as clear as possible, to the respondents.

They’re given different questionnaires. There’s actually - in senior year, there are six different questionnaires. So the people sitting around them in the classroom aren’t necessarily answering the same questionnaire. They are told - the teachers are told not to circulate among the kids, so that they don’t see what the kids are answering. We try to make it clear that there’s important reasons for our asking these questions, because we’ve got to motivate them to do so.

And what we find is that also and people have raised the question about might there be historical changes and a willingness to admit these things. So we’ve looked at that as well, both looking at the trends in what the students themselves say and the trends in what they say about their friends’ use. And those again, are highly parallel. So overall, we think that we get a very high level of truth telling and pretty high levels in some years, of total use, which itself is kind of de facto evidence of truth telling.

I’d say that probably the most serious reservation that we have is about the fact that we are missing a small segment of the age group who are those that don’t finish high school, the dropouts. They’ve actually been declining in percentage in recent years, according to census data. But still we miss probably 8% of the population. I have no doubt that that 8% is heavier in their use of various substances and in particular, cigarettes, than the rest of the population. But I think we do a good job with the remaining 90% and I guess this is our evidence, but that’s all I’ll talk about now.

Dr. Richard Miech: Could I add to that too? I echo of course, everything Lloyd just said. But I also want to point out that one of the main contributions of MTF is to study trends over time. So to the extent that there is any bias, we think it’s very little, but to the extent that there is some, it would be expected to be the same from year to year. And that’s what we’re particularly interested in - which drugs have increased and which have decreased. And if there are any biases, it cancels itself out when we’re just looking at what has changed from one year to the next.

Dr. Jack Stein: Thank you. (Julie), I think there’s one more question that we have. We’re happy to field it now.

Coordinator: Thank you. Our next question comes from Jim McDonald with Vaping360. Your line is open.

Jim McDonald: Hi. Thank you. During the surge in use experimentation with vaping, we’ve seen the steepest historical declines in teen smoking. Twelfth graders who now show record low smoking rate were 9th and 10th graders during the explosion in youth vaping. If a gateway effect exists, isn’t it pretty clear that it’s insignificant compared to the overall decline in smoking?

Dr. Nora Volkow: Well I think that what you are pointing is actually very relevant. And we - and this is an area of research that we are prioritizing to actually perform perspective logically in our study, that can evaluate kids that start vaping nicotine versus those that do not. And follow the trajectories to see if actually there is an increase of them taking cigarettes. There have been to my knowledge, only one prospective study that has come out and in that case they did report a significant increase for the likelihood of smoking among those that were vaping. And there is another retrospective story that also reported at actually a higher rate of cigarette smoking in those that vape.

However, having said that, the follow up are relatively short and we need to have longer lasting stories and larger samples. It is always difficult to actually when you are getting information of an overall population, to ascribe a one to one relationship. When I was speaking about that issue of nicotine priming, that’s based on actual data that has emerged both from particular studies where if you exposed animals during their adolescent period to nicotine, they’re much more likely as adults, to actually go into escalating use of other substances, including nicotine itself.

And also from epidemiological studies that have noted that individuals that started smoking are at a greater likelihood of becoming exposed and become addicted to other drugs. So of course, that’s a reflection of the fact that they have a vulnerability that makes them prone from one or the other. And again, that is an area where it is not clear cut, where the relationship is existing. But in the animal experiments, the data has been quite solid, showing that you actually (prime) the reward system when you expose with nicotine to the reinforcing effects of other drugs.

Dr. Richard Miech: I’d like to add to that if I could. What you say is definitely true that since 2013 or so as there’s been this explosion in vaping is (cigarette) use has calmed down. Although if you look at broader perspective, actually cigarette use among adolescents, has been decreasing for the last decade if not longer. So the decline was set in place before vaping arrived on scene. That being said, it’s difficult to tell from a study, what the influence of vaping is on the overall trend, because there are hundreds of factors going on, some of which increase cigarette smoking and some which decrease cigarette smoking. And vaping is just one of those.

Dr. Nora Volkow: And it is an important question and I think it behooves us to try to understand it in a way that it is actually clear and (unintelligible). So one of the priorities of the institute has been to launch a study in partnership with the Alcohol Institute and other institutes here at the NIH, to study prospectively, 10,000 children as they transition from childhood into adulthood and to monitor periodically their patterns of drug use, to do brain imaging to assess how if they get exposed to drug that influences the development of their brain, how that use of drugs may influence their educational achievement and how ultimately, genetics also influences patterns.

So the (unintelligible) study was launched last September and it has already collected 6000 children and the first release of the data is probably going to be happening in January and it’s going to be an open access for everybody to be able to analyze it. And it is going to be stories like this that will be able to address your question in a very I think final way. Because as of now, while we have to be concerned about this potential issue, there is no sufficient evidence for us to say unequivocally, that yes, it is a risk factor.

Dr. Jack Stein: Thank you Dr. Volkow. Dr. Johnston, do you - (Julie), I believe those were the end of our questions that we had in the queue. Can you confirm that for me?

Coordinator: Yes. That is correct.

Dr. Jack Stein: Well we’re very good on time. Before we conclude, let me just turn once again, to our three panelists, if there are any additional comments that they would like to make for the folks still on the phone, and then we will formally adjourn. Dr. Volkow?

Dr. Nora Volkow: Yes. I would like to comment that I think while we need - when we needed to look at it, I mean we want to actually learn and say well what is this data telling us? And what it’s telling us is that if we invest in prevention campaigns as has been noted for the tobacco or the alcohol or the prescription opioids, we get pretty dramatic results. And the results are not just in terms of what we’re observing today, but as Dr. Johnston pointed out, they are actually likely to be influencing what happens to these teenagers as they’re progressing to adulthood.

So I would like to say that these are very exciting news that we’re getting from Monitoring the Future. And basically, the result of the recognition that interventions that are targeted to children and adolescents towards the healthy patterns of behavior that exclude the use of drugs and have a large impact on what they decide to do.

Dr. Jack Stein: Thank you.

Dr. Lloyd Johnston: If I could add to what Dr. Volkow said, I share her enthusiasm about what we’re observing, but I also, having been in the field for 40 some years, want to urge a note of caution. And that is I think the country has the potential to take its eye off the problem of drug abuse among kids and in general. Right now it’s not taking its eye off because of the opium epidemic, not opium, but narcotic epidemic. And so it’s in the news, it’s in the Congress, it’s in the administration. The issue is very salient at the moment.

But I can look back at a time, at the beginning of the ‘90s, where the issue of drugs after the heavy coverage of the cocaine epidemic in the mid ‘80s, virtually fell off the national screen. The media had very few evening news stories that dealt with drugs. The Congress put less emphasis and money into anti-drug programs and so forth. And that was partly because we had gotten down to a low level of drug use among teens, by the end of the ‘80s.

And what happened? Well we saw a major relapse in the epidemic in the ‘90s, after about ‘92. So I think it’s possible to take our eye off the problem and not consider the fact that there’s a new generation of kids coming in every year and they don’t know what the previous kids know about drugs. They weren’t around when a lot of people were falling, they weren’t around when the media was covering it heavily, they maybe weren’t around when the schools were even dealing with it.

So they have a new vulnerability. They’re innocent in a sense. And they don’t know about why they shouldn’t use drugs anymore than they know how to read, unless we teach them again. And I think that’s something, as a country, we need to keep in mind.

Dr. Nora Volkow: In other words, we should not become complacent when it comes to prevention programs in children and adults.

Dr. Lloyd Johnston: Absolutely.

Dr. Jack Stein: On that note, that’s a terrific note to end on, thank you all. Please again - is the NIDA Web site, where all of this information can be found. We thank everybody for participating and this officially concludes this press teleconference. Thank you very much. (Julie)?

Coordinator: Thank you. Thank you for your participation. You may disconnect at this time.

Dr. Nora Volkow: Guys, thanks a lot. That was...