Press Briefing by John Walters, Director of the Office of National Drug Control Policy, and Nora Volkow, Director of National Institute on Drug Abuse on the "Monitoring the Future" Report (Text Only)

Press Briefing by John Walters, Director of the Office of National Drug Control Policy, and Nora Volkow, Director of National Institute on Drug Abuse on the "Monitoring the Future" Report
James S. Brady Press Briefing Room

DIRECTOR WALTERS: Thank you. As you know, the President announced the latest results of "Monitoring the Future," the annual survey that has been done since the mid-'70s, about rates of teen drug use among 12th, 10th and 8th graders. The President noted that in 2002 we set a goal of reducing overall teenage drug use by 25 percent. Today's results, covering the 2007 school year, note an overall reduction of 24 percent for selected drugs. Obviously, the widest drug abuse by teenagers and adults is marijuana; that's been down 25 percent. This is the overall trend for the three grades -- the 8th graders being the one at the bottom with the lowest rates, and some of the steepest declines the 10th and 12th graders, for the period since the studies existed, since 1975.

This has a summary of the results for different drugs, from 2001 to 2007. As you see, the rates have changed. You'll note that the overall number -- 25 percent decline for marijuana, ecstasy use down over 50 percent, methamphetamine use down 64 percent, alcohol use by this age group -- underage drinking -- down 15 percent, cigarette use down 33 percent.

This highlights the decline we've seen with methamphetamine use in three categories: those reporting they used in the past month, those reporting they used in the past year, and those reporting they've used in their lifetime -- with the month, year and lifetime in that order.

Also, the study asked questions about steroid use. You may remember in the 2004 State of the Union, the President mentioned the problem of steroid use. We've seen a drop of overall a third. But also, and by month, by year, and by lifetime, 33, 45 and 45 percent for this age group, which is also obviously good news; and the effect of these drugs, especially on growing adolescence, is particularly detrimental.

As the President pointed out, these reductions are a result of hard work by many, many people and communities; working coalitions; young people; parents that have been working in these areas; small, faith-based and community groups; schools; many adults giving time to help young people; and many young people helping each other. We had a sampling of those people -- Dr. Volkow and I were with the President and talking to a sample of a people from around the country working this area from our major cities to a Native American anti-drug treatment and prevention efforts.

In addition, as the President pointed out, we've seen declines in some areas of supply. One of the areas we haven't seen a decline that the President highlighted was prescription drug abuse, particularly pain killers. The overall decline has been maintained, but within it there has been during the five-year period an increase and a stubborn resistance to decline by prescription drug abuse. This is a different problem. These are certainly dangerous, mostly synthetic opiates that are the most widely abused. They are not only a source of addiction, but they are of course -- can be a source of seizure, even death, when taken in quantities.

It's also a different problem because the source of supply is different: 71 percent of young people from other surveys we have say they have -- the source of supply is the medicine cabinets of their own home, and the medicine cabinets of the parents of their friends in their homes. So this is a uniquely susceptible problem to education and information. We need to get people that information, one, to tell young people and parents these are a dangerous threat, they need to pay attention to them more than ever; and, two, to shut down the source of supply, which is not having control of these substances when they're used in the home, when they may be used for legitimate purposes, which obviously we want people to have access to them.

And secondly, throw them away when they're done. Proper disposal and control are a key way to help to reduce this, in addition to education. That's all something we need help getting information out into people's hands: recognize the problem and recognize what you need to do about it, in terms of helping to educate young people and to remove this attractive hazard.

Q What's your plan for next year? What drugs will you be focusing on? Where is drug czar money going to go? What's the emphasis going to be, in terms of drug testing?

DIRECTOR WALTERS: Well, we'd like to reinforce the things that work. Sometimes government has problem seeing this, but we've tried to, again, push a balanced strategy, as the President said, across both supply and demand. It began with the Access to Recovery program. We're seeking -- and we hope Congress, when it finishes this appropriations cycle, will continue to give us the resources to expand treatment that follows individuals and helps to support them in recovery.

Secondly, we want to follow up with the President's initiative on random testing, as well as strengthening the messaging we do with media campaign for both parents and for young people directly. We're going to focus on prescription drugs. I think that we are working with NIDA, with our nonprofit partners, with community groups to prepare and we're working aggressively to get these things out in the coming months. Where we have some things in the works, we'll see whether they prove as effective at promising, and we'll be rolling them out as quickly as possible because it's a serious threat.

Q Two questions. One, on the graph you showed with the illicit drug use -- it looked like, yes, the overall trend of decline was sustained, but that there seemed to be a leveling off effect, that the declines that we've seen from the previous year were far fewer than what we had demonstrated in the past. What could explain that? And then also, as part of prescription drug abuse, what about the prevalence of these things on the Internet? I've heard reports of online pharmacies that are -- you can basically get any prescription drug that you need just by lying about your age and other things to get these. So what are you doing to address that piece of the problem?

DIRECTOR WALTERS: Let me take those in reverse order. While most young people -- through other survey data, as I said, not this survey -- the preponderance of the drugs they report using in prescription abuse come from their own homes. There is, obviously, abuse on the Internet. There have been cases -- the DEA has been involved in pill mills over the Internet. And we are working aggressively with Congress to move forward legislation that will help us do a better job of providing regulation and control.

In addition we've been working with states -- 33 states now have prescription monitoring programs for patient safety. Doctors can then have access to a confidential data base, find out whether someone has been doctor-shopping, whether they've been given an inordinate amount of certain abusable prescriptions when they present themselves. In addition, pharmacists can see whether or not a prescription is a forgery or a valid prescription, or whether it's one that's been also gotten from others. So it helps both prevent illegal activity, but it also helps patient safety.

On the decline -- different years there has been different rates of decline. And for some of these categories and for some of the age groups, the change year to year has not been down, it's been flat. Again, that's why the overall trend -- again, there are a couple factors to keep in mind. One, fortunately the majority of young people do not use illegal drugs. And so what Dr. Johnston is looking at when he does the research is both the overall number -- and then looking at changes within that, you end up with smaller and smaller differences, especially year to year. That's why we've looked over a number of years to kind of see change, also to make progress.

In addition, we have seen steeper declines with younger -- the younger age group. It is true that the -- and that's a good thing, because the younger you start, the more dangerous this is.

And I think the other thing I omitted that I think is important here for people to understand why it is important what we do here: if you don't begin using drugs of abuse, alcohol and cigarettes, up through adolescence, you have a much reduced risk of using afterwards. And if you do use afterwards, you also have a reduced risk of becoming dependent. Now, it's not true of every person, there are other factors. And I think there's no more striking example of that than my generation -- the baby boomer generation, had as a cohort the largest involvement with drugs and alcohol. And now we, in our 50s and 60s, have some of the highest rates of alcoholism and continuing substance abuse of any generation before or after.

So not only is this good news good today, but this generation will tend to be less involved with drugs and alcohol and cigarettes for the rest of their lives. So this is something that has a durable effect on the future of the substance abuse problem in the country by the basic common-sense, I think, direction of -- keep kids away from this, and more markets (inaudible).

But there has been different rates of change in -- but overall, the last five years have shown, I think, a pretty remarkable decline, and a decline sustained across a number of dimensions. That's why we're particularly troubled about prescription drugs, is it hasn't followed that pattern.

Q Sorry, let me just write. Don't want to miss that. You can't write and talk at the same time. Sorry. (Laughter.)

So on September 6th at the Press Club when we were talking about the other survey, as I recall, that survey showed that the numbers had basically stagnated in '06; that the nice drops that we had seen had almost completely leveled off. And as I recall, what you said was that all of the other gains in other areas of illicit drug use were basically being negated by rising prescription drug use. And part of your message that day was that we were in real trouble, because of prescription use, of not hitting the President's goals, your goals, for an overall reduction.

It's only three months later and we're on the cusp of victory here. So I'm a little bit confused about how to interpret whether we're there or not there. I understand there are two different studies, I understand the methodology is different, but --

DIRECTOR WALTERS: Well, the age groups are also different. This is a study of 8th, 10th and 12th graders. The survey is talking about -- is a national survey on drug abuse and health, which measures people in households, age 12 and over. So it goes all the way up to young and old.

And part of the discussion, I remember I was talking about, was also, the initiation rates of this cohort of adolescence in the 8th, 10th and 12th age group are important. But we also see that the highest rates of use are by those who are 18 to 26, 18 to 30. And I think what we were talking about at that point was also the trajectory of use by young adults, particularly as they affect, because of the intensity of their use, the over-18 population as a whole. And there, we'd also see an increased use of prescription drugs. And in that case, we isolate the prescription drugs -- because you can take the survey data and take out everything but prescription drugs -- we were talking about that data that showed what happened, because overall we would have a decline; prescription drug use had created a kind of flat line.

But that was an older cohort, which is -- but they're still seeing the same phenomenon. I think, again, we are seeing the prescription drug problem is not just a problem of teens, it's also a problem of adults. But, again, we particularly want to reverse it, obviously, with teens, not only because of the importance of initiation at that age, but also because of how dangerous these drugs are.

Q Just to try more to understand the -- I just called it the (inaudible) survey, I don't even know what it's called anymore -- the (inaudible) survey versus this one --

DIRECTOR WALTERS: Also, that survey was for -- it's important to point out what it's trying to -- I think that I should mention that the survey that was released there was for 2006. This is a 2007 survey, so they're different time periods.

Q But you -- so if that cohort is 12 -- I just -- for people who don't get into, like, cohort and how this is statistically analyzed, they read our stories from three months ago saying, we're in danger of not making it because prescription drugs use is negating everything. Twelve and older -- I mean, I was 12 when I was in 8th grade, so it's -- everybody says, oh, the same group of people. And three months ago we were in real danger of not hitting the goals, and today we're hitting the goals.

DIRECTOR WALTERS: Okay, maybe I could be clear this way. This survey is about adolescents, and we're talking about trends within adolescents. I would say that the household survey that you talk about, in terms of its category of 12- to 17-year-olds, which overlaps the same age group, has similar trends. It doesn't show exactly the same rates. The "Monitoring the Future" survey, which was taken in schools, shows -- has consistently shown some of the higher rates of reported use than the survey taken in the household, although the trend lines have been the same. There are various hypotheses for this; I'm not an expert, others can talk about what the difference is. But we've seen similar trends, downturns, pretty steadily. And they've been going down going back to '75, this is the longest continuous survey instrument of its kind. But we've seen similar up-ticks.

What we were talking about at the Press Club was also not simply adolescents, but adults. And the concern is people over 18 -- because we also are concerned about them -- not seeing the same kind of declines, largely as a result of the parent effect of additional prescription drug abuse in the over-18 population at that time.

So maybe I could help you by just saying there is not an inconsistency as long as you recognize one age group is adolescents, one age group is, kind of, post-adolescent and adult.

Q This is for Dr. Volkow. What's the latest in the brain science regarding -- I mean, one of the things that we've been talking about is how difficult it has been to kick the OxyContin addiction -- there weren't really good treatments available for narcotic addiction -- and also for methamphetamine addiction. What things have changed in the brain science, and what do we know now about treating folks with these types of addictions?

DR. VOLKOW: Well, I mean, those are very important questions that we've been trying to actually promote research to do it, specifically, the one, what are the treatments for addiction to OxyContin? Addiction to OxyContin is basically addiction to an opiate which, in a way, is similar to addiction to heroin. And what we're doing now is evaluating -- for which we have effective medication interventions, both methadone and (inaudible) are very successful in the treatment of heroin addiction.

So currently we are doing a study, a large clinical study, to determine and evaluate specifically the value of (inaudible) for the treatment of addiction to opiates analgesics -- and that includes not just OxyContin, but also Vicodin.

Now within that line of work, there's something that compounds the problem and which is -- we haven't discussed it -- that what we've seen, particularly in all the group of subjects that become addicted, in many instances -- in some of those instances, they have become addicted after proper prescription of the medication, because they suffer from chronic pain. And the a challenge there for treatment is how do you intervene on an individual that has severe pain, that needs potent analgesics, yet at the same time is addicted to the medication that is likely to help him or her perform better.

And that's a very unique situation that we have not experienced before, so we're evaluating what may be the best interventions. And as of now, (inaudible) is -- even though the studies have not been done -- is being widely utilized for the treatment of patients that are addicted to opiate analgesics.

DR. VOLKOW: Methamphetamine addiction: We currently do not have any medication that has proven to be effective in the treatment of methamphetamine addiction. We have -- we're initiating several clinical trials to evaluate promising medications, but we don't have any specific results. We're also (inaudible) research to develop a vaccine that will basically destroy methamphetamine when the person administers it -- it's just like any other vaccine -- to interfere with relapsing an individual sick in treatment.

That's what we have in the pipeline. What is that we have currently that has been shown to be effective? Those are behavioral interventions, and there is a program that has generated a lot of interest because it has very good success, which is called the Matrix program. It's a multi-pronged approach that addresses individual as well as group treatment interventions; and that's one of them. We also have -- there's also evidence of effectiveness of motivation and incentive therapies for the treatment of methamphetamine addiction.

Q So what has been the change in attitudes regarding prescription drugs among teens? Does the fact that they're -- you know, we're seeing a leveling-off effect of illicit drugs suggest that teens are thinking that prescription drugs are somehow safer, and that they're able to abuse them more? And what are the demographics in that? Is it people that are -- you know, is it in higher-income households, where they're able to afford these prescription drugs, that teens are abusing these things?

DIRECTOR WALTERS: I think we can let Lloyd Johnston afterwards kind of talk about the demographic data he has on this, because I think there's a fair amount of it. What we've seen generally, and in working on prevention messaging, with this research and other research, is young people have reported that they understand -- this is where I think the efforts of parents, the media, and others have been helpful -- that so-called street drugs are dangerous: they can be dangerous for them to take; they can be dangerous to them just because of what's uncontrolled and may be in them; that the traditional drugs of abuse are something they have learned they should avoid in greater numbers, and I think the numbers in this survey and others reflect that.

But they have been told irresponsibly, or they believe that pharmaceuticals -- because they come from a regulated industry, they come from a medical establishment -- are safe, and they can actually go, on or their friends have gone on irresponsible web sites that can suggest combinations of pills to take for getting high so-called safely.

Now, again, these are synthetic opiates, as Nora said. They have a similar effect on the body as heroin. They are powerful, many of them -- they are particularly dangerous in combination with alcohol, which is not -- which is a common combination with young people, as well as some adults. They can be fatal, in addition to causing seizures and other problems, in addition to addiction.

So, yes, we do need to some education. They think of these pills in a different way and, as I said, the occasion to use them is greater because -- they report -- they're in the house. They don't have to find somebody to give them marijuana or cocaine or meth outside the home. They have them in many kinds in their medicine cabinet, a medicine cabinet of a relative, or a friend gets it for them. So the occasion is much greater, and that's why we need to tell people to help, and they can take specific steps to keep these under their control, throw away unused medications.

We want them -- again, we want people to have the best medical care. We want people to be treated for pain. These medications, we understand, are a godsend for many people that have been suffering chronic pain. But they also have an abuse potential and we need to handle them with the knowledge that that is there, and we can do things to have the benefit without the harm. So I do think this is a unique opportunity for information to be turned into more effective prevention and lower rates of abuse.

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