Introduction
A Turning Point
Six years ago our country faced an increasing problem with drug abuse. On February 12, 2002, the President addressed the Nation, noting that “more than 50 percent of our high school seniors have said that they’ve experimented with illegal drugs at least once prior to graduation.” Further, a full 25 percent of high school seniors had reported using illegal drugs in the past month. It was clear that after declines in youth drug use throughout the 1980s and early 1990s, drug use in the United States had rebounded.
In response to these negative trends, the President announced the release of his Administration’s first National Drug Control Strategy, a balanced approach to reducing drug use in America focusing on stopping use before it starts, healing America’s drug users, and disrupting the market for illegal drugs. The Strategy would pursue ambitious goals: a 10 percent reduction in youth drug use in 2 years and a 25 percent reduction in youth drug use over 5 years. As Figure 1 clearly demonstrates, the President’s announcement marked a turning point. Results from the Monitoring the Future Study for calendar year 2002 would reveal a downturn in youth drug use after a decade in which rates of use had risen and remained at high levels.
Figure 1. Current Use of Any Illicit Drug Among Youth
Six years later, this decline in youth drug use continues, at a rate almost precisely consistent with the Administration’s goals. These trends are even more striking when viewed by specific drug. As illustrated in Figure 2, past month drug use among youth has decreased across the board. The declines in youth alcohol and tobacco use, combined with sharp declines in illegal drug use, are particularly meaningful as they demonstrate a broad shift in youth attitudes and behavior.
Figure 2. Percent Reporting Past Month Use
| 2001 | 2007 | Change as a % of 2001 |
|
|---|---|---|---|
| Any Illicit Drug | 19.4% | 14.8% | -24* |
| Marijuana | 16.6% | 12.4% | -25* |
| MDMA (Ectasy) | 2.4% | 1.1% | -54* |
| LSD | 1.5% | 0.6% | -60* |
| Amphetamines | 4.7% | 3.2% | -32* |
| Inhalants | 2.8% | 2.6% | -7 |
| Methamphetamine | 1.4% | 0.5% | -64* |
| Steroids | 0.9% | 0.6% | -33* |
| Cocaine | 1.5% | 1.4% | -7 |
| Heroin | 0.4% | 0.4% | 0 |
| Alcohol | 35.5% | 30.1% | -15* |
| Cigarettes | 20.2% | 13.6% | -33* |
|
*Denotes statistically significant change from 2001. Note: Past-month use, 8th, 10th, and 12th grades combined; percent change calculated from figures having more precision than shown. Source: 2007 Monitoring the Future (MTF) study special tabulations for combined 8th, 10th, and 12th graders (December 2007). | |||
The Monitoring the Future Study is not the only instrument indicating significant declines in drug use among Americans. Data collected through workplace drug testing show similar declines in the adult workforce, providing further evidence of a cultural shift away from drug use. As shown in Figure 3, the percentage of workers testing positive for marijuana declined by 34 percent from January 2000 to December 2006. Methamphetamine use among workers is declining after a significant increase during the first half of the decade, falling by 45 percent between 2004 and 2006. Perhaps most remarkably, overall drug test positives, as measured by Quest Diagnostics' Drug Testing Index, show the lowest levels of drug use in the adult workforce since 1988.
Figure 3. National Workforce Positives for Marijuana are Down
Improved Understanding Has Yielded Results
These trends show that when we push back against illicit drug use we can indeed make the problem smaller. And when this particular problem becomes smaller, the real-world result is that hundreds of thousands of people are spared from addiction and lives are saved. Improving our understanding of drug use and drug markets has been essential to the National Drug Control Strategy over the past 6 years. This Administration has significantly advanced the understanding of the illegal drug phenomenon, while concentrating resources where research demonstrates that they will have the greatest impact. For example, we know that adolescence is a critical period in determining an individual's risk for drug dependence later in life. Research indicates that those who initiate drug use at an early age are significantly more likely to develop substance abuse or dependence as an adult than those who initiate drug use later in life. By ensuring that prevention messages reach young people, by screening for those with substance problems and intervening, and by making it more difficult and costly for young people to obtain drugs, we can ensure that this generation will experience lower rates of addiction throughout the rest of their lives.
We have certainly seen that the reverse is true. One of the more disturbing data trends identified in the past several years is a dramatic rise in current drug use among adults aged 50-54 (see Figure 4). This trend does not necessarily mean that people are taking up drug use as they enter middle age, but rather that a segment of the population that experienced high rates of drug use in their youth continue to carry high rates of use with them as they get older. While drug use is a burden that the baby boomer generation has borne into middle age, the generation coming of age today will benefit from comparatively lower rates of drug use for the rest of their lives.
Figure 4. Baby Boomers are Carrying Higher Rates of Drug Use with Them as They Age
The importance of youth prevention leads to another fundamental insight: drug control efforts must aggressively target marijuana. Aside from the misuse of prescription drugs, marijuana is the drug most frequently cited by new initiates of illicit drug use. This means that when young people try illegal drugs for the first time, the odds are that they are trying marijuana. The association of early marijuana use with addiction to other drugs later in life offers a compelling case to focus on marijuana prevention during the critical and vulnerable adolescent period. Data on youth drug use supports this approach: since 2001, youth use of marijuana has declined by 25 percent, while youth use of any illicit drug has declined by 24 percent—remarkably similar trends.
Beyond the strategic importance of targeting youth marijuana use in order to reduce youth drug use in general, there are also compelling health reasons to focus on marijuana. For far too long marijuana has represented a "blind spot" in our society. Notions carried over from the 1960s and 1970s—and perpetuated by popular culture—have characterized marijuana as a "soft," or relatively harmless, drug. This view was not accurate in the past, and it is certainly not true today. It is now well-accepted that marijuana is addictive and that it can induce compulsive drug-seeking behavior and psychological withdrawal symptoms, as do other addictive drugs such as cocaine or heroin. One out of every four past-year marijuana users between the ages of 12 and 17 display the characteristics for abuse or dependency, now surpassing alcohol and tobacco. The record-high average potency of marijuana today—two to three times the potency of marijuana during the 1980s—further increases the danger to marijuana users. As shown in Figure 5, increasing marijuana potencies have coincided with drastic increases in emergency room visits involving marijuana—a nearly 200 percent increase since the mid-1990s. This is a particular hazard to young people, who have been shown to be the most vulnerable to marijuana's detrimental effects on health. Because their brains are still developing, young people who use marijuana regularly are especially vulnerable to the drug's effects on their brains. Recent research has shown that regular marijuana use is associated with increased risk for long-term mental health problems, including psychosis and schizophrenia. The dangers of marijuana make it all the more important to maintain the gains we have made and further reduce its use.
Figure 5. Marijuana Potency and DAWN Emergency Department Visits
This Administration's efforts to improve our understanding of drug use and availability have guided us toward focused, evidence-based approaches that have yielded broad declines in drug use, especially among adolescents. However, data has also alerted us to a rising and troubling threat: the abuse of prescription drugs. The only major category of illegal drug use to have risen since 2002, prescription drug abuse poses a particular challenge, as these substances are widely available to treat legitimate medical conditions and can often be obtained within the home. These medications are both a blessing to those with chronic illness and a challenge for those who are at risk for substance abuse. Opioid pain-killers are the most widely abused drugs in this category. The 2006 National Survey on Drug Use and Health shows that 71 percent of those abusing prescription pain relievers in the past year obtained them from friends or family; the vast majority received them for free. The threat posed to young people by this ease of access is clearly illustrated in Figure 6, which shows that initiation of illegal drug use via prescription pain relievers is now roughly even with that of marijuana. The Administration is aggressively confronting this challenge, raising awareness of the dangers of prescription drug abuse through the National Youth Anti-Drug Media Campaign; supporting random student drug testing programs; educating families, medical professionals, and school officials; investigating illegal online pharmacies, and by supporting State-level Prescription Drug Monitoring Programs (PDMPs).
Figure 6. Past Year Initiates for Specific Illicit Drugs Among Persons Aged 12 or Older, 2006
Moving Forward: Challenge and Hope
By addressing the epidemiology of drug use and the economics of drug markets, the National Drug Control Strategy has produced measurable results for the American people. But significant challenges remain, such as the continuing threat posed by the abuse of pharmaceuticals and other synthetic drugs. With tools that have proven effective, we will rise to these challenges and seek to achieve a further 10 percent reduction in youth drug use in 2008, using 2006 as the baseline. This effort will continue to be guided by the three National Priorities set by the President in 2002:
Chapter 1 addresses the prevention priority, stopping drug use before it starts, and details efforts to expand and amplify the cultural shift away from drug use, especially among young people. Through a robust National Youth Anti-Drug Media Campaign; the work of community coalitions throughout the country; State-level prescription drug monitoring programs; and drug testing in schools, sports, and workplaces, American attitudes are turning against drug use. Millions of people, especially youth, are receiving the tools and support to help them make healthy decisions and reject drug use. In 2008, the Administration will strengthen these efforts by helping to expand random student drug testing programs to hundreds of additional schools and by encouraging all 50 States to adopt prescription drug monitoring programs.
Chapter 2 details efforts to implement the treatment priority, intervening and healing those who have already succumbed to drug use and addiction. The vast majority of those who abuse or are dependent on illegal drugs do not realize that they need help. This Administration has greatly expanded the reach of treatment services, using the tools available in our systems of public health and criminal justice to help people in need achieve and maintain recovery. In healthcare settings, screening and brief intervention services help to identify and treat those with substance abuse problems who otherwise may not have received help. With the adoption this year of reimbursable healthcare codes for substance abuse, these services can now be mainstreamed into healthcare systems, and this year the Administration will pursue the goal of establishing screening and brief intervention services at a total of 15 Level 1 Trauma Centers in major U.S. cities. In the criminal justice system, Drug Courts are putting nonviolent offenders with drug problems in treatment programs instead of jails. In addition, the Access to Recovery Program is breaking down barriers to treatment by providing vouchers that pay for treatment and recovery support services from a range of providers, including community- or faith-based providers. Chapter 2 also includes a discussion of the progress made during this Administration in understanding the science of addiction—knowledge that promises to help future generations realize the hope and renewal of recovery.
Chapter 3 focuses on U.S. initiatives to disrupt the market for illicit drugs—our supply reduction effort. As prevention and treatment programs reduce the demand for drugs and the size of the drug-using market in the United States, the efforts of Federal, State, local, tribal, foreign, and international law enforcement agencies can serve to further destabilize the business of drug producers and traffickers, reducing the scale and impeding the flow of drug profits to the criminal organizations and terrorist groups that benefit from them. Throughout history, successful market disruption efforts have been accompanied by lower rates of use, from the destruction of the French Connection in the 1970s to the recent reports of cocaine shortages in 38 U.S. cities. Through cooperation with international organizations; the work of courageous allies in Colombia, Mexico, and Afghanistan; improved border security; enhanced intelligence; record-setting interdictions on the high seas; and the targeting of precursor chemicals and criminal finances, market disruption promises to further reduce not only the number of Americans who experience the sorrow of addiction but also the number of innocent people around the world who are victimized by organized crime and terrorism. In 2008, the Administration will place special emphasis on reducing the diversion of prescription drugs and methamphetamine precursors, reducing Andean cocaine production and Afghan opium poppy cultivation, stemming the flow of illegal drugs across the Southwest Border, and combating the domestic production and use of marijuana.
When the President released the Administration’s first Strategy in 2002, he stated that “by moving aggressively, without hesitation or apology, in all three of these areas we can make an enormous difference in America.” History has borne out this statement. What was once an escalating drug problem has been turned around.
Figure 7. Federal Drug Control Spending by Function, FY09*
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