Government survey: Adolescents' drug use lessening

Addiction and recovery

By Bob Gaydos

Good news and drugs. It’s not a typical pairing in most people’s minds. Right now, for example, the United States is trying to come to grips with what many are calling an epidemic of deaths due to heroin overdoses tied to opioid addiction. The attorney general of the United States recently cited this serious reality in asking Congress for permission to prosecute states which have legalized the use of marijuana for medical purposes. This kind of political exploitation tends to confuse issues and make the bad news sound even worse. So I went looking for some good news.

It didn’t take long to find and it came, if you will, from the horse’s mouth, which is to say, the National Institute on Drug Abuse, which is part of the National Institutes of Health, which are part of the U.S. Department of Health and Human Services. The government.

Since 1975, the NIDA has been conducting the Monitoring the Future Survey, which tracks drug use and attitudes among eighth, tenth and 12th graders in the United States. Its most recent report was released in December of 2016. It contained quite a bit of good news.

According to the NIDA: “Use of many substances is at its lowest level since the survey’s inception (1975), including alcohol, cigarettes, heroin, cocaine, methamphetamine, inhalants, and sedatives (reported only by 12th graders). Other illicit drugs showed 5-year declines, including marijuana (among 8th and 10th graders), synthetic cannabinoids (K2/herbal incense, sometimes called "synthetic marijuana"), prescription opioids (reported in the survey as "narcotics other than heroin"), hallucinogens, amphetamines, and over-the-counter cough and cold medications.”

And on that national epidemic, here’s NIDA again: “Despite the continued rise in opioid misuse and overdose deaths among adults, past-year misuse of prescription opioids has continued to decline among high school seniors. Over the past 5 years, misuse has dropped 45 percent, from 8.7 to 4.8 percent. Heroin use remains very low, with past-year use reported by 0.3 percent in all grades.”

Bottom line, in a lot of ways an increasing number of adolescents are getting the message to do what Nancy Reagan suggested years ago regarding drugs -- just say no.

Of course, it took a little more to achieve these results than just telling teenagers to not do something because it could be harmful to their health. The all-time low levels of use of tobacco and alcohol surely are a reflection in part of federal laws that a) required states to raise their ages for purchase and public possession of alcohol to 21 or lose 10 percent of their federal highway funds (it worked) and b) banned cigarette and tobacco advertising on TV and radio, required warning labels on the packages and regulated product placement and ads in stores. It took a concerted, community effort, in other words.  

That effort continues with regard to tobacco, as Hawaii in 2015 led the way to raising the age for purchase of tobacco to 21. More than 100 cities and counties, including New York City, Suffolk and, recently, Orange County have also adopted the policy. Alabama, Alaska, New Jersey and Utah have set the legal age at 19.

These legislative efforts were accompanied by well-publicized campaigns that heightened awareness of the numerous health risks associated with smoking and drinking -- especially at a young age -- and the dangers of driving while under the influence of alcohol or other drugs. Stiffer DWI laws accompanied the raised drinking age in many states, again, a reflection of communities coming to terms with an unhealthy situation, discussing options and taking steps to remedy it. These positive actions and attitudes by adults are not lost on children and are passed on through generations, just as the negative ones are.

In response to the current opioid epidemic, law enforcement agencies have cracked down on over-prescription of pain-relief medicines and stricter regulations have been put in place to monitor their use. In addition, many communities have formed action groups to provide information about the abuse of prescription pain medicines and heroin, as well as other drugs. Such efforts increase awareness of the issue -- including the fact that help is available -- and tend to reduce the shame that prevents many who are suffering from addiction from seeking help.

As with the changes in drug and alcohol use among adolescents reported in the latest Monitoring the Future Survey, these attitudes and actions could certainly carry through generations. That would be more welcome positive news.  

From the 2016 survey

--  Marijuana: Among both 8th and 10th graders, daily marijuana use decreased over the past 5 years from 1.3 to 0.7 percent and from 3.6 to 2.5 percent, respectively. Among 12th graders, 6.0 percent continue to report daily use -- that’s about 1 in 16 high school seniors. Among all grades, the perception of risk associated with smoking marijuana regularly continues to decline, with only 31.1 percent of 12th graders reporting that regular marijuana use is harmful compared to 58.3 percent in 2000. However, disapproval among 12th graders remains somewhat high, with 68.5 percent saying they disapprove of smoking marijuana regularly.

-- Alcohol: The percentage of high school students who reported ever using alcohol dropped by as much as 60 percent compared to peak years. This year’s survey found that 22.8 percent of 8th graders reported ever trying alcohol, a 60 percent drop from a peak of 55.8 percent in 1994. Among 10th graders, lifetime use fell by 40 percent from 72.0 percent in 1997 to 43.4 percent this year. Among 12th graders, there was a significant 25 percent drop in lifetime alcohol use from 81.7 percent in 1997 to the current 61.2 percent.

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FYI

Monitoring the Future is an ongoing study of the behaviors, attitudes, and values of American secondary school students, college students, and young adults. Each year, a total of approximately 50,000 8th, 10th and 12th grade students from more than 300 schools are surveyed (12th graders since 1975, and 8th and 10th graders since 1991). The survey is funded by the NIDA, a component of the National Institutes of Health (NIH), and conducted by the University of Michigan.

For more information about the Monitoring the Future survey:

-- http://www.monitoringthefuture.org/

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Socety is still out of touch with the reality of addiction

(My latest Addiction and Recovery column.)

By Bob Gaydos

Philip Seymour Hoffman
 ... on the cover of Rolling Stone

        The congenital disconnect between much of society and the reality of addiction reappeared recently with the death of actor Philip Seymour Hoffman, apparently due to an overdose of heroin.
The Oscar-winning actor was found dead in his Manhattan apartment with a needle in his arm and bags of what was believed to be heroin nearby, according to police. Almost immediately, the familiar reactions were heard: How could he? He was so talented, so  admired, so wealthy, had so much to live for. He had been to rehab and he was sober more than 20 years. How could he risk it all for a fleeting high? And with heroin no less. Who does heroin today?
Apparently, aside from Hoffman and the late Amy Winehouse, a lot of people. And not just the down-and-out addicts who were once the stereotype for what some considered to be “serious” addiction, as opposed to what, one presumes, were considered less serious forms, like addiction to alcohol or cocaine. Addiction pecking order aside, today’s heroin user is just as likely to be your neighbor’s teen-aged son or daughter as a famous actor or singer.
The Substance Abuse and Mental Health Services Administration, which tracks drug use in this country, says a recent survey showed a more than 100 percent increase in the use of heroin in the United States between 2002 and 2012. Slightly less than half a million people were regarded as heroin dependent. How pervasive is it? The states of Maine, New Hampshire and Vermont (so much for stereotypes) report serious problems with heroin addiction and overdoses and deaths as a result of heroin use. Heroin use is up in Pennsylvania, Illinois, Ohio, name a state.
          Much of this increase is tied to the abuse of prescription pain killers, such as Oxycodone, Oxycontin, Vicodin and Percocet, which are opiates, like heroin. Concern over the over-prescription of such drugs and the growing use of them by teenagers who simply took them from their parents’ medicine cabinet, has made it more difficult to get the pills and to crush them for snorting. This makes them more expensive. In comparison, heroin on the street is much cheaper.
        And, quite possibly, much deadlier. Police are examining the many bags of heroin they found in Hoffman’s apartment, among other reasons, to learn if the heroin had been cut with another substance -- a dangerous synthetic heroin” that has emerged -- or if it were too pure. Heroin is not only one of the most addictive drugs, it reacts quickly on the brain, sometimes giving the user insufficient time to react to a bad batch.
Does any of this explain why Hoffman -- famous and sober -- decided to try heroin? No. Relapse, as professionals in the substance abuse field explain, starts in the addict’s brain, with changes in attitudes, behavior, a relaxing of diligence. Dr. Nora Volkow, director of the National Institute on Drug Abuse, in commenting on Hoffman’s death, said, “You need continued awareness of the possibility of relapse. No matter how long you’ve been clean, if you take the drug, you’re at high, high risk of relapse.” Meaning, if you think you can take “just one more hit,” you’re probably delusional and definitely risking your life.
Addiction is considered a chronic, incurable disease because once the brain is reintroduced to the addictive substance -- alcohol, heroin, cocaine -- it can quickly return to its old ways. Addicts often say that when they started using their drug of choice after a period of abstinence, they were right back where they left off, or worse. This is why abstinence and continued treatment, be it therapy or a 12-step program, is recommended for recovery. A change in lifestyle and constant awareness are the keys, the experts say. Over time, the approach may gradually change, but as Volkow reminds, an addict can never forget what he is. And society would do well to remember as well.

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Stepping down, slowly, from suboxone

(MyAddiction and Recovery column.)

By Bob Gaydos

Five years ago, hooked on heroin and pain pills, Mary (not her real name) says, “I was depressed, malnourished, angry and I had just gotten out of jail. That was my turning point. I could continue downhill or change my life.”
Mary decided to change her life. Today, she is clean and sober, married, has a son and is attending classes at SUNY Orange. She says she owes much of this change to another drug -- suboxone -- which allowed her to kick the pain pills and heroin. Taking suboxone, which cost $200 a week and was not covered by her health insurance, was still cheaper than the drugs she was using, she says.
Now, she’s at another turning point. She’s weaning herself off suboxone. “I’m scared,” she admits. I feel when I’m on it, I’m safe. I don’t know if it’s the A.A. meetings or suboxone or both.”
Dr. Rodolfo Nazario, who calls suboxone “a miracle drug,” would say both. Nazario says some kind of outpatient program is also necessary to “deal with the psychological part of the disease.” Even then, it’s no easy transition. Despite his decade of treating patients with suboxone, Nazario says he has been able to wean “very few” off it. And, as he and Mary both emphasized, withdrawal from suboxone can be “horrible.” Which may explain Mary’s fear.
She has first-hand experience of using it in other than the prescribed manner. Two years after starting the suboxone treatment, Mary had a craving for heroin. She stopped taking suboxone for three days, then got heroin. She used it for two months, then one night decided to go back on suboxone before being in withdrawal from the heroin. That is not the prescribed method of treatment. “I felt the heroin on one side of my head, suboxone on the other,” she says. “I had seizures, sweating, vomiting, shaking. I was speaking a different language.”
She hasn’t tried that approach again. From 2 1/2 pills a day five years ago, when she first saw Nazario, Mary is down to half a pill (4 milligrams) a day. She’s following doctor’s orders. Thus far, she says, everything has been fine. “I’ve never gotten high from it,” she says. “I’ve heard you can. I don’t know how.”
In fact, the secret of suboxone, according to those who recommend and prescribe it, is that, while it is a morphine-like substance that provides an addict with a feeling of “normalcy,” it’s impossible to get high on it. Now widely prescribed to treat opiod dependence, suboxone is actually two drugs in one delivery system. Buprenorphine does the same thing for the brain that opiates do, thus the feeling of “normalcy.” The second drug, naloxone, prevents the high that comes from the opiods reaching brain receptors. For safety reasons, the delivery system itself has changed from tablets to a film that is placed on the tongue.
While a strong proponent of it, Nazario has no illusions about taking patients off suboxone. He says some patients do not have the willingness to try weaning off the drug. “I try to step them down slowly,” he says. “Some can take more withdrawal than others. We aren’t here to be martyrs anymore. If they don’t have the medicine, they suffer. They need the drug just to get by. I encourage them to try to get off. If they can’t, they can’t. The important thing is, the patient isn’t doing  anything illegal and is performing well.”
“My goal,” says Mary, “is to get off the suboxone, maintain my sobriety, keep going to AA meetings. I consider myself an addict. I don’t drink. I feel fine. No cravings, no side effects. I’ve been doing it very slowly.” Her doctor and people in recovery would say that’s the way to do it. I’ll keep you posted.

*  *  *

Doctors in New York state must take a special course to be licensed to treat patients with suboxone. When they are accredited, they are limited to 30 suboxone patients in the first year, 100 thereafter.
Dr. Rodolfo Nazario, of Middletown, who has been prescribing suboxone for 10 years,  says, because of the growing abuse of opiod pain killers, especially among young people, “We should be able to treat more.” He says he’s never had 100 patients.
He also is a strong proponent of the new state law that closely monitors prescription of pain medications by doctors. Some of the growing abuse has been attributed to doctors being too willing to prescribe addictive pain medications. “I hate to say it, Nazario offers, “but there are some physicians … I call them licensed drug dealers.”
Nazario also has some harsh words for insurance companies that won’t pay for suboxone treatment, but paid for the Oxycontin and Vicodin: “You make them addicts, but then won’t treat them.”

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