For decades, the government and news media have trumpeted drug use surveys as the jumping-off point for how well the nation is dealing with teen drug abuse.
But an odd and little-noticed trend has emerged. While drug use rates have leveled off and even declined in recent years, the number of teens dying from drug-related overdoses has skyrocketed – up by more than 300 percent from 1993 to 2003.
The inverse relationship between drug use and drug-related deaths raises questions not only about what’s behind the increase in deaths, but also about the relationship between drug use and risky behavior. Some who study youth drug abuse say the rising number of deaths indicates that the field is too preoccupied with overall drug use, and not focused enough on specific drug problems that have more fatal consequences.
“Our whole approach is wrong, because our goal is impossible: eliminating drug use,” says Stanton Peele, a psychologist and addiction expert.
Several surveys use different approaches to ask teens about the frequency with which they use drugs and alcohol, as well as how often they engage in other activities. Many hold the University of Michigan’s Monitoring the Future (MTF) survey as the gold standard. MTF comparisons show declines in overall drug use over the past five years. In 2005, 23.1 percent of high school seniors reported using any kind of drug, which is the lowest level in 10 years and down from 26 percent in 2001.
Such findings get widely reported. Far less often reported is that among older teens, drug use is landing more and more in the emergency room and the morgue.
More youth are dying from drug overdoses than at any time since 1970, according to data from the National Center on Health Statistics. In 2003, it says, 27.6 out of every 1 million 15- to 19-year-olds died of a drug overdose, up from six per million in 1993 and 4.7 per million in 1983.
The increase is not limited to teens. The rate for adults ages 35 to 59 was 144.5 per million in 2003, up from 65 in 1993.
That is no cause for alarm, says the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). James Colliver, a statistician for the administration’s Office of Applied Studies and a former government liaison for the MTF study, says data from the Drug Abuse Warning Network (DAWN) is more reliable than those from the national center. That, he says, is because DAWN studies are based on information from hospital emergency room cases and medical examiners’ reports. The national center relies only on death certificates.
So do the DAWN figures show fewer drug-related deaths? “I really don’t know. I haven’t looked at it,” he says.
(The way the DAWN report is compiled, and recent changes made in it, make it just about impossible to do year-by-year comparisons nationwide.)
But if the death rate has gone up, Colliver says, “it doesn’t necessarily mean there are more bad drug users.”
In other words, an increase in deaths might be caused not by a rise in the number of serious abusers, but by the nature of the drugs teens are using. Some substance-abuse prevention experts cite growing experimentation with inhalants and with prescription and over-the-counter drugs.
“With Vicodin and OxyContin use, it’s easy to overdose, especially if you’re drinking,” says Drug Strategies President Mathea Falco. “But we don’t think of them in the same way as heroin.
“I can’t prove that, but that would be my hypothesis.”
The numbers support that reasoning. Marijuana remains by far the most frequently abused drug among teens. The next five are inhalants, Vicodin, OxyContin, Ritalin or Adderall and cough medication (see chart), according to the 2004 Partnership Attitude Tracking Study done by the Partnership for a Drug-Free America.
“The menu of abusable substances is much larger now than it was in the mid-1990s,” says partnership CEO Steven Pasierb.
Many of the newly popular drugs are as likely to kill teens on the first use as on the 50th, particularly when mixed with alcohol.
“These drugs are every bit as dangerous as street heroin,” Pasierb says. “[Kids] do them with some Grey Goose [vodka] shots, and then, sometimes, they die.”
Perhaps the scariest part, he says, is that nobody appears particularly worried about it.
About 60 percent of teens do not believe using cough syrup to get high is “risky,” according to the partnership’s 2004 attitude tracking study. It says that only 48 percent see “great risk” in trying the pain relievers Vicodin or OxyContin, and 34 percent do not agree strongly that sniffing or huffing inhalants can kill you.
That blasé view on the dangers of medications and inhalants might be particularly important in light of the relationship between teens’ drug use and their perception of risk. As the perceived risk of marijuana use among high school seniors rose on the MTF surveys in the 1980s, their rates of marijuana use in the previous month decreased. When the perceived risk declined in the early 1990s, their use increased proportionally.
Drug Use and Behavior
So maybe teen drug use is down, but deaths are up because an increasing portion of users underestimate the risk of certain drugs. How should that affect drug policies and programs, if at all?
The death rate itself is not a priority indicator for SAMHSA in studying the drug problem among teens, Colliver says. “There are more prominent problems,” he says. The agency’s goal is to prevent initial use in order to curb the number of youth who develop into frequent users and the negative behavior that seems to go with it.
But what’s the link between drug use and negative behavior?
According to data from the 2002 household survey, 40 percent of youth who reported using marijuana on at least 300 days that year also reported fighting in school or engaging in group-against-group fighting.
“Criminal behavior, school attendance – there are a whole constellation of problems that go with drug use,” Colliver says. He cautions that the correlations don’t mean drug use causes the behaviors. “It’s not an ‘if this, then that’ ” relationship, he says.
Some research says there is little if any relationship between use and negative behavior. A study published in the Journal of School Health (January 2005) looked at MTF survey results among high school seniors from 1975 to 2002, comparing their reported use of drugs in the previous month with their reports of negative behaviors such as fighting, robbery and early pregnancy. The researcher, University of California-Santa Cruz professor Mike Males (also a Youth Today columnist), found that higher reported use in the previous month actually correlated to lower rates of reported negative behavior.
At the very least, some who applaud efforts to curb initial drug use say more needs to be done to prevent abuse of the pharmaceuticals that are more likely to be fatal.
“It doesn’t mean [preventing] marijuana use isn’t important, but nobody is dying from that,” Pasierb says. “The risk perception of prescription stuff [among youth] is that it’s way safer” than it really is.
“We’re not focused enough on the threat of prescription drugs,” he says. “Capitol Hill is not, the administration is not. Nobody is.”