Drug Use Estimates

Basic Data

(Current Usage Rates, 2011) "In 2011, an estimated 22.5 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 8.7 percent of the population aged 12 or older. Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics (pain relievers, tranquilizers, stimulants, and sedatives) used nonmedically.
"• The rate of current illicit drug use among persons aged 12 or older in 2011 (8.7 percent) was similar to the rate in 2010 (8.9 percent)."

(Current Marijuana and Other Illicit Drug Use 2011) "In 2011, marijuana was the most commonly used illicit drug, with 18.1 million current users. It was used by 80.5 percent of current illicit drug users. About two thirds (64.3 percent) of illicit drug users used only marijuana in the past month. Also, in 2011, 8.0 million persons aged 12 or older were current users of illicit drugs other than marijuana (or 35.7 percent of illicit drug users aged 12 or older). Current use of other drugs but not marijuana was reported by 19.5 percent of illicit drug users, and 16.2 percent of illicit drug users reported using both marijuana and other drugs."

(Prevalence of Illicit Drug Use Among Youth) "Any Illicit Drug.
"The index of any illicit drug use tends to be driven by marijuana, which is by far the most prevalent of the many illicitly used drugs. Like marijuana, it showed no significant changes in 2012 for annual prevalence. In 2012 the percentages of students indicating any use of an illicit drug in the prior 12 months were 13%, 30% and 40% in grades 8, 10, and 12, respectively. The percentages indicating any use in their lifetime were 19%, 37%, and 49%. In other words, about half of America’s high school seniors have tried an illicit drug by the time they graduate and four fifths of those used it in just the past year.
"Any Illicit Drug Other than Marijuana. When marijuana is removed from the list of illicit drugs, far fewer students report use of any of the other drugs included in the index. (These include hallucinogens, cocaine, crack, and heroin, as well as use of any of the psychotherapeutic drugs—amphetamines, sedatives, tranquilizers, or narcotics—taken without medical supervision.) In 2012, 6%, 11%, and 17% of the students in the three grades, respectively, reported using any of these other drugs. Those percentages have continued to drop gradually since around 1996 or 1997, but the declines in annual prevalence between 2011 and 2012 were not statistically significant.
"Most of the individual illicit drugs showed no significant change in use between 2011 and 2012. Only ecstasy, salvia, and use of heroin without a needle showed statistically significant declines this year."

(Prevalence of Marijuana Use Among Youth) "Annual marijuana prevalence peaked among 12th graders in 1979 at 51%, following a rise that began during the 1960s. Then use declined fairly steadily for 13 years, bottoming at 22% in 1992—a decline of more than half. The 1990s, however, saw a resurgence of use. After a considerable increase (one that actually began among 8th graders a year earlier than among 10th and 12th graders), annual prevalence rates peaked in 1996 at 8th grade and in 1997 at 10th and 12th grades. After these peak years, use declined among all three grades through 2006, 2007, or 2008; after the declines, there began an upturn in use in all three grades, lasting for three years in the lower grades and longer in grade 12. In 2011 and 2012 there was some decline in use in grade 8, with 10th and 12th grades leveling in 2012. In 2010 a significant increase in daily use occurred in all three grades, followed by a nonsignificant increase in 2011. In 2012 there were non-significant declines for daily use in the lower grades and a leveling at 12th grade with use reaching 1.1%, 3.5%, and 6.5% in grades 8, 10, and 12, respectively."

(Prevalence of Daily Marijuana Use Among Youth) "Annual marijuana prevalence peaked among 12th graders in 1979 at 51%, following a rise that began during the 1960s. Then use declined fairly steadily for 13 years, bottoming at 22% in 1992—a decline of more than half. The 1990s, however, saw a resurgence of use. After a considerable increase (one that actually began among 8th graders a year earlier than among 10th and 12th graders), annual prevalence rates peaked in 1996 at 8th grade and in 1997 at 10th and 12th grades. After these peak years, use declined among all three grades through 2006, 2007, or 2008; after the declines, there began an upturn in use in all three grades, lasting for three years in the lower grades and longer in grade 12. In 2011 and 2012 there was some decline in use in grade 8, with 10th and 12th grades leveling in 2012. In 2010 a significant increase in daily use occurred in all three grades, followed by a nonsignificant increase in 2011. In 2012 there were non-significant declines for daily use in the lower grades and a leveling at 12th grade with use reaching 1.1%, 3.5%, and 6.5% in grades 8, 10, and 12, respectively."

(Cocaine and Crack Use and Initiation of Use) "According to the 2008 National Survey on Drug Use and Health, the estimated percentage of persons aged 12 or older who used cocaine in the past month (0.7 percent) was similar to the percentage in 2007 and 2002. However, the percentage of past-month crack users in 2008 (0.1 percent of the population) was lower than in 2007 and all other years going back to 2002, with the exception of 2004. From 2002 to 2008, rates of past-month cocaine use among youth aged 12 to 17 declined significantly, from 0.6 percent to 0.4 percent. Past-month cocaine use also dropped significantly among young adults aged 18 to 25 during this time period, from 2.0 percent to 1.5 percent.
"Significant declines in the number or percentage of past-year cocaine initiates were also estimated among several age groups measured, including persons 12 or older and those aged 18 to 25. The percentage of past-year initiates also dropped significantly from 2007 to 2008 for crack use among the 12–17 age group."

(Cocaine & Crack Use and Perceived Risk Among Youth) "According to the 2009 Monitoring the Future survey—a national survey of 8th-, 10th-, and 12th-graders—there were continuing declines reported in the use of powder cocaine, with past-year** usage levels reaching their lowest point since the early 1990s. Significant declines in use were measured from 2008 to 2009 among 12th-graders across all three survey categories: lifetime use decreased from 7.2 percent to 6.0 percent; past-year use dropped from 4.4 percent to 3.4 percent; and past-month use dropped from 1.9 percent to 1.3 percent. Survey measures showed other positive findings among 12th-graders as well; their perceived risk of harm associated with powder cocaine use increased significantly during the same period. Additionally, survey participants in the 10th grade reported significant changes, with past-month use falling from 1.2 percent in 2008 to 0.9 percent in 2009."

(Current Marijuana Use, 2011) "The number and percentage of persons aged 12 or older who were current users of marijuana in 2011 (18.1 million or 7.0 percent) were similar to the estimates for 2010 (17.4 million or 6.9 percent). The 2011 rate of current marijuana use also was similar to the rate in 2009 (6.7 percent), but it was higher than those in 2002 through 2008. Between 2007 and 2011, for example, the rate of use increased from 5.8 to 7.0 percent, and the number of users increased from 14.5 million to 18.1 million."

(Prevalence of Daily Marijuana Use)
"• In 2011, an estimated 16.7 percent of past year marijuana users aged 12 or older used marijuana on 300 or more days within the past 12 months. This translates into nearly 5.0 million persons using marijuana on a daily or almost daily basis over a 12-month period.
"• In 2011, an estimated 39.1 percent (7.1 million) of current marijuana users aged 12 or older used marijuana on 20 or more days in the past month. This was similar to the 2010 estimate of 39.8 percent or 6.9 million users."

(Current Use of Psychotherapeutics, 2011) "The number and percentage of persons aged 12 or older who were current nonmedical users of psychotherapeutic drugs in 2011 (6.1 million or 2.4 percent) were lower than those in 2010 (7.0 million or 2.7 percent) and 2009 (7.0 million or 2.8 percent)."

(Current Use of Pain Relievers, 2011) "The number and percentage of persons aged 12 or older who were current nonmedical users of pain relievers in 2011 (4.5 million or 1.7 percent) were lower than those in 2010 (5.1 million or 2.0 percent) and 2009 (5.3 million or 2.1 percent)."

(Current Use of Stimulants, 2011) "The number and percentage of persons aged 12 or older who were current nonmedical users of stimulants in 2011 (970,000 or 0.4 percent) were similar to those in 2010 (1.1 million or 0.4 percent), but lower than those in 2009 (1.3 million or 0.5 percent)."

(Current Methamphetamine Use, 2011) "The number and percentage of persons aged 12 or older who were current users of methamphetamine in 2011 (439,000 or 0.2 percent) were similar to those from 2007 through 2010, but lower than those from 2002 through 2006. The previous numbers and percentages were 353,000 (0.1 percent) in 2010, 502,000 (0.2 percent) in 2009, 314,000 (0.1 percent) in 2008, 530,000 (0.2 percent) in 2007, 731,000 (0.3 percent) in 2006, 628,000 (0.3 percent) in 2005, 706,000 (0.3 percent) in 2004, 726,000 (0.3 percent) in 2003, and 683,000 (0.3 percent) in 2002."

(Current Cocaine Use, 2011) "The number and percentage of persons aged 12 or older who were current users of cocaine in 2011 (1.4 million or 0.5 percent) were similar to those in 2010 (1.5 million or 0.6 percent) and 2009 (1.6 million or 0.7 percent), but lower than those from 2002 through 2008 (Figure 2.2). The previous numbers and percentages were 1.9 million (0.7 percent) in 2008, 2.1 million (0.8 percent) in 2007, 2.4 million (1.0 percent) in 2006, 2.4 million (1.0 percent) in 2005, 2.0 million (0.8 percent) in 2004, 2.3 million (1.0 percent) in 2003, and 2.0 million (0.9 percent) in 2002."

(Current Heroin Use, 2011) "The number and percentage of persons aged 12 or older who were current heroin users in 2011 (281,000 or 0.1 percent) were similar to those from 2006 through 2010 (239,000 or 0.1 percent in 2010; 193,000 or 0.1 percent in 2009; 213,000 or 0.1 percent in 2008; 161,000 or 0.1 percent in 2007; and 339,000 or 0.1 percent in 2006), but were higher than those in 2005 (136,000 or 0.1 percent) and 2003 (119,000 or 0.1 percent) (Figure 2.4). Additionally, the number and percentage of persons aged 12 or older who were past year heroin users in 2011 (620,000 or 0.2 percent) were similar to those in 2008 to 2010 (621,000 or 0.2 percent in 2010; 582,000 or 0.2 percent in 2009; and 455,000 or 0.2 percent in 2008) and in 2006 (560,000 or 0.2 percent), but were higher than those from 2003 through 2005 and in 2007."

(Current Hallucinogen Use, 2011) "The number and percentage of persons aged 12 or older who were current users of hallucinogens in 2011 (972,000 or 0.4 percent) were lower than those in 2010 (1.2 million or 0.5 percent), 2009 (1.3 million or 0.5 percent), and 2002 (1.2 million or 0.5 percent)."

(Initiation of Use, 2011) "In 2011, about 3.1 million persons aged 12 or older used an illicit drug for the first time within the past 12 months; this averages to about 8,400 new users per day. This estimate was not significantly different from the number in 2010 (3.0 million). Over half of initiates (55.5 percent) were younger than age 18 when they first used, and 55.8 percent of new users were female. The 2011 average age at initiation among persons aged 12 to 49 was 18.1 years, which was similar to the 2010 estimate (19.1 years). See Section B.4.1 in Appendix B for a discussion of the effects of older adult initiates on estimates of mean age at first use.
"• Of the estimated 3.1 million persons aged 12 or older in 2011 who used illicit drugs for the first time within the past 12 months, a majority reported that their first drug was marijuana (67.5 percent) (Figure 5.1). More than 1 in 5 initiated with nonmedical use of psychotherapeutics (22.0 percent, including 14.0 percent with pain relievers, 4.2 percent with tranquilizers, 2.6 percent with stimulants, and 1.2 percent with sedatives). A notable proportion reported inhalants (7.5 percent) as their first illicit drug, and a small proportion used hallucinogens (2.8 percent). Except for marijuana, all of the above percentages of first illicit drug use were similar to the corresponding percentages in 2010. The percentage whose first illicit drug was marijuana in 2011 was greater than the percentage in 2010 (62.0 percent)."

(Nonmedical Use of Psychotherapeutics, 2011) "In 2011, there were 2.3 million persons aged 12 or older who used psychotherapeutics nonmedically for the first time within the past year, which averages to around 6,400 initiates per day. The number of new nonmedical users of psychotherapeutics in 2011 was similar to the 2010 estimate (2.4 million), but was lower than the 2004 estimate (2.8 million). The number of new nonmedical users of pain relievers in 2011 (1.9 million) was lower than the numbers in 2002 through 2005 and in 2008 and 2009 (ranging from 2.2 million to 2.5 million). In 2011, the number of initiates was 1.2 million for tranquilizers, 670,000 for stimulants, and 159,000 for sedatives.
"• In 2011, the average age at first nonmedical use of any psychotherapeutics among recent initiates aged 12 to 49 was 22.4 years. More specifically, it was 21.8 years for pain relievers, 22.0 years for sedatives, 22.2 years for stimulants, and 24.6 years for tranquilizers. All of these estimates were similar to the corresponding estimates in 2010.
"• In 2011, the number of new nonmedical users of OxyContin® aged 12 or older was 483,000, which was similar to the 2010 estimate of 600,000. The average age at first use of OxyContin® among past year initiates aged 12 to 49 was the same in 2010 and 2011 (22.8 years)."

(Use by Educational Status, 2011) "Illicit drug use in 2011 varied by the educational status of adults aged 18 or older, with the rate of current illicit drug use lower among college graduates (5.4 percent) than those with some college education (10.4 percent), high school graduates (8.9 percent), and those who had not graduated from high school (11.1 percent)."

(Use Among Adults 50-59, 2011) "Among adults aged 50 to 59, the rate of current illicit drug use increased from 2.7 to 6.3 percent between 2002 and 2011 (Figure 2.9). For those aged 50 to 54, the rate increased from 3.4 percent in 2002 to 6.7 percent in 2011. Among those aged 55 to 59, current illicit drug use increased from 1.9 percent in 2002 to 6.0 percent in 2011. These patterns and trends partially reflect the aging into these age groups of members of the baby boom cohort, whose rates of illicit drug use have been higher than those of older cohorts. The baby boom cohort refers to persons born in the United States after World War II between 1946 and 1964 (Han, Gfroerer, & Colliver, 2009)."

(50 Year Olds, 2011) "Among 50-year-old high school graduates in 2011, we estimate that about three-quarters (76%) have tried marijuana, and that about two thirds (65%) have tried an illicit drug other than marijuana. (These estimates are adjusted to correct for panel attrition, as described in chapter 4 of Volume II.)
"Their current behavior is far less extreme than those statistics might suggest, but it is not by any means negligible. One in nine (11%) indicates using marijuana in the last 12 months, and the same proportion indicate using any other illicit drug in the same period. Their past-month prevalence rates are lower—5.9% and 4.3%, respectively, for marijuana and any other illicit drug. About 1 in 43 (2.3%) is a current daily marijuana user, though substantially more indicate that they have used marijuana daily at some time in the past."

(Baby Boomers) "In 2007, the rate of past year use in this age group [persons aged 50 to 59] was 9.4 percent for any illicit drug, 5.7 percent for marijuana, and 4.0 percent for nonmedical use of prescription drugs. Analyses show that the observed increases are driven primarily by the aging of the baby boom cohort, which has a much higher lifetime illicit drug use rate than earlier cohorts, representing an increasing proportion of persons aged 50 to 59. Less than 3 percent of past year users initiated drug use at ages 50 to 59. Almost 90 percent of past year users initiated drug use before age 30, and many have been continuing users over the years."

(Prescription Antidepressants) "Antidepressants were the third most common prescription drug taken by Americans of all ages in 2005–2008 and the most frequently used by persons aged 18–44 years. From 1988–1994 through 2005–2008, the rate of antidepressant use in the United States among all ages increased nearly 400%."

(Nonmedical Use of Psychotherapeutic Drugs by Type, 2004) "In 2004, 6.0 million persons were current users of psychotherapeutic drugs taken nonmedically (2.5 percent). These include 4.4 million who used pain relievers, 1.6 million who used tranquilizers, 1.2 million who used stimulants, and 0.3 million who used sedatives. These estimates are all similar to the corresponding estimates for 2003.
"There were significant increases in the lifetime prevalence of use from 2003 to 2004 in several categories of pain relievers among those aged 18 to 25. Specific pain relievers with statistically significant increases in lifetime use were Vicodin®, Lortab®, or Lorcet® (from 15.0 to 16.5 percent); Percocet®, Percodan®, or Tylox® (from 7.8 to 8.7 percent); hydrocodone products (from 16.3 to 17.4 percent); OxyContin® (from 3.6 to 4.3 percent); and oxycodone products (from 8.9 to 10.1 percent)."

(Nonmedical Use of Ritalin and Adderal, 2011) "Use of the amphetamine Ritalin outside of medical supervision showed a distinct increase around 1997—with annual prevalence among 12th graders going from 0.1% in 1992 to 2.8% in 1997—and then stayed level for a few years (see appendix E in Volume I, Table E-29). Because of its increasing importance, a differently structured question was introduced for Ritalin use in 2001 (2002 in the follow-ups of college students and young adults). This new question, which we prefer to the original, does not use a prior branching question and produced somewhat higher prevalence rates. Results from the new question suggest an ongoing, gradual decline in Ritalin use, which continued into 2009 in all five populations. The decline continued further in 2010 among 8th and 10th graders, but use leveled in 2010 among 12th graders, college students, and young adults. There were no significant changes in 2011.
"Another amphetamine used in the treatment of the symptoms of attention deficit hyperactivity disorder (ADHD) is Adderall. A new question on its use was introduced in 2009; annual prevalence rates in 2009 through 2011 were higher than those for Ritalin in all five populations. This suggests that Adderall may have to some degree replaced the use of Ritalin and may help to account for the declines that we have been observing for the latter drug. Annual prevalence of Adderall changed very little between 2009 and 2011. The absolute prevalence rates are fairly high, particularly among college students (9.8% in 2011)."

Global Estimates

(Global User Estimates, 2010) "The world population has reached 7 billion people. Of these, the United Nations Office on Drugs and Crime estimates that about 230 million use an illegal drug at least once a year. This represents about 1 in 20 persons between the ages of 15 and 64. In the same age group, approximately 1 in 40 people use drugs more regularly, at least once a month, and fewer than 1 in 160, that is, about 27 million people, use drugs in a manner that exposes them to very severe health problems."

(Global Cannabis Use Rates, 2010) "Cannabis remains the most widely used illicit substance globally, with an estimated annual prevalence in 2010 of 2.6-5.0 per cent of the adult population (between 119 million and 224 million users aged 15-64 years). Overall, annual prevalence of cannabis use remained stable in 2010 (2.8-4.5 per cent of the adult population in 2009), the highest prevalence of cannabis use being reported in Oceania (essentially Australia and New Zealand) at 9.1-14.6 per cent, followed by North America (10.8 per cent), Western and Central Europe (7.0 per cent) and West and Central Africa (5.2-13.5 per cent). While the prevalence of cannabis use in Asia (1.0 - 3.4 per cent) remains lower than the global average, due to Asia's large population the absolute number of users in Asia, estimated between 26 million and 92 million, remains the highest worldwide.
"In 2010, experts from many countries in West and Central Africa, Southern Africa, South Asia and Central Asia reported a perceived increase in cannabis use. Cannabis use has remained stable in North America (at an annual prevalence of 10.8 per cent), as well as in Oceania (at an annual prevalence of 9.1-14.6 per cent), while it has actually decreased in South America (from 2.9-3 per cent in 2009 to 2.5 per cent in 2010). The latter essentially reflects revised estimates based on new data for the region."

(Global Amphetamine-Type Stimulant Use, 2010) "ATS (excluding "ecstasy") have an estimated prevalence of 0.3-1.2 per cent in 2010, or between 14 million and 52.5 million estimated global users. This group of drugs remains the second most widely used globally. Oceania, North America and Central America are the regions with a high prevalence of ATS use, but experts from countries in Asia, not only in East and South-East Asia but also in Central Asia and Transcaucasia, have reported an increase in ATS use. With reports of increasing seizures of methamphetamine, it is speculated that the use of ATS is likely to increase in those regions."

(Global Opioid Use Rates, 2010) "The estimated annual prevalence of opioids in 2010 was 0.6-0.8 per cent of the population aged 15-64 (between 26 million and 36 million opioid users), nearly half of whom used opiates, particularly heroin. The estimated annual prevalence of opiate use is between 0.3 and 0.5 per cent of the adult population (between 13 million and 21 million past-year users). North America (3.8-4.2 per cent), Oceania (2.3-3.4 per cent) and Eastern Europe and South-Eastern Europe (1.2 - 1.3 per cent) are the regions with a higher than global average prevalence of opioid users. It is important to note, however, that in North America and Oceania prescription opioids are used more than heroin, whereas in Eastern Europe and South-Eastern Europe, opiates (heroin and, to a lesser extent, “kompot”2) are the main concern (prevalence of opiate use is estimated at 0.8 per cent).

"In 2010, an increase in heroin users was observed in South Asia and in East and South-East Asia in particular,3 but experts from many African countries also reported a perceived increase in the use of heroin. In comparison with other regions, opiate use in Europe has been reported as showing a declining or stable trend, particularly in countries with substantial opiate use. Furthermore, reports from European countries such as Estonia and Finland suggest that the use of synthetic opioids, particularly fentanyl and buprenorphine, may have displaced heroin use, while in some parts of the Russian Federation reports suggest that a heroin shortage has led many heroin users to use, as a substitute for heroin, desomorphine (also known as “krokodil”), acetylated opium or fentanyl.4 In terms of the harm to health that they cause, opioids, particularly heroin, are reported as the main type of drug that is injected and as a major cause of drug-related deaths."

(Mortality and IDU, Worldwide 2010) "It is also estimated that there were between 99,000 and 253,000 deaths globally in 2010 as a result of illicit drug use, with drug-related deaths accounting for between 0.5 and 1.3 per cent of all-cause mortality among those aged 15-64.1 Moreover, it was estimated that in 2008 there were 16 million injecting drug users worldwide and that 3 million (18.9 per cent) of them were living with HIV, though no new figures are available after 2008. Global prevalence of hepatitis C infection among injecting drug users in 2010 was 46.7 per cent, meaning that some 7.4 million injecting drug users worldwide are infected with hepatitis C. And some 2.3 million injecting drug users are infected with hepatitis B. Evidence is also emerging that non-injecting drug use is also associated with an increased risk of HIV infection, principally due to unprotected sex."

(Global Data, Licit vs. Illicit Drugs) "Global estimates suggest that past-month prevalence of tobacco use (25 per cent of the population aged 15 and above) is 10 times higher than past-month prevalence of illicit drug use (2.5 per cent). Annual prevalence of the use of alcohol is 42 per cent (the use of alcohol being legal in most countries), which is eight times higher than annual prevalence of illicit drug use (5.0 per cent). Heavy episodic weekly drinking is eight times more prevalent than problem drug use. Drug use accounts for 0.9 per cent of all disability-adjusted life years lost at the global level, or 10 per cent of all life years lost as a result of the consumption of psychoactive substances (drugs, alcohol and tobacco)."

(Global Data, Problem Drug Use) "UNODC estimates that the number of problem drug users in 2010 was between 15.5 million and 38.6 million, or about 10-13 per cent of the global estimate of all drug users, while in 2008, according to the Reference Group to the United Nations on HIV and Injecting Drug Use, there were an estimated 16 million people who injected drugs. Both of these estimates have remained essentially stable."

(Afghan Opiate Use) "Illicit drug use has increased across the country, dramatically so for opium, heroin and other opiates. In four years, the number of regular opium users in Afghanistan grew from 150,000 to approximately 230,000 ‐ a jump of 53 per cent. The numbers are even more alarming for heroin. In 2005, the estimate of regular heroin users in the country was 50,000, compared to approximately 120,000 users in 2009, a leap of 140 per cent. Overall, the annual prevalence of regular opiate use is estimated to be 2.7 per cent of the adult population1 (between 290,000 and 360,000 persons). Opium is by far the most commonly used opiate with an estimated prevalence of about 1.9 per cent of the adult population. Heroin prevalence is estimated to be about 1.0 per cent of the adult population and other opiates users2 are estimated to make up about 0.5 per cent of the adult population."

(Global Distribution of Drug Use) "Globally, drug use is not distributed evenly. In general, the US had among the highest levels of use of all drugs. Much lower levels were observed in lower income countries in Africa and the Middle East, and lower levels of use were reported in the Asian locales covered."

(Comparison of US and Europe) "Although statistics on drug use in the United States are not fully reliable, the numbers available indicate that US consumption of cocaine and marijuana has been essentially stable for many years—although considerably reduced from its peak in the 1970s and 1980s. The data also show that, today, the United States consumes illegal substances at a rate some three times that of Europe—although the use of drugs in the EU continues to grow rapidly and a few countries actually consume more per capita than the United States. In both the United States and Europe, the wholesale and street prices of cannabis and cocaine have declined in the past several years, although reportedly their potency has increased and demand remains steady. Across the world, illicit drugs appear to be available at stable or declining prices. A recent EU Commission study concluded that global drug production and use remained largely unchanged during the period from 1998 through 2007."

(Other Substance Use by 'Lifetime' Alcohol Users) "Lifetime alcohol users aged 21 or older had a significantly higher rate of past year illicit drug use (13.7 percent) compared with lifetime nondrinkers (2.7 percent). In addition, lifetime alcohol users had significantly higher rates of past year use across all illicit drug categories, with the exception of inhalants (Table 1). Nonmedical use of pain relievers was the illicit drug used most often by lifetime nondrinkers, whereas lifetime alcohol users reported using marijuana most frequently."

('Lifetime' Alcohol Users) "In 2002 and 2003, an estimated 88.2 percent of persons aged 21 or older (175.6 million) were lifetime alcohol users, whereas an estimated 11.8 percent (23.5 million) were lifetime nondrinkers. Over half of lifetime alcohol users (52.7 percent) had used one or more illicit drugs at some time in their life, compared to 8.0 percent of lifetime nondrinkers. Among persons who had used an illicit drug in their lifetime, the average age at first illicit drug use was 19 years for lifetime alcohol users, versus 23 years for lifetime nondrinkers."

(Nonmedical Prescription Drug Use by Young People) "NSDUH data showed a decline in past month nonmedical prescription drug use among youths between 2002 (4.0 percent) and 2008 (2.9 percent), with no significant change between 2008 and 2011 (2.8 percent). Among young adults aged 18 to 25, past month prevalence of nonmedical prescription drug use was 5.0 percent in 2011. This prevalence in 2011 was lower than the rates in other years since 2003, which varied between 5.9 and 6.5 percent. The most prevalent category of misused prescription drugs is pain relievers. Nonmedical pain reliever use in the past month among youths declined from 3.2 percent in 2002 to 2.3 percent in 2011, while the rate among young adults was lower in 2011 (3.6 percent) than in 2010 (4.4 percent) as well as in years from 2002 to 2009 (between 4.1 and 5.0 percent)."

(Mephedrone or "Meow Meow") "The abuse of 4-methyl-methcathinone, a 'designer drug' also known as 'mephedrone' or '4-MMC', has been reported in a growing number of countries and regions. Mephedrone is a derivative of methcathinone, which itself is chemically related to cathinone, one of the psychoactive ingredients found in khat (Catha edulis). Its chemical structure is also related to amphetamines. The effects of the substance are reported to be similar to other stimulant drugs, such as cocaine, amphetamine and MDMA ('ecstasy'), although there is little existing research into its pharmacology and toxicity."

("Joe Camel" Ad Campaign) "It is possible that the introduction of the Joe Camel advertising campaign in 1988 helped account for the closing of the socioeconomic gap in the late 1980s, and that its termination in 1997 helped account for the re-emergence of that gap. We know that between 1986 and 1997, the rise in smoking was sharper among 12th-grade boys than 12th-grade girls, and the Camel brand was particularly popular among boys and those whose parents had higher than average education.⁷³ So, the Joe Camel ad campaign appears to have been particularly effective with boys from more educated strata, raising the smoking rate of their SES [socioeconomic status] strata and nearly eliminating the relationship between SES and smoking that existed before and after the years of the campaign for that brand."

Data by Race & Ethnicity

(Current Illicit Use, by Race/Ethnicity) "In 2011, among persons aged 12 or older, the rate of current illicit drug use was lowest among Asians (3.8 percent). The rates were 8.4 percent among Hispanics, 8.7 percent among whites, 10.0 percent among blacks, 11.0 percent among Native Hawaiians or Other Pacific Islanders, 13.4 percent among American Indians or Alaska Natives, and 13.5 percent among persons of two or more races."

(Prevalence of Use Among African-American Students)
"• African-American students have the lowest 30-day prevalence rate for alcohol use. They also have the lowest rates for self-reports of having been drunk during the prior 30 days.
"• Recent occasions of heavy drinking (having five or more drinks in a row during the prior two weeks) is also lowest among African Americans in all three grades; in 12th grade their rate is 11% versus 26% for Whites and 21% for Hispanics. In 8th grade, Hispanics have the highest rate at 10%, compared to 6% for Whites and 5% for African Americans."

(Use by Hispanic Youth) "Fifty-two percent of Hispanic youth report using illicit drugs in the past year (vs. 42 percent for African-American youth and 40 percent for Caucasian teens). They are also more likely than other teens to have used prescription medicine, Ecstasy or cocaine/crack to get high.
"Marijuana use levels are of significant concern among Hispanic youth. Half of Hispanic teens report smoking marijuana in the past year (43 percent more than Caucasian teens and 25 percent more than African-American youth)."

(Adolescent Use of Crack & Heroin) "Hispanic 12th graders now have the highest (or close to highest) lifetime, annual, and 30-day prevalence rates for crack and heroin. The rate of cocaine use by Hispanic students has tended to be high compared to the other two racial/ethnic groups, particularly in the lower grades. It bears repeating that Hispanics have a considerably higher dropout rate than Whites or African Americans, based on Census Bureau statistics, which would tend to diminish any such differences by 12th grade."

(Subtance Abuse or Dependence by Race) "In 2010, among persons aged 12 or older, rates of substance dependence or abuse were lower among Asians (4.1 percent) and Native Hawaiians or Other Pacific Islanders (5.6 percent) than among other racial/ethnic groups. The rates for the other racial/ethnic groups were 16.0 percent for American Indians or Alaska Natives, 9.7 percent for persons reporting two or more races, 9.7 percent for Hispanics, 8.9 percent for whites, and 8.2 percent for blacks."

(Alcohol Use by Race/Ethnicity) "Among persons aged 12 or older, whites in 2011 were more likely than other racial/ethnic groups to report current use of alcohol (56.8 percent) (Figure 3.2). The rates were 46.9 percent for persons reporting two or more races, 44.7 percent for American Indians or Alaska Natives, 42.5 percent for Hispanics, 42.1 percent for blacks, and 40.0 percent for Asians.
"• The rate of binge alcohol use was lowest among Asians (11.6 percent). Rates for other racial/ethnic groups were 18.6 percent for persons reporting two or more races, 19.4 percent for blacks, 23.4 percent for Hispanics, 23.9 percent for whites, and 24.3 percent for American Indians or Alaska Natives.
"• Among youths aged 12 to 17 in 2011, Asians had lower rates of current alcohol use than any other racial/ethnic group (7.4 percent), while 10.5 percent of black youths, 12.6 percent of Hispanic youths, 14.6 percent of white youths, 15.2 percent of American Indian or Alaska Native youths, and 17.5 percent of youths reporting two or more races were current drinkers."

(Alcohol Use Among African-Americans) "Past month alcohol use, binge alcohol use, and illicit drug use remained relatively stable among black adults between 2002 and 2008 (Figure1).^4,5
"Combined 2004 to 2008 data indicate that, in the past month, 44.3 percent of black adults used alcohol, 21.7 percent reported binge alcohol use, and 9.5 percent used an illicit drug (Figure 2).
"Rates of past month alcohol use and binge alcohol use were lower among black adults than the national averages. The rate of past month illicit drug use among black adults, however, was higher than the national average.
"Rates of past month and binge alcohol use were considerably lower among young black adults than the national average of young adults (48.6 vs. 61.1 percent and 25.3 vs. 41.6 percent, respectively) (Figure 3). Past month illicit drug use among young black adults was slightly lower than the national average (18.7 vs. 19.7 percent).
"Older black adults had a rate of past month alcohol use that was considerably lower than the national average of older adults (20.3 vs. 38.3 percent) (Figure 4). Their rates of binge alcohol use and past month illicit drug use, however, did not differ significantly from the national averages.
"Compared with the national averages, adult black females had lower rates of past month alcohol use and binge alcohol use and a slightly higher rate of past month illicit drug use (Table 1).
"Compared with the national averages, adult black males had lower rates of past month alcohol use and binge alcohol use and a slightly higher rate of past month illicit drug use (Table 2)."

(Substance Use Among Hispanics)
"● Rates of past month alcohol use and illicit drug use were lower among Hispanic adults than the national averages for adults (46.1 vs. 55.2 percent and 6.6 vs. 7.9 percent, respectively); however, past month binge alcohol use was higher among Hispanics than the national average (26.3 vs. 24.5 percent)
"● Among Hispanic adults, substance use varied greatly by subgroup; past month illicit drug use, for example, ranged from a high of 13.1 percent among adults of Spanish origin (from Spain) to a low of 3.9 percent among those of Dominican origin
"● Hispanic adults who were born in the United States had higher rates of past month substance use than Hispanic adults who were not born in the United States, regardless of age
"● Among Hispanics who needed treatment for an alcohol or illicit drug problem, the percentage who received such treatment did not differ significantly from the national average"

(Hispanic Population) "In 2010, there were 50.5 million Hispanics in the United States, composing 16 percent of the total population .... Between 2000 and 2010, the Hispanic population grew by 43 percent—rising from 35.3 million in 2000, when this group made up 13 percent of the total population.⁹ The Hispanic population increased by 15.2 million between 2000 and 2010, accounting for over half of the 27.3 million increase in the total population of the United States."
^{According to the 2010 Census, "'Hispanic or Latino' refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race."}

(US Population by Race) "In the 2010 Census, 97 percent of all respondents (299.7 million) reported only one race (see Table 1).¹⁰ The largest group reported White alone (223.6 million), accounting for 72 percent of all people living in the United States.¹¹ The Black or African-American alone population was 38.9 million and represented 13 percent of the total population.¹² There were 2.9 million respondents who indicated American Indian and Alaska Native alone (0.9 percent). Approximately 14.7 million (about 5 percent of all respondents) identified their race as Asian alone."

(Adolescent Drug Use Prevalence by Race) "Two general points can be derived from the tables.[†] First, for nearly all drugs, 12th-grade African-American students report lifetime, annual, 30-day, and daily prevalence rates that are lower—sometimes dramatically so—than those for White or Hispanic 12th graders. Second, use rates for most drugs are generally lower for African-American students in 8th and 10th grades, as well; therefore, their low usage rates in 12th grade are almost certainly not due to differential dropout rates."
[†] "Tables 4-5 to 4-8 ... combined 2010–2011 prevalence estimates for lifetime, annual, 30-day, and selected daily use for the three racial/ethnic groups at all three grade levels, along with the numbers of cases upon which the estimates are based."

Substance Use in the Military

(Illicit Drug Use Among Military Personnel) "The prevalence of any reported illicit drug use (including prescription drug misuse) during the past 30 days declined sharply from 28% in 1980 to 3% in 2002. In 2005, the prevalence of illicit drug use for the past 30 days was 5% and in 2008 it was 12%. Improved question wording in 2005 and 2008 may partially account for the higher observed rates, which are largely attributable to reported increases in misuse of prescription pain medications (see Section 3.3.2 for additional discussion). Because of wording changes, data from 2005 and 2008 are not comparable to data from prior surveys and are not included as part of the trend line. An additional line from 2002 to 2008 shows estimates of illicit drug use excluding prescription drug misuse. As shown, those rates were very low (2% in 2008) and did not change across these three iterations of the survey."

(Heavy Alcohol Use Among Military Personnel) "Heavy alcohol use in the past 30 days decreased between 1980 and 1988, remained relatively stable with some fluctuations between 1988 and 1998, showed a significant increase from 1998 to 2002, and remained at that same level in 2005 (19%) and 2008 (20%). However, taken together, heavy alcohol use over the decade from 1998 to 2008 showed an increasing pattern (15% to 20%). The heavy drinking rate for 2008 (20%) was not significantly different from when the survey series began in 1980 (21%)."

(Positive Drug Tests) "Given that illicit drug use is inconsistent with Army Values, one would not expect the presence of multiple and serial drug offenders in the Army. Data for FY 2001 – FY 2009 indicate otherwise.⁷⁶ Drug testing results reveal that of the total number of Soldiers tested, 3.5% (58,687 of 1,662,004) were positive for illicit drug use (see Table 7, page 50). That includes Soldiers who tested positive one, two or three or more times. When separated into these specific categories, 36,470 (62%) were first time positives, 11,828 (20%) were multiple, and 10,389 (18%) were serial offenders."

(Drug-Positive Rates In US Military) "While the overall illicit drug use rate is holding constant, the number of MRO reviews is increasing (includes legitimate prescription drug use and positive UAs for other pharmaceutical drugs; see Figure 15, page 54). As previously noted, current policy governing prescription drug use may be masking illicit drug use due to open-ended prescriptions. Overall use of amphetamines (including both legal and illegal) is growing at a rate of 2.8 percent per year for all COMPOS. This means that by the end of next year it is expected that there will be over 5,000 MRO [Medical Regulating Officer] reviewable positive tests for amphetamines alone. Among the street drugs, marijuana is increasing significantly within the National Guard population. In fact, if we look at the rate of THC positives over the last four years, it is predicted that over 7,500 Guard Soldiers will test positive for THC this year."

(Tobacco Use Among Military Personnel) "For the DoD services, the percentage of military personnel who smoked cigarettes in the past 30 days decreased significantly from 51% in 1980 to 30% in 1998. It increased significantly from 1998 (30%) to 2002 (34%), and while not showing significant declines in 2005 (32%) and in 2008 (31%), has been slowly trending downward since 2002."

(Binge Drinking Among Military Personnel) "In 2008, 47% of all DoD services personnel were binge drinkers. For all DoD services, binge drinking increased between 1998 and 2008 but was stable between 2005 and 2008.
"For each service, binge drinking also increased overall between 1998 and 2008. Between 2005 and 2008, binge drinking rates significantly increased for the Navy and the Air Force and were stable for the Army and the Marine Corps."

(Heavy Drinking, Military Personnel Compared with Civilian Population) "Military personnel aged 18 to 25 showed significantly higher rates of heavy drinking (26%) than did civilians (16%).
"Likewise, military personnel aged 26 to 35 showed higher rates of heavy drinking (18%) than did their civilian counterparts (11%). For those aged 36 to 45, this rate was slightly higher for military personnel than civilians (10% vs. 8%) though this difference did not reach statistical significance.
"Among those aged 46 to 64, military personnel exhibited lower rates of heavy alcohol use (4%) than did civilians (9%).
"Across all age groups, military personnel showed significantly higher rates of heavy drinking (20%) than did civilians (14%)."

(Drug Use by Veterans, 2003) "In 2003, there were an estimated 25 million veterans comprising roughly 11.5 percent of the 217 million non-institutionalized civilians aged 17 or older in the United States."
"An estimated 3.5 percent of veterans used marijuana in the past month compared with 3.0 percent of their nonveteran counterparts in 2003"
"Heavy use of alcohol was more prevalent among veterans than comparable nonveterans, with an estimated 7.5 percent of veterans drinking heavily in the past month compared with 6.5 percent of their nonveteran counterparts."
"Using criteria from the DSM-IV, an estimated 2.6 percent of veterans were dependent on alcohol in the past year (Figure 2). A much smaller proportion of veterans (0.9 percent) was dependent on illicit drugs in the past year."
"An estimated 0.8 percent of veterans received specialty treatment4 for a substance use disorder (alcohol or illicit drugs) in the past year compared with 0.5 percent of their nonveteran counterparts (Figure 3). An estimated 2.8 percent of veterans were dependent on illicit drugs or alcohol but did not receive treatment in the past year.5 A similar proportion of comparable nonveterans went untreated."

Sociopolitical Research

(Employment) "There were little or no differences in the probability of employment by lifetime alcohol and drug use patterns. Men who had an alcohol disorder at some point in their life were equally likely as men who had never drunk alcohol to be currently employed (.91) and only slightly less likely than moderate alcohol users (.91 vs. .92, p=.09). Similarly, men who had a drug disorder at some point in their life were somewhat less likely (.90 vs. 92, p=.07) to be currently employed, but there was no statistically difference between moderate drug users and non-users. Differences among men by their current (last 12 months) alcohol and, especially, drug use patterns were greater. Current moderate alcohol drinkers were actually more likely than those who had not drunk alcohol in the last year to be employed (.93 vs. 91), while those with a current alcohol problem were less likely to be employed than either moderate or nondrinkers (.89). In contrast to moderate alcohol users, current moderate drug users were less likely to be employed than nonusers (.88 vs. .92). Men with a current drug problem were substantially less likely to be employed (.82) than either moderate or non drug users."

(Progression of Drug Use) "... patterns of prescription drug misuse among high-risk young adults in LA and NY appear to conform to and be shaped by differences in local markets for illicit drugs in each city. Our findings indicate that current misuse of prescription drugs in both cities encompasses a broad range of practices, such as sniffing, injecting, polydrug use, and drug substitution, and involves frequent misuse of illicit substances. Initiation into prescription drug misuse was often preceded by being prescribed one or more types of prescription drugs, which was then followed by initiating illicit drugs with similar psychotropic effects."

(Use Unrelated to Enforcement) "Opponents of drug policy reform commonly argue that drug use would increase if health-based models were emphasized over drug law enforcement,¹⁴ but we are unaware of any research to support this position. In fact, a recent World Health Organization study demonstrated that international rates of drug use were unrelated to how vigorously drug laws were enforced, concluding that 'countries with stringent user-level illegal drug policies did not have lower levels of use than countries with liberal ones.'¹⁵"

(Chronic Substance Use and Employment) "In conclusion, this study found that chronic drug use was significantly related to employment status for men and women. On the other hand, male chronic drug users were less likely to participate in the labor force, but no significant relationship existed between chronic drug use and labor force participation for females. Perhaps the most important finding of this study, however, was the lack of any significant relationships between nonchronic drug use, employment, and labor force participation. An implication of this finding is that employers and policy makers should focus on problematic drug users in the same way that they focus on problematic alcohol users."

(Impact of Decriminalization) "The information we have presented adds to the current literature on the impacts of decriminalization. It disconfirms the hypothesis that decriminalization necessarily leads to increases in the most harmful forms of drug use. While small increases in drug use were reported by Portuguese adults, the regional context of this trend suggests that they were not produced solely by the 2001 decriminalization. We would argue that they are less important than the major reductions seen in opiate-related deaths and infections, as well as reductions in young people’s drug use. The Portuguese evidence suggests that combining the removal of criminal penalties with the use of alternative therapeutic responses to dependent drug users offers several advantages. It can reduce the burden of drug law enforcement on the criminal justice system, while also reducing problematic drug use."

(Decriminalization and Substitution Effects) "... our results suggest that participation in the use of both licit and illicit drugs is price sensitive. Participation is sensitive to own prices and the price of the other drugs. In particular, we conclude that cannabis and cigarettes are complements, and there is some evidence to suggest that cannabis and alcohol are substitutes, although decriminalization of cannabis corresponds with higher alcohol use. Alcohol and cigarettes are found to be complements."

(Use in Low Income Areas) "Although residents of disadvantaged neighborhoods, neighborhoods with high concentrations of minorities, and neighborhoods with high population densities reported much higher levels of visible drug sales, they reported only slightly higher levels of drug use, along with somewhat higher levels of drug dependency. This finding indicates that conflating drug sales with use, so that poor and minority areas are assumed to be the focus of the problem of drug use, is plainly wrong. The finding is based on the data collected across 41 sites, including city and suburban (but not rural) areas in all regions."

(Occupational Injury) "We conclude that there is an association between substance use and occupational injury. This association is stronger for males and in certain industries, such as manufacturing and construction, and may also be stronger for younger workers, though future research is needed on this last point. The proportion of injuries caused by substance use, however, is relatively small. Instead, there is mounting evidence that harmful substance use is one of a constellation of behaviors exhibited by certain individuals who may avoid work-related safety precautions and take greater work-related risks. Thus, we suspect that it is more likely that risk-taking dispositions, often termed deviance proneness, and other omitted factors can explain most empirical associations between substance use and injuries at work."

(Income and Relationship Status) "Legal and illegal use of drugs was most strongly associated with age, sex, and income. Higher income was associated with a greater likelihood of drug use for all drug types examined, which is perhaps not surprising given that drug use requires disposable income. Relationship status was linked to illegal (but not legal) drug use: both cocaine and cannabis use were more likely among persons who had never been married or previously been married."

(Disadvantaged Areas) "Although serious drug use is slightly more prevalent in poor minority neighborhoods than elsewhere, the major problem for disadvantaged neighborhoods is drug distribution. These communities are victims not only of their own drug abuse but also of a criminal drug market that serves the entire society. The market establishes itself in disadvantaged communities in part because of the low social capital in these neighborhoods. The drug economy further erodes that social capital."

(Limited Effects of Punitive Drug Policies) "The use of drugs seems to be a feature of more affluent countries. The US, which has been driving much of the world’s drug research and drug policy agenda, stands out with higher levels of use of alcohol, cocaine, and cannabis, despite punitive illegal drug policies, as well as (in many US states), a higher minimum legal alcohol drinking age than many comparable developed countries. The Netherlands, with a less criminally punitive approach to cannabis use than the US, has experienced lower levels of use, particularly among younger adults. Clearly, by itself, a punitive policy towards possession and use accounts for limited variation in nation level rates of illegal drug use."

(Stigmatization) "Because the impacts of problem drug users are largely hidden, and also because their number is actually relatively small (approximately 330,000; Hay et al., 2008),²² people’s understanding of problem drug use tends to come from remote sources – the media (including the internet, television, films, magazines and books) and anecdote – rather than from direct experience. This provides fertile ground for the growth of myths and stereotypes: for example, the prevalent belief in instant addiction and the myth of the drug dealer offering free drugs at the school gates."

(Sewage Testing) "Some scientists have recently turned to the sewer to develop a more accurate estimate of drug use. They examine tiny samples of raw sewage for the presence of illicit drugs and their metabolites in a science known as sewer epidemiology.⁴ These samples are essentially a diluted urine test collected from an entire community,⁵ making them akin to a “community urinalysis.”⁶ The basic science is simple: nearly every drug ingested into the body is eventually excreted and finds its way into the sewer system, allowing scientists to profile a community’s drug use based on objective data."

Monitoring the Future Survey

(MTF History) "MTF [the Monitoring the Future study] is an investigator-initiated study that originated with and is conducted by a team of research scientists at the University of Michigan’s Institute for Social Research. It has been continuously funded since its onset in 1975 by the National Institute on Drug Abuse—one of the National Institutes of Health—under a series of peer-reviewed, competitive research grants."
"MTF has conducted in-school surveys of nationally representative samples of (a) 12th-grade students each year since 1975 and (b) 8th- and 10th-grade students each year since 1991. In addition, beginning with the class of 1976, the project has conducted follow-up mail surveys on representative subsamples of the respondents from each previously participating 12th-grade class. These follow-up surveys now continue well into adulthood."

(Long Term Trends Among Youth) "In the late 20th century, young Americans reached extraordinarily high levels of illicit drug use by U.S. as well as international standards. The trends in lifetime use of any illicit drug are given in the first panel on the facing page. In 1975, when MTF began, the majority of young people (55%) had used an illicit drug by the time they left high school. This figure rose to two thirds (66%) in 1981 before a long and gradual decline to 41% in 1992—the low point. After 1992 the proportion rose considerably, reaching a recent high point of 55% in 1999; it then declined gradually to 47% in 2007 through 2009, before rising to 50% in 2011 as marijuana use has been rising again."

(Alcohol Prevalence 2011) "Alcohol use is more widespread than use of illicit drugs. Seven out of ten 12th-grade students (70%) have at least tried alcohol, and four out of ten (40%) are current drinkers—that is, they reported consuming some alcohol in the 30 days prior to the survey (Table 4-2). Even among 8th graders, the proportion of students reporting any alcohol use in their lifetime is one third (33%), and about one eighth (13%) are current (past 30-day) drinkers.⁴⁷
"• Of greater concern than just any use of alcohol is its use to the point of inebriation: in 2011, 15% of 8th graders, 36% of 10th graders, and 51% of 12th graders said they have been drunk at least once in their lifetime. The prevalence rates of self-reported drunkenness during the 30 days immediately preceding the survey are strikingly high — 4%, 14%, and 25%, respectively, for grades 8, 10, and 12.
"• Another measure of heavy drinking asks respondents to report how many occasions during the previous two-week period they had consumed five or more drinks in a row. Prevalence rates for this behavior, which is also referred to as binge drinking or episodic heavy drinking, are 6%, 15%, and 22% for the three grades, respectively."

(Tobacco Prevalence 2011) "Like alcohol, prevalence of cigarettes is generally higher than illicit drugs, except for marijuana. Four tenths (40%) of 12th graders reported having tried cigarettes at some time, and nearly one fifth (19%) smoked in the prior 30 days. Even among 8th graders, nearly one fifth (18%) reported having tried cigarettes and 6% smoked in the prior 30 days. Among 10th graders, 12% reported smoking in the prior 30 days. The percentages smoking cigarettes in the prior 30 days are actually lower in all three grades in 2011 than the percentages reporting using marijuana in the prior 30 days: for 8th grade (6.1% for cigarettes vs. 7.2% for marijuana), 10th grade (11.8% vs. 17.6%), and 12th grade (18.7% vs. 22.6%), reflecting the considerable decline in cigarette use that has occurred in recent years. Among 10th and 12th graders, lifetime prevalence of marijuana use in 2011 is also higher than lifetime prevalence of cigarette use. (Annual prevalence of cigarettes is not assessed.) As noted below, however, daily use in the prior 30 days is considerably higher for cigarettes than for marijuana or alcohol in all three grades."

(Illicit Use of Prescription Narcotics) "Narcotics other than heroin now constitute the class of drugs that is second highest in ranking among 12th graders, at a 13% lifetime prevalence. Data for 8th and 10th graders are not reported for narcotics other than heroin due to questionable validity.
"• Tripwire questions about use without a doctor’s orders of OxyContin and Vicodin, two specific narcotic analgesics, were introduced in 2002. The results for OxyContin, a brand of oxycodone, show an annual prevalence rate in 2011 of 1.8%, 3.9%, and 4.9% for grades 8, 10, and 12, respectively. Rates for Vicodin use are considerably higher, with the comparable prevalence rates being 2.1%, 5.9%, and 8.1%, respectively. These prevalence rates are far higher than for heroin.
"• Tranquilizers also fall in the top third of the prevalence rankings of illicit drugs, with lifetime prevalence rates of 3.4%, 6.8%, and 8.7% for grades 8, 10, and 12, respectively.
"• Methaqualone is used by many fewer 12th graders, at 0.6% lifetime prevalence of use, than the much broader subclass of sedatives (barbiturates), at 7.0% lifetime prevalence of use.⁴⁶ Because methaqualone use has become so limited among 12th graders, questions on this drug have not been included in the 8th- and 10th-grade questionnaires. The sedative (barbiturate) questions are included in the 8th- and 10th-grade questionnaires, but the results are not reported because we suspect that these respondents inappropriately include the use of non-prescription drugs."

(Effects of Decriminalization on Adolescent Use) "A study of the effects of decriminalization by several states during the late 1970s found no evidence of any impact on the use of marijuana among young people, nor on attitudes and beliefs concerning its use.96 However, it should be noted that decriminalization falls well short of the full legalization posited in the questions here. Moreover, the situation today is very different than it was in the late 1970s, with much more peer disapproval and more rigorous enforcement of drug laws. More recent studies suggest that there might be an impact of decriminalization, because “youths living in decriminalized states are significantly more likely to report currently using marijuana.”⁹⁷ As more states take on the legalization issue, it seems likely that attitudes about and use of marijuana will change.

(Perceived Availability of Drugs) "Substantial differences were found in perceived availability of the various drugs. In general, the more widely used drugs are reported to be available by higher proportions of the age group, as would be expected (see Tables 9-6, 9-7, and 9-8). Also, older age groups generally perceive drugs to be more available. For example, in 2011, 38% of 8th graders said marijuana would be fairly easy or very easy to get, versus 68% of 10th graders and 82% of 12th graders. In fact, compared to 8th graders, the proportion of 12th graders indicating that drugs are available to them is two to three times as high for other drugs included in the study and four times as high for narcotics other than heroin. (Tranquilizers, on the other hand, are reported as only a little less available by 8th graders.) Both associations are consistent with the notion that availability is largely attained through friendship circles. The differences among age groups may also reflect less willingness and/or motivation on the part of those who deal drugs to establish contact with younger adolescents. Because many inhalants—such as glues, butane, and aerosols—are universally available, we do not ask about their availability. See Table 9-8 for the full list of drugs included in the questions for 12th graders; a few of these drugs were not asked of the younger students (see Tables 9-6 and 9-7)."

(Attitudes Toward Legalization) "• Table 8-8 lists the proportions of 12th graders in 2011 who favor making marijuana use entirely legal (39%), a minor violation like a parking ticket but not a crime (27%), or a crime (21%). The remaining 13% said they “don’t know.” It is noteworthy just how variable attitudes about this contentious issue are.
"• Asked whether they thought it should be legal to sell marijuana if it were legal to use it, about three in five (62%) said “yes.” However, about 80% of those answering “yes” (51% of all respondents) would permit sale only to adults. A small minority (11%) favored the sale to anyone, regardless of age, while 28% said that sale should not be legal even if use were made legal, and 10% said they “don’t know.”"

(Perceived Effects of Legalization) "Most 12th graders felt that they would be little affected personally by the legalization of either the sale or the use of marijuana. Over half (55%) of the respondents said that they would not use the drug even if it were legal to buy and use, while others indicated they would use it about as often as they do now (18%) or less often (2%). Only 7% said they would use it more often than they do at present, while 10% thought they would try it. Another 9% said they did not know how their behavior would be affected if marijuana were legalized. Still, this amounts to 17% of all seniors, or about one in six, who thought that they would try marijuana, or that their use would increase, if marijuana were legalized."

(Trends in Attitudes Toward Legalization) "• In the 12-year interval between 1978 and 1990, American 12th graders became much more supportive of legal prohibitions of the use of all the illegal drugs shown in Table 8-7, whether used in private or in public.
"• Between 1976 and 1979, 12th graders’ preferences for decriminalization or legalization of marijuana remained fairly constant (see Table 8-8). But between 1979 and 1990, the proportion favoring outright legalization dropped by half (from 32% in 1979 to 16% in 1990), and there was a corresponding doubling in the proportion saying marijuana use should be a crime (from 24% to 53%). Also reflecting this increased conservatism about marijuana use, somewhat fewer said they would support legalized sale even if use were made legal (down from 65% in 1979 to 48% in 1990).
"• After 1990 these policy attitudes reversed direction. The proportion favoring marijuana use being a crime dropped from 53% in 1990 to 34% by 1996, while the proportion saying marijuana should be entirely legal increased from 16% in 1990 to 31% in 1996. (See Table 8-8.) There was not much further change in these two measures through 2006, but since then there has been further change in the direction of more tolerant attitudes. The proportion favoring marijuana use being a crime dropped from 32% in 2006 to 21% in 2011, while the proportion saying marijuana should be entirely legal increased from 27% in 2006 to 39% in 2011. These recent trends toward a more tolerant view of marijuana may be due in part to the passage of “medical marijuana” laws in several states. The presence of ballot initiatives to legalize marijuana in various states has likely also contributed to an increased tolerance for marijuana."

(Effectiveness of Supply Reduction) "Overall, supply reduction—that is, reducing the availability of drugs—does not appear to have played as major a role as many had assumed in four of the five most important downturns in illicit drug use that have occurred to date, namely, those for marijuana, cocaine, crack, and ecstasy (see, for example, Figures 8-4, 8-5, and 8-6). In the case of cocaine, perceived availability actually rose during much of the period of downturn in use. (These data are corroborated by data from the Drug Enforcement Administration on trends in the price and purity of cocaine on the streets.104) For marijuana, perceived availability has remained very high for 12th graders since 1976, while use dropped substantially from 1979 through 1992. Perceived availability for ecstasy did increase in parallel with increasing use in the 1990s, but the decline phase for use appears to have been driven much more by changing beliefs about the dangers of ecstasy than by any sharp downturn in availability. Similarly, amphetamine use declined appreciably from 1981 to 1992, with only a modest corresponding change in perceived availability. Finally, until 1995, heroin use had not risen among 12th graders even though availability had increased substantially."

(Effectiveness of Supply Reduction) "• What did change dramatically were young peoples’ beliefs about the dangers of using marijuana, cocaine, crack, and ecstasy. We believe that increases in perceived risk led to a decrease in use directly through their impact on young people’s demand for these drugs and indirectly through their impact on personal disapproval and, subsequently, peer norms. Because the perceived risk of amphetamine use was changing little when amphetamine use was declining substantially (1981–1986), other factors must have helped to account for the decline in demand for that class of drugs—quite conceivably some displacement by cocaine. Because three classes of drugs (marijuana, cocaine, and amphetamines) have shown different patterns of change, it is highly unlikely that a general factor (e.g., a broad shift against drug use) can explain their various trends.
"• The increase in marijuana use in the 1990s among 12th graders added more compelling evidence to this interpretation. It was both preceded and accompanied by a decrease in perceived risk. (Between 1991 and 1997, the perceived risk of regular marijuana use declined 21 percentage points.) Peer disapproval dropped sharply from 1993 through 1997, after perceived risk began to change, consistent with our interpretation that perceived risk can be an important determinant of disapproval. Perceived availability remained fairly constant from 1991 to 1993 and then increased seven percentage points through 1998."

(Comparison of Youth Substance Use in the US and EU) "The concept of 'illicit drugs' includes marijuana, hashish, amphetamines, cocaine, crack, ecstasy, GHB, LSD or other hallucinogens, and heroin. GHB has been added to this list since the 2007 ESPAD report. Reported use of any of these illicit drugs varies considerably across the ESPAD countries. In the Czech Republic, 43% of the students report having used any of the drugs in question at least once, which is more than twice the ESPAD average of 18%. Students in France, Monaco and the United States (not an ESPAD country) also exhibit high levels of experience with illicit drugs (38–39%)."

(Drug Use Comparisons Between EU and US) "On average, 7% of the ESPAD students stated that they had used marijuana or hashish during the past 30 days. As a proportion of the group reporting lifetime use, this corresponds to roughly four in ten. The highest rates of past-30-days cannabis use are found in the two neighbouring countries of France and Monaco (24% and 21%, respectively), followed by the United States (not an ESPAD country) (18 %) and the Czech Republic and Spain (not an ESPAD country) (15% each). In these top countries, about 10% of all students had used cannabis at an average frequency roughly corresponding to at least once a week during the period in question (3–5 times or more in the past 30 days). This proportion is considerably larger than the average for all ESPAD countries (4%)."

(Any Drug Use vs Specific Drug Use) "Overall, these data reveal that, while use of individual drugs (other than marijuana) may fluctuate widely, the proportion using any of them is much more stable. In other words, the proportion of students prone to using such drugs and willing to cross the normative barriers to such use changes more gradually. The usage rate for each individual drug, on the other hand, reflects many more rapidly changing determinants specific to that drug: how widely its psychoactive potential is recognized, how favorable the reports of its supposed benefits are, how risky its use is seen to be, how acceptable it is in the peer group, how accessible it is, and so on."

Data Tables

^{Notes:
• "Psychotherapeutics" include the nonmedical use of any prescription-type pain relievers, tranquilizers, stimulants, or sedatives. Over-the-counter substances are not included.
• Methodological changes make comparison of survey data from different years problematic.
• The shift to 2010 census data from 2000 could affect comparisons between substance use estimates in 2011 and those from prior years, particularly with respect to some demographic groups.}

^{Notes:
• "Psychotherapeutics" include the nonmedical use of any prescription-type pain relievers, tranquilizers, stimulants, or sedatives. Over-the-counter substances are not included.
• “Heavy” alcohol use is defined as drinking five or more drinks on the same occasion on each of 5 or more days in the past 30 days.
• Methodology changes make comparison between different survey years problematic.
• The shift to 2010 census data from 2000 could affect comparisons between substance use estimates in 2011 and those from prior years, particularly with respect to some demographic groups.}

^{Notes:
• "Psychotherapeutics" include the nonmedical use of any prescription-type pain relievers, tranquilizers, stimulants, or sedatives. Over-the-counter substances are not included.
• “Heavy” alcohol use is defined as drinking five or more drinks on the same occasion on each of 5 or more days in the past 30 days.
• NSDUH reports did not begin reporting Ecstasy user data until 2001, making 2002 the first year for which a percent change over the prior year could be computed.}