Exploring Drug Use Among Adolescents: Contributing Factors and Proposed Prevention Strategies

The CDC indicates that substance abuse, including opioid use disorder (OUD), often begins during adolescence and increases the probability of continued substance use disorders (SUD) and drug overdoses in adulthood.¹ Individuals with SUDs are more likely to experience greater rates of physical and mental health issues as well as reduced overall health and well-being.¹ The Institutes for Safe Medication Practices indicates that due to the easy access to nonprescription drugs, adolescents also abuse various OTC medications (ie, dextromethorphan, diet supplements, and laxatives) and herbal supplements, with abuse most common in those between 13 and 16 years of age.²

In a recent publication in the journal Translational Psychiatry, authors noted that substance use during adolescence is a well-established risk factor for the development of neuropsychiatric disorders and SUDs in adulthood.³ According to a study published in JAMA Network, in the US from 2019 to 2020, the number of overdoses that resulted in mortality increased by 94.03%, and from 2020 to 2021, it expanded by 20.05%.⁴ Additionally, in 2021, there were 1,146 overdose deaths among adolescents which was more than double the number of overdose deaths in 2010 reported as 518.⁴

Contributing Factors and Prevention

According to new data from the annual Monitoring the Future survey, the percentage of adolescents reporting drug usage remains low. Still, the number of deaths attributed to overdose has increased in recent years.^5,6 The Monitoring the Future survey is led by researchers at the University of Michigan and sponsored by the National Institute on Drug Abuse.5,6 The report indicated in 2023, the rate of drug use among adolescents continued to remain stable or decline with respect to the pre-pandemic levels reported in 2020, with 10.9% of eighth graders, 19.8% of 10th graders, and 31.2% of 12th graders reporting any illicit drug use.^5,6 The report also indicated that among adolescents, the most frequently reported drugs included alcohol, nicotine vaping, cannabis, and the use of narcotics.^5,6 In a press release, Richard Miech, team lead of the study, stated, “We’ve been watching closely to see if the big declines in teen substance use after the pandemic would persist, or if substance use levels would bounce back when students returned to school. We’re glad to see that the declines have persisted. These results support a growing body of evidence showing that a one-year delay in drug use during adolescence can lower future trajectories of drug use for years to come.”⁷

In a 2024 publication by the CDC, researchers conducted a cross-sectional study among adolescents who were being evaluated for SUD treatment in the United States during 2014–2022 to understand factors that may have contributed to substance use in this patient population. Results revealed the following:⁸

• 73% of participants revealed that the most commonly reported reason for substance use was “to feel mellow, calm, or relaxed.”⁸
• Primary stress-related motives included: “to stop worrying about a problem or to forget bad memories” (44%) and “to help with depression or anxiety” (40%).⁸
• 50% reported using substances “to have fun or experiment.”⁸
• An estimated 81% of the adolescents reported using drugs with friends, and 50% reported using drugs when alone.⁸

The researchers indicated that based on the factors cited by participants, they suggested the implementation of measures to decrease stress and focus on mental health concerns, which may diminish the principal motivations for substance use among adolescents.⁸ The researchers also indicated that educating adolescents about “harm reduction strategies,” such as education initiatives about the adverse effects and consequences of substance use, as well as resources for identifying and knowing how to respond to an overdose, have the potential to decrease the risk for mortality due to overdoses.⁸

In a press release in October 2023, the National Association of Boards of Pharmacy (NABP) discussed the issue of the role of pharmacists in treating substance use among adolescents.⁹ The NABP indicated that while the number of adolescents with SUD has declined, the mortality rates of adolescents who used controlled substances continue to rise and are principally the result of synthetic opioid use.⁹ The NABP also indicated that pharmacists could be instrumental in treating SUD including OUD by working collaboratively with prescribers to promote safe prescribing practices, devising patient-centered SUD treatment plans using FDA approved therapies for OUD, identifying patients with risk factors or signs of SUD and in educating patients about the dangers of drug use to reduce or thwart drug abuse/misuse.⁹

According to the 2024 annual ASHP/ASHP Foundation Pharmacy Forecast Report, results from an American Society of Health-System Pharmacists (ASHP) survey revealed that 71% of participants indicated that due to their drug expertise, pharmacists are well poised to initiate and make modifications to medication treatment plans for individuals with SUDs. The authors of the Pharmacy Forecast recommend that health-system leaders incorporate pharmacists' knowledge into novel approaches to address the gaps in care and obstacles to recognizing and treating substance use and mental health disorders.¹⁰

Conclusion

SUDs, including OUDs, impose a significant burden on affected individuals, loved ones, society, and the health care system. The solution to reducing and preventing SUDs is not an easy achievement due to the complex and multifaceted aspects that contribute to drug abuse/misuse. Continued education and efforts to expand awareness about the negative impact of substance use are critical to addressing this issue. Gaining more insight into understanding, identifying, and addressing factors or root causes that may contribute to substance abuse, especially among adolescents, could be instrumental in preventing or reducing SUDs and their detrimental consequences.

References

1. High-Risk substance use among youth. CDC. Published September 2022. Accessed March 6, 2024. https://www.cdc.gov/healthyyouth/substance-use/index.htm
2. Top ten OTC medicines and herbals abused by teens and young adults. MedSafety.org. 2024. Accessed March 8, 2024. https://www.consumermedsafety.org/over-the-counter-medicines/otc-drug-abuse/top-ten-otc-medicines-and-herbals-abused-by-teens-and-young-adults
3. Steinfeld MR, Torregrossa, MM. Consequences of adolescent drug use. Transl Psychiatry. 13, 313 (2023). doi:10.1038/s41398-023-02590-4
4. Friedman J, Godvin M, Shover CL, Gone JP, Hansen H, Schriger DL. Trends in drug overdose deaths among US adolescents, January 2010 to June 2021. JAMA Network. 2022;327(14):1398–1400. doi:10.1001/jama.2022.2847
5. Reported drug use among adolescents continued to hold below pre-pandemic levels in 2023. News release. National Institute on Drug Abuse. Published December 2023. Accessed March 6, 2024. https://nida.nih.gov/news-events/news-releases/2023/12/reported-drug-use-among-adolescents-continued-to-hold-below-pre-pandemic-levels-in-2023
6. Miech RA, Johnston LD, Patrick ME, O’Malley PM, Bachman JG. National survey results on drug use, 1975-2023: Secondary school students. University of Michigan Institute for Social Research. Published December 2023. Accessed March 8, 2024. https://monitoringthefuture.org/wp-content/uploads/2023/12/mtf2023.pdf
7. Teen drug use remains below pre-pandemic levels. News release. University of Michigan. Published December 13, 2023. Accessed March 6, 2024. https://news.umich.edu/teen-drug-use-remains-below-pre-pandemic-levels/
8. Connolly S, Govoni TD, Jiang X, et al. Characteristics of alcohol, marijuana, and other drug use among persons aged 13–18 years being assessed for substance use disorder treatment — United States, 2014–2022. MMWR Morb Mortal Wkly Rep. 2024;73:93–98. doi:10.15585/mmwr.mm7305a1
9. NAPB Staff. Pharmacists’ role in treating substance use in adolescents. NAPB. Published October 18, 2023. Accessed March 6, 2024. https://nabp.pharmacy/news/blog/pharmacists-role-in-treating-substance-use-in-adolescents/
10. Pharmacy forecast identifies growing societal challenges expected to impact care. ASHP News Center. Published December 4, 2023. Accessed March 6, 2024. https://news.ashp.org/news/ashp-news/2023/12/04/pharmacy-forecast-identifies-growing-societal-challenges-expected-to-impact-care