Adolescent Substance Abuse (Ages 12-17)
Heroin Admissions by Usual Route of Administration and Opioid Replacement Therapy
This chapter highlights topics that are of current or special interest:
Adolescent Substance Abuse (Ages 12-17)
TEDS data indicate an overall increase in adolescent admissions aged 12 to 17 for substance abuse treatment between 1994 and 2004, attributable primarily to increased admissions involving marijuana and increased referral to treatment through the criminal justice system.
Tables 5.1a and 5.1b and Figure 27. The number of adolescents aged 12 to 17 admitted to substance abuse treatment increased 43 percent between 1994 and 2004. This increase is largely accounted for by the increase in the number of adolescent primary marijuana admissions (115 percent between 1994 and 2004). The proportion of adolescent primary marijuana admissions grew from 43 percent of adolescent admissions in 1994 to 64 percent in 2004.
The number of adolescent primary stimulant, opiate, and cocaine admissions also increased (by 154 percent, 125 percent, and 4 percent, respectively) from 1994 to 2004, but the proportion of adolescent admissions for stimulants represented only 5 percent of all adolescent admissions in 2004, while the proportions of adolescent admissions for cocaine and opiates were 2 percent each.
Adolescent treatment admissions for primary alcohol abuse decreased over this time period. The proportion of adolescent primary alcohol admissions decreased from 39 percent in 1994 to 19 percent in 2004, as the number of adolescent alcohol admissions fell 32 percent.
Table 5.2a. Overall, 69 percent of adolescent admissions were male. However, this proportion was heavily influenced by marijuana admissions, where 76 percent were male. The proportions of adolescent female admissions were greater than those for adolescent males for methamphetamine/amphetamines (57 percent female vs. 43 percent male) and for heroin (53 percent female vs. 47 percent male).
Table 5.3a. In 2004, more than half (51 percent) of adolescent admissions were referred to treatment through the criminal justice system. Seventeen percent were self- or individual referrals, and 11 percent were referred through schools.
Figure 28. The number of adolescent admissions referred by the criminal justice system increased every year from 1994 to 2002, but declined in 2003 and 2004. Admissions from schools declined slightly between 1994 and 2004, while those from self- or individual referrals and other referral sources increased slightly.
Table 5.4. In 2004, 44 percent of all adolescent admissions involved the use of both alcohol and marijuana. The number of admissions involving both alcohol and marijuana increased by 24 percent between 1994 and 2004. Admissions involving primary marijuana and no alcohol increased by 216 percent. Over the same period, admissions involving primary alcohol and no marijuana declined by 40 percent.
Table 5.5a and Figure 29. An admission was considered marijuana-involved if marijuana was reported as a primary, secondary, or tertiary substance. Between 1994 and 2004, the number of marijuana-involved adolescent admissions increased for both criminal justice and other referral sources. (The increases were 121 percent and 29 percent, respectively, yielding a net increase of 66 percent.) However, while the number of marijuana-involved adolescent admissions originating in the criminal justice system increased every year from 1994 to 2002, the number from other referral sources was relatively stable, varying within a range of 4,000 admissions between 1995 and 2004. Beginning in 1998, marijuana-involved adolescent admissions referred through the criminal justice system outnumbered those entering treatment through other referral sources. Adolescent admissions not involving marijuana declined by 3 percent between 1994 and 2004; an increase of 6 percent in criminal justice referrals was more than offset by a decrease of 9 percent in referrals from other sources.
Heroin Admissions by Usual Route of Administration and Opioid Replacement Therapy
TEDS data indicate that heroin injection has been a growing problem among young adults since the 1990s. Despite increases in the numbers of admissions for heroin abuse, there was a decline in the number receiving opioid replacement therapy (medication-assisted therapy with methadone or buprenorphine) was planned.
Tables 5.6a and 5.6b. Heroin admissions increased by 23 percent between 1994 and 2004. Increases of 64 percent in admissions for heroin inhalation and 4 percent in admissions for heroin injection were largely responsible. The proportion of heroin admissions represented by injection declined from 73 percent in 1994 to 63 percent in 2004. Heroin inhalation made up 32 percent of all heroin admissions in 2004, an increase from 24 percent in 1994.
Tables 5.6a, 5.6b, and Figure 30. The number of admissions receiving opioid replacement therapy did not keep pace with the increase in heroin admissions. While heroin admissions increased by 23 percent between 1994 and 2004, the number receiving opioid replacement therapy decreased by 33 percent. In 2004, opioid replacement therapy was more likely to be given to heroin smokers (36 percent) than to the much larger groups of injectors and inhalers (31 percent and 27 percent, respectively). Among admissions for heroin injection, opioid replacement therapy fell by 45 percent between 1994 and 2004. The proportion of admissions for heroin inhalation receiving opioid replacement therapy declined from a high of 40 percent in 1994 to a low of 23 percent in 1996 and 1997. Rebounding to 32 perent in 1998, the rate declined to 27 percent in 2004.
Table 5.7b and Figure 31. Between 1994 and 2004, the proportion of admissions under age 30 decreased among heroin inhalers and increased among heroin injectors. Until the year 2000, heroin inhalers admitted to treatment tended to be younger than heroin injectors admitted to treatment. In 1994, 39 percent of admissions for inhalation were under 30 years of age, compared to 18 percent of those injecting heroin. By 2004, the proportion of those admitted for inhaling heroin who were under age 30 had fallen to 21 percent. The proportion admitted for injecting heroin who were under age 30 had increased to 35 percent. Among heroin smokers, the proportion under age 30 was 37 percent in 2004.
Table 5.7a. Among heroin abusers experiencing a first treatment episode in 2004, the average duration of use was 11 years for smoking, 12 years for injection, and 13 years for inhalation.
Polydrug abuse (the use of more than one substance) was more common among TEDS admissions than was the abuse of a single substance.
Table 5.8 and Figure 32. Polydrug abuse was reported by 55 percent of all TEDS admissions in 2004. Alcohol, marijuana, and cocaine were the most commonly reported secondary and tertiary substances.
Abuse of alcohol as a primary, secondary, or tertiary substance was characteristic of most treatment admissions. Forty percent of all treatment admissions were for primary alcohol abuse, and 22 percent of admissions for other drugs reported that they also had an alcohol problem. Overall, 62 percent of all treatment admissions reported alcohol as a substance of abuse.
Alcohol and opiates were reported more often as primary substances than as secondary or tertiary substances. Twenty-three percent of all admissions involved opiate abuse, with 18 percent reporting primary abuse and 6 percent reporting secondary or tertiary abuse.
For marijuana and cocaine, more admissions reported these drugs as secondary or tertiary substances than as primary substances. Marijuana was reported as a primary substance by 16 percent of all admissions, but was a secondary or tertiary substance for another 21 percent, so that 37 percent of all treatment admissions reported marijuana as a substance of abuse. Cocaine was a primary substance for 14 percent of admissions, but was a secondary or tertiary substance for an additional 17 percent. Thus nearly one-third (31 percent) of all treatment admissions involved cocaine abuse.
Table 5.9. This table details the most common substance combinations for selected primary substances. For example, for primary alcohol admissions, 55 percent reported abuse of alcohol alone, 14 percent reported abuse of alcohol and marijuana but no other drugs, and 7 percent reported primary abuse of alcohol with abuse of cocaine and marijuana as secondary and tertiary substances.
TEDS permits analysis of racial/ethnic subgroups that are generally poorly represented in sample surveys. Substance abuse patterns differed widely among racial/ethnic subgroups. Among Hispanics, substance abuse patterns differed according to country of origin. Patterns also differed between men and women within subgroups.
Table 3.3b and Figures 33-38. Among non-Hispanic Whites [Figure 33], alcohol as the primary substance accounted for 48 percent of male admissions and 36 percent of female admissions. Marijuana and opiates were the most frequently reported illicit drugs for non-Hispanic White men (16 percent and 15 percent, respectively), followed by cocaine and stimulants (8 percent each). For non-Hispanic White women, opiates were the primary illicit drug (20 percent), followed by stimulants (13 percent), and cocaine and marijuana (12 percent each).
Among non-Hispanic Blacks [Figure 34], 35 percent of male admissions used alcohol as the primary substance. Among non-Hispanic Black women, cocaine (35 percent) was more frequently reported as a primary substance than was alcohol (26 percent). Cocaine was the most commonly reported illicit substance for men (25 percent), followed by marijuana (22 percent) and opiates (14 percent). For women, other primary substances were opiates (19 percent) and marijuana (16 percent). Stimulants were reported by 1 percent each of non-Hispanic Black men and women.
Among persons of Mexican origin [Figure 35], alcohol was the primary substance involved in 43 percent of male admissions. Among women of Mexican origin, however, stimulants were more frequently reported as a primary substance than was alcohol (31 percent and 24 percent, respectively). Marijuana (18 percent) was the most commonly reported illicit substance for men, followed by opiates and stimulants (15 percent each) and cocaine (7 percent). For women, other commonly reported primary substances were opiates (16 percent), marijuana (15 percent), and cocaine (11 percent).
Among persons of Puerto Rican origin [Figure 36], opiates were the main substances at treatment admission for both men and women (49 percent and 42 percent, respectively). Opiates were followed by alcohol for both men and women (28 percent and 22 percent, respectively). For men, other primary substances were marijuana (12 percent) and cocaine (9 percent). For women, other primary substances were cocaine (17 percent) and marijuana (14 percent). Admissions for stimulant use were 2 percent for women and less than 1 percent for men.
American Indians and Alaska Natives together accounted for 2 percent of all TEDS admissions [Table 3.1a]. Among American Indian/Alaska Native admissions, 64 percent of men and 49 percent of women entered treatment because of primary alcohol abuse [Figure 37]. Marijuana was the most frequently reported illicit substance for men (14 percent), followed by stimulants and opiates (6 percent each) and cocaine (5 percent). Stimulants were the most frequently reported illicit substances for women (14 percent), followed by marijuana (12 percent), opiates (11 percent), and cocaine (8 percent).
Asians and Pacific Islanders accounted for just under 1 percent of all TEDS admissions [Table 3.1a]. Among this group [Figure 38], alcohol was the primary substance involved in 36 percent of male admissions. Among women, however, stimulants were more frequently reported as a primary substance than was alcohol (36 percent and 25 percent, respectively). Stimulants and marijuana were the most commonly reported illicit drugs for men (24 percent and 21 percent, respectively), followed by opiates (8 percent) and cocaine (7 percent). For women, other commonly reported primary substances were mariijuana (16 percent, opiates (10 percent), and cocaine (8 percent).
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