Adolescent Admissions to Substance Abuse Treatment
Trends in Heroin Admissions and Medication-Assisted Opioid Therapy
Polydrug Abuse
Racial/Ethnic Subgroups

This chapter highlights topics that are of current or special interest:

• Adolescent substance abuse 1999-2009

TEDS data indicate that admissions to substance abuse treatment aged 12 to 17 increased by 15 percent between 1999 and 2002, but declined by 5 percent between 2002 and 2009. In 2009, 86 percent of adolescent treatment admissions involved marijuana as a primary or secondary substance, and 43 percent were referred to treatment through the criminal justice system.

• Heroin admissions and medication-assisted opioid therapy 1999-2009

The number of TEDS admissions for primary heroin abuse increased by 10 percent between 1999 and 2009.

The proportion of heroin admissions whose treatment plans included medication-assisted opioid therapy (opioid therapy using methadone or buprenorphine) declined from 38 percent in 1999 to 28 percent in 2009.

• Polydrug abuse

Polydrug abuse (the use of more than one substance) was more common among TEDS admissions than was abuse of a single substance.

• Racial/ethnic subgroups

TEDS data indicate that substance abuse patterns differed widely among racial/ethnic subgroups; however, alcohol was the predominant substance for all racial/ethnic groups except persons of Puerto Rican origin, where the predominant substance was heroin.

Adolescent Admissions to Substance Abuse Treatment

Tables 3.1a and 3.1b and Figure 19. The number of adolescent admissions aged 12 to 17 increased by 15 percent from 1999 to 2002, then declined by 5 percent from 2002 to 2009.

• Two primary substances—marijuana and alcohol—accounted for between 83 and 89 percent of adolescent admissions from 1999 to 2009.
• Marijuana admissions increased from 60 percent of adolescent admissions in 1999 to 71 percent in 2009. The number of adolescent marijuana admissions increased by 29 percent between 1999 and 2009.
• Alcohol admissions declined from 26 percent of adolescent admissions in 1999 to 18 percent in 2009.
• Methamphetamine/amphetamine admissions increased from 2 percent in 1999 to 6 percent in 2005, but then decreased to 2 percent in 2009.
• Opiate admissions represented 1 to 2 percent of adolescent admissions from 1999 to 2008 but rose to 3 percent in 2009. Opiates other than heroin¹ represented 11 percent of adolescent opiate admissions in 1999 but rose to 65 percent in 2009.
• Cocaine accounted for 1 to 3 percent of adolescent admissions between 1999 and 2009.
• All other substances combined accounted for 2 to 3 percent of adolescent admissions between 1999 and 2009.

Table 3.2. In 2009, overall 71 percent of adolescent admissions were male, a proportion heavily influenced by the 77 percent of marijuana admissions that were male. The proportion of female admissions was greater than 40 percent for most other substances. There were more female than male adolescent admissions for methamphetamine/amphetamines (57 percent).

Almost half (48 percent) of adolescent admissions were non-Hispanic White, 23 percent were of Hispanic origin, 20 percent were non-Hispanic Black, and 9 percent were of other racial/ethnic groups.

¹ These drugs include methadone, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, pro­poxyphene, tramadol, and any other drug with morphine-like effects.

Table 3.3. The number of adolescent admissions increased with age; 1 percent were 12 years old, increasing to 33 percent who were age 17. Among admissions for inhalants, 21 percent were aged 12 or 13. Among admissions for heroin and for opiates other than heroin, 63 percent and 46 percent, respectively, were age 17.

In 2009, almost half (49 percent) of adolescent admissions were referred to treatment through the criminal justice system. Sixteen percent were self- or individual referrals, and 12 percent were referred through schools.

Table 3.4 and Figure 20. An admission was considered marijuana-involved if marijuana was reported as a primary, secondary, or tertiary substance. In 1999, 43 percent of all adolescent admissions were marijuana-involved admissions referred to treatment by the criminal justice system, and 39 percent were marijuana involved but referred by other sources. Between 1999 and 2002, the proportion referred by the criminal justice system increased to 45 percent while the proportion referred by other sources decreased to 37 percent. The proportions started to converge in 2007.

Adolescent admissions not involving marijuana that were referred by the criminal justice system fell from 8 percent in 1999 to 5 percent in 2009. Admissions not involving marijuana that were referred from other sources were fairly stable, at between 9 and 11 percent of adolescent admissions.

Trends in Heroin Admissions and Medication-Assisted Opioid Therapy

General measures of heroin abuse among treatment admissions were relatively consistent from 1999 through 2009. Primary heroin abuse accounted for 14 to 16 percent of TEDS admissions in every year from 1999 through 2009. Injection was the preferred route of administration for 60 to 67 percent of primary heroin admissions, inhalation for 29 to 34 percent, and smoking or other route for 4 to 5 percent. The majority of primary heroin admissions were 35 years of age or older (54 to 56 percent from 1999 through 2007 and 48 percent in 2009).

However, these measures conceal substantial changes in the age, race/ethnicity, and route of administration of heroin-using subpopulations.

Table 3.5 and Figure 21. TEDS data indicate that heroin abuse has been increasing among young non-Hispanic White adults. Among non-Hispanic Blacks, however, admissions have declined except among older admissions.

• In 1999, just over 1 in 5 heroin admissions (22 percent) was non-Hispanic White aged 20 to 34. By 2009, more than 1 in 3 primary heroin admissions (38 percent) belonged to this subgroup. The proportion of primary heroin admissions who were non-Hispanic White aged 35 to 44 fell from 16 percent to 10 percent in the same period, while the proportions of non-Hispanic White admissions aged 12 to 19 and older than 45 remained constant, at 2 to 3 percent and 7 to 8 percent, respectively.
• In contrast, the proportion of primary heroin admissions that were non-Hispanic Black aged 20 to 34 fell from 7 percent to 2 percent between 1999 and 2009, while the proportion aged 35 to 44 fell from 10 percent to 7 percent.
• However, the proportion of non-Hispanic Black admissions aged 45 and older increased from 7 percent in 1999 to 10 percent in 2009. Non-Hispanic Black admissions aged 12 to 19 accounted for less than one-tenth of 1 percent of all primary heroin admissions.
  

Table 3.6 and Figure 22. Route of administration of heroin was closely linked to age and race/ ethnicity. Injection increased among young adults; inhalation increased among those 45 and older.

• In 1999, 1 in 4 primary heroin admissions (25 percent) were injectors aged 20 to 34 and a similar proportion (24 percent) were injectors aged 35 to 44. By 2009, more than 1 in 3 primary heroin admissions (37 percent) were injectors aged 20 to 34, but the proportion that were injectors aged 35 to 44 had dropped to about 1 in 7 (14 percent).
• The proportion of primary heroin admissions who were inhalers aged 20 to 34 fell from 14 percent in 1999 to 9 percent in 2009, while the proportion who were inhalers aged 45 and older rose from 4 percent to 10 percent.
  

Table 3.7 and Figures 23 and 24. Planned use of medication-assisted opioid therapy (opioid therapy using methadone or buprenorphine) declined among TEDS admissions for heroin abuse between 1999 and 2009.

• Table 3.7 and Figure 23. In 1999, 38 percent of primary heroin admissions had treatment plans that included medication-assisted opioid therapy. The proportion varied by route of administration—50 percent of heroin smokers, 45 percent of heroin injectors, and 30 percent of heroin inhalers received it. By 2009, only 28 percent of primary heroin admissions had treatment plans that included medication-assisted opioid therapy, and there was little difference by the major routes of administration.
  

• Figure 24. Older heroin admissions were most likely to have medication-assisted opioid therapy planned. In 1999, opioid therapy was planned for 53 percent of admissions aged 45 and older, 42 percent of those aged 35 to 44, 31 percent of those aged 20 to 34, and 15 percent of those aged 12 to 19. The proportions fell for all age groups, and by 2009, opioid therapy was planned for 40 percent of primary heroin admissions aged 45 and older, 31 percent of those aged 35 to 44, 22 percent of those aged 20 to 34, and 14 percent of those aged 12 to 19.
  

Polydrug Abuse

Polydrug abuse (the use of more than one substance) was more common among TEDS admissions than was abuse of a single substance.

Table 3.8 and Figure 25. Polydrug abuse was reported by 54 percent of TEDS admissions aged 12 or older in 2009. Marijuana, alcohol, 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-two percent of all treatment admissions were for primary alcohol abuse, and 19 percent of admissions for primary drug abuse reported that they also had an alcohol problem. Overall, 61 percent of all treatment admissions reported alcohol as a substance of abuse.

• Alcohol, opiates, and methamphetamine/amphetamines were reported more often as primary substances than as secon­dary or tertiary substances. Twenty-nine percent of all admissions involved opiate abuse, with 21 percent reporting primary abuse and 8 percent reporting secondary or tertiary abuse. Ten percent of all admissions reported methamphetamine/amphetamine abuse, with 6 percent reporting primary abuse and 4 percent reporting secondary or tertiary abuse.
• Marijuana and cocaine were reported more often as secondary or tertiary substances than as primary substances. Mari­juana was reported as a primary substance by 18 percent of all admissions, but was a secondary or tertiary substance for another 20 percent, so that 38 percent of all treatment admissions reported marijuana as a substance of abuse. Cocaine was a primary substance for 9 percent of admissions, but was a secondary or tertiary substance for an additional 15 percent. Thus 24 percent of all treatment admissions involved cocaine abuse.
• Table 3.9. This table details the most common substance combinations for selected primary substances. For example, for primary alcohol admissions, 56 percent reported abuse of alcohol alone, ­15 percent reported abuse of alcohol and marijuana but no other drugs, and 6 percent reported primary abuse of alcohol with abuse of cocaine and marijuana as secondary and tertiary substances.

Racial/Ethnic Subgroups

Table 2.3b and Figures 26-31. TEDS data indicate that substance abuse patterns differed widely among racial/ethnic subgroups. Among admissions of Hispanic origin, substance abuse patterns differed accord­ing to country of origin. Patterns also differed between men and women within subgroups.

• Among non-Hispanic Whites [Figure 26], alcohol as the primary substance accounted for 48 percent of male admissions and 37 percent of female admissions.
  • Opiates and marijuana were the most frequently reported illicit drugs among non-Hispanic White male admissions (22 per­cent and 16 percent, respectively), followed by cocaine (5 percent) and methamphetamine/amphetamines (5 percent).
  • Among non-Hispanic White female admissions, opiates were the primary illicit drug (29 percent), followed by marijuana (12 percent), methamphetamine/amphetamines (9 percent), and cocaine (8 percent).

• Among non-Hispanic Blacks [Figure 27], 36 percent of male admissions used alcohol as the primary substance. Among non-Hispanic Black female admissions, cocaine (28 percent) was more frequently reported as a primary substance than was alcohol (27 percent).
  • Marijuana and cocaine were the most commonly reported illicit substances for male admissions (28 percent and 18 percent, respectively), followed by opiates (14 percent).
  • For female admissions, other primary substances were marijuana (22 percent) and opiates (18 percent).
  • Methamphetamine/amphetamines were reported by about 1 percent each of non-Hispanic Black female and male admissions.

• Among persons of Mexican origin [Figure 28], alcohol was the primary substance involved in 44 percent of male admissions, but among female admissions, however, methamphetamine/amphetamines were reported as a primary substance almost as frequently as was alcohol (25 and 30 percent, respectively).
  • Marijuana (25 percent) was the most commonly reported illicit substance for male admissions, followed by opiates and methamphetamine/amphetamines (13 percent and 12 percent, respectively).
  • For female admissions, other commonly reported primary substances were marijuana (19 percent), opiates (15 percent), and cocaine (9 percent).

• Among admissions of Puerto Rican origin [Figure 29], opiates were the main primary substances at treatment admission for both men and women (44 percent and 37 percent, respectively), followed by alcohol (30 percent and 24 percent, respectively).
  • For male admissions, other primary substances were marijuana (15 percent) and cocaine (8 percent).
  • For female admissions, other primary substances were marijuana (20 percent) and cocaine (15 percent).
  • Admissions for primary methamphetamine/amphetamine abuse were 2 percent for women and 1 percent for men.

• American Indians and Alaska Natives together accounted for 2 percent of all TEDS admissions [Table 2.2] [Figure 30]. Among American Indian/Alaska Native admissions, 72 percent of men and 57 percent of women entered treatment because of primary alcohol abuse.
  • Marijuana was the most frequently reported illicit substance for male admissions (14 percent), followed by opiates (6 percent), methamphetamine/amphetamines (4 percent), and cocaine (3 percent).
  • Opiates and marijuana were the most frequently reported illicit substances for female admissions (14 percent and 12 percent, respectively), followed by methamphetamine/amphetamines (9 percent) and cocaine (5 percent).

• Asians and Pacific Islanders accounted for 1 percent of all TEDS admissions [Table 2.2]. Among this group [Figure 31], alcohol was the primary substance involved in 42 percent of male admissions and 36 percent of female admissions.
  • Marijuana and methamphetamine/amphetamines were the most commonly reported illicit drugs for male admissions (22 percent and 18 percent, respectively), followed by opiates (11 percent) and cocaine (6 percent).
  • For female admissions, methamphetamine/amphetamines were the most commonly reported illicit substance (24 percent), followed by marijuana (18 percent), opiates (13 percent), and cocaine (6 percent).

TO TABLES

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