Misuse of Rx Opioids by Young Adults Falls to Record Lows

By Pat Anson, PNN Editor

The misuse of prescription opioids by young adults has fallen to the lowest levels ever recorded, according to an annual survey that’s been tracking drug use in the U.S. since 1975. The Monitoring the Future (MTF) survey also found that use of marijuana and hallucinogens by young adults rose to an all-time high last year.

The MTF survey and annual report is a joint project of the National Institute on Drug Abuse (NIDA) and the University of Michigan. Over 28,000 people were surveyed last year, including young adults aged 19 to 30 and adults aged 35 to 60.

Only 1.7% of young adults reported using “narcotics other than heroin,” a poorly named category that refers to the non-medical use of prescription opioids such as hydrocodone and oxycodone. Misuse of prescription opioids has been in a steep decline since reaching a peak of 8.9% in 2006.

NON-MEDICAL USE OF Rx OPIOIDS BY YOUNG ADULTS AGED 19-30

Source: Monitoring the Future

“One of the best ways we can learn more about drug use and its impact on people is to observe which drugs are appearing, in which populations, for how long and under which contexts,” said Megan Patrick, PhD, a research professor and principal investigator of the MTF study. 

“Monitoring the Future and similar large-scale surveys on a consistent sample population allow us to assess the effects of ‘natural experiments’ like the pandemic. We can examine how and why drugs are used and highlight critical areas to guide where the research should go next and to inform public health interventions.”

The MTF survey reflects the declining role that prescription opioids have in the U.S. drug epidemic, which is primarily fueled by illicit fentanyl and other street drugs. According to the IQVIA Institute, a healthcare data tracking firm, prescription opioid use has fallen by 48% over the past five years and now stands at levels last seen in 2000.

Once the most widely prescribed drug in the United States, hydrocodone (Vicodin) prescriptions have plummeted since the opioid was reclassified as a Schedule II Controlled Substance in 2014 and became harder to obtain.

According to the MTF survey, only 1.3% of young adults reported using Vicodin last year, down from a peak of 9.2% in 2009.

VICODIN USE BY YOUNG ADULTS AGED 19-30

Source: Monitoring the Future

Marijuana and Hallucinogens

While fewer younger adults are misusing prescription opioids, they are using marijuana and hallucinogens far more often.

Daily marijuana use (use on 20 or more occasions in the past 30 days) in 2021 reached the highest levels ever recorded since the MTF survey started monitoring it in 1988. Daily marijuana use was reported by 11% of young adults last year, up from 8% in 2016 and 6% in 2011.

In 2021, 8% of young adults reported using a hallucinogen such as LSD, ecstasy or psilocybin, an all-time high since the category was first surveyed in 1988. By comparison, only 3% reported using hallucinogens a decade earlier.

“As the drug landscape shifts over time, this data provides a window into the substances and patterns of use favored by young adults. We need to know more about how young adults are using drugs like marijuana and hallucinogens, and the health effects that result from consuming different potencies and forms of these substances,” NIDA Director Nora Volkow, MD, said in a news release.

“Young adults are in a critical life stage and honing their ability to make informed choices. Understanding how substance use can impact the formative choices in young adulthood is critical to help position the new generations for success.”

Alcohol remains the most-used substance among young adults, by far, with nearly 82% reporting alcohol use last year, unchanged from 2020. However, binge drinking (five or more drinks) rebounded to 32% in 2021 from an historic low in 2020, during the early stages of COVID-19 pandemic. 

Magic Mushrooms, Psychedelics and Chronic Pain

By Roger Chriss, PNN Columnist

The recent news that Denver has decriminalized “magic” mushrooms is the latest sign of growing interest in the use of psychedelics. Whether it’s microdosing mushrooms to stimulate the mind or using them to treat depression and chronic pain, psychedelic drugs are having a moment.

Magic mushrooms are any of roughly 200 different types of fungi that produce psilocybin, a hallucinogenic substance. Other psychedelics include LSD, DMT, ayahuasca and ibogaine. For reasons of chemistry and cultural baggage, DMT is generally avoided, LSD is used with extra caution and psilocybin is getting the most attention in clinical studies.

Preliminary research has found positive outcomes for psychedelic therapy in smoking cessation,  anxiety, post-traumatic stress disorder and refractory depression. And there are promising findings on psychedelics for cluster headaches and phantom limb pain.

A 2015 review in the Journal of Psychoactive Drugs reported that for patients with cluster headaches, psilocybin and other hallucinogens “were comparable to or more efficacious than most conventional medications.”  

In a 2006 Neurology review, researchers interviewed 53 cluster headache patients who used LSD or psilocybin. Most reported success in stopping cluster attacks and extending periods of remission.

And a 2018 Neurocase report described positive results for one patient with intractable phantom pain who combined psilocybin with mirror visual-feedback.

Obviously, these studies are very preliminary. Patient self-reports on drug use outside of clinical settings have limited value as evidence of efficacy. And case reports are by definition too small-scale to generalize from.

Fortunately, more clinical trials are underway for psilocybin and LSD. Last year the FDA approved a “landmark” psilocybin trial for treatment-resistant depression. And the Multidisciplinary Association for Psychedelic Studies is also working to promote robust clinical research.

Of course, psychedelics are not without risks. As described in detail in the book DMT: The Spirit Molecule, patients need to be screened and monitored before, during and after psychedelic therapy.

Michael Pollan, author of “How to Change Your Mind”, told The New York Times that psilocybin has risks “both practical and psychological, and these can be serious.”

There are also risks of conflating the pop culture phenomenon of microdosing to clinical benefits obtained under medical supervision.

The “betterment of healthy people” through microdosing is enthusiastically endorsed in books like “A Really Good Day” by Ayelet Waldman. But a 2018 placebo-controlled study on LSD microdosing found no “robust changes” in perception, mental acitivty or concentration.

The microdosing trend could stymie serious research and bias public opinion about psychedelics — just as it did in the 1960’s.

The potential for psychedelic therapy in the management of chronic pain disorders is two-fold. First, psychedelics may represent a safe and effective way to manage otherwise intractable disorders like cluster headaches and phantom limb pain. Second, psychedelics may help address the depression, PTSD and anxiety that often contribute to or accompany such disorders.

It is to be hoped that more research on psychedelics comes quickly.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.