The chart below is not comprehensive, but serves to illustrate percentages of use for some of the more common substances.
Prescription Narcotic Abuse
It may surprise you to find out that among 12th-graders, 8 of the 13 most commonly abused drugs (excluding tobacco and alcohol) were prescription or over-the-counter medications, over half of which were given to them or were purchased from a friend or relative. According to the 2009 Monitoring the Future survey (NIDA-sponsored), nearly 1 in 10 high school seniors reported past-year nonmedical use of Vicodin, and 1 in 20 abused OxyContin. In 2008, the number of individuals aged 12 or older who abused prescription pain relievers for the first time (2.2 million) was roughly even with that of marijuana (National Survey on Drug Use and Health)
The numbers on marijuana abuse are equally striking. According to the National Survey on Drug Use and Health, in 2007, 14.4 million Americans aged 12 or older used marijuana at least once in the month prior to being surveyed. About 6,000 people a day used marijuana for the first time in 2007 —2.1 million Americans. Of these, 62.2 percent were under age 18.
Methamphetamine is also prevalent in the United States: an estimated 529,000 Americans were current (past-month) users of methamphetamine (0.2 percent of the population). Of the 157,000 people who used methamphetamine for the first time in 2007, the mean age at first use was 19.1 years, which is down from the mean age of 22.2 in 2006 (National Survey on Drug Use and Health). However, the number of individuals aged 12 years or older reporting past-year methamphetamine use declined from 1.9 million in 2006 to 1.3 million in 2007.
Although inhalants are not often perceived as a substance of misuse or abuse yet, this is an increasingly common risky behavior affecting your patients. The NIDA-funded 2010 Monitoring the Future Study showed that 8.1% of 8th graders, 5.7% of 10th graders, and 3.6% of 12th graders had abused inhalants at least once in the year prior to being surveyed.
Finally, according to the CDC’s State Tobacco Activities Tracking and Evaluation (STATE) system report, in 2008, 26.1% of Indiana residents used tobacco which was second in prevalence only to West Virginia, at 26.6%. In 2008, nearly 71 million Americans age 12 and older had used a tobacco product at least once in the month prior to being surveyed (National Survey on Drug Use and Health). Such tobacco use is linked to increased morbidity and mortality.
Prevalence and Possibilities
Substance use is a problem, one that is prevalent and growing, and that affects many of our patients, even in the absence of an obviously related primary complaint. This prevalence is troubling but it also represents an opportunity for health care providers. SBIRT is a tool set to assist in taking advantage of this opportunity. And, SBIRT can help us reduce the likelihood that substance use will lead to serious adverse personal and health consequences. Those consequences are diverse, pervasive, sometimes subtle, and are the subject of our next section of this module.