The Walters - Try Again
Ono no Tofu, having failed his government promotion exams seven times, watches a frog repeatedly attempt to jump up to a willow branch. When the frog finally makes it on the eighth try Ono no Tofu resolves to try his exams again. His perseverance was rewarded, and he became one of the great Chinese statesmen of the 10th century.
The Walters - Try Again
Press Briefing by John Walters, Director of the Office of National Drug Control Policy, and Nora Volkow, Director of National Institute on Drug Abuse on the "Monitoring the Future" ReportJames S. Brady Press Briefing Room Press Briefings Press Briefing Slides (PDF, 1.16MB, 6 pages)11:13 A.M. ESTDIRECTOR WALTERS: Thank you. As you know, the President announced thelatest results of "Monitoring the Future," the annual survey that has beendone since the mid-'70s, about rates of teen drug use among 12th, 10th and8th graders. The President noted that in 2002 we set a goal of reducingoverall teenage drug use by 25 percent. Today's results, covering the 2007school year, note an overall reduction of 24 percent for selected drugs. Obviously, the widest drug abuse by teenagers and adults is marijuana;that's been down 25 percent. This is the overall trend for the threegrades -- the 8th graders being the one at the bottom with the lowestrates, and some of the steepest declines the 10th and 12th graders, for theperiod since the studies existed, since 1975.This has a summary of the results for different drugs, from 2001 to 2007. As you see, the rates have changed. You'll note that the overall number --25 percent decline for marijuana, ecstasy use down over 50 percent,methamphetamine use down 64 percent, alcohol use by this age group --underage drinking -- down 15 percent, cigarette use down 33 percent.This highlights the decline we've seen with methamphetamine use in threecategories: those reporting they used in the past month, those reportingthey used in the past year, and those reporting they've used in theirlifetime -- with the month, year and lifetime in that order.Also, the study asked questions about steroid use. You may remember in the2004 State of the Union, the President mentioned the problem of steroiduse. We've seen a drop of overall a third. But also, and by month, byyear, and by lifetime, 33, 45 and 45 percent for this age group, which isalso obviously good news; and the effect of these drugs, especially ongrowing adolescence, is particularly detrimental.As the President pointed out, these reductions are a result of hard work bymany, many people and communities; working coalitions; young people;parents that have been working in these areas; small, faith-based andcommunity groups; schools; many adults giving time to help young people;and many young people helping each other. We had a sampling of thosepeople -- Dr. Volkow and I were with the President and talking to a sampleof a people from around the country working this area from our major citiesto a Native American anti-drug treatment and prevention efforts.In addition, as the President pointed out, we've seen declines in someareas of supply. One of the areas we haven't seen a decline that thePresident highlighted was prescription drug abuse, particularly painkillers. The overall decline has been maintained, but within it there hasbeen during the five-year period an increase and a stubborn resistance todecline by prescription drug abuse. This is a different problem. Theseare certainly dangerous, mostly synthetic opiates that are the most widelyabused. They are not only a source of addiction, but they are of course --can be a source of seizure, even death, when taken in quantities.It's also a different problem because the source of supply is different: 71 percent of young people from other surveys we have say they have -- thesource of supply is the medicine cabinets of their own home, and themedicine cabinets of the parents of their friends in their homes. So thisis a uniquely susceptible problem to education and information. We need toget people that information, one, to tell young people and parents theseare a dangerous threat, they need to pay attention to them more than ever;and, two, to shut down the source of supply, which is not having control ofthese substances when they're used in the home, when they may be used forlegitimate purposes, which obviously we want people to have access to them.And secondly, throw them away when they're done. Proper disposal andcontrol are a key way to help to reduce this, in addition to education. That's all something we need help getting information out into people'shands:recognize the problem and recognize what you need to do about it,in terms of helping to educate young people and to remove this attractivehazard.Other than that, I'll be happy -- and help Dr. Volkow to answer yourquestions.Q What's your plan for next year? What drugs will you be focusing on? Where is drug czar money going to go? What's the emphasis going to be, interms of drug testing?DIRECTOR WALTERS: Well, we'd like to reinforce the things that work. Sometimes government has problem seeing this, but we've tried to, again,push a balanced strategy, as the President said, across both supply anddemand. It began with the Access to Recovery program.We're seeking --and we hope Congress, when it finishes this appropriations cycle, willcontinue to give us the resources to expand treatment that followsindividuals and helps to support them in recovery.Secondly, we want to follow up with the President's initiative on randomtesting, as well as strengthening the messaging we do with media campaignfor both parents and for young people directly. We're going to focus onprescription drugs. I think that we are working with NIDA, with ournonprofit partners, with community groups to prepare and we're workingaggressively to get these things out in the coming months. Where we havesome things in the works, we'll see whether they prove as effective atpromising, and we'll be rolling them out as quickly as possible becauseit's a serious threat.Q Two questions. One, on the graph you showed with the illicit drug use-- it looked like, yes, the overall trend of decline was sustained, butthat there seemed to be a leveling off effect, that the declines that we'veseen from the previous year were far fewer than what we had demonstrated inthe past. What could explain that? And then also, as part of prescriptiondrug abuse, what about the prevalence of these things on the Internet? I've heard reports of online pharmacies that are -- you can basically getany prescription drug that you need just by lying about your age and otherthings to get these. So what are you doing to address that piece of theproblem?DIRECTOR WALTERS: Let me take those in reverse order.While most youngpeople -- through other survey data, as I said, not this survey -- thepreponderance of the drugs they report using in prescription abuse comefrom their own homes. There is, obviously, abuse on the Internet. Therehave been cases -- the DEA has been involved in pill mills over theInternet. And we are working aggressively with Congress to move forwardlegislation that will help us do a better job of providing regulation andcontrol.In addition we've been working with states -- 33 states now haveprescription monitoring programs for patient safety. Doctors can then haveaccess to a confidential data base, find out whether someone has beendoctor-shopping, whether they've been given an inordinate amount of certainabusable prescriptions when they present themselves. In addition,pharmacists can see whether or not a prescription is a forgery or a validprescription, or whether it's one that's been also gotten from others.Soit helps both prevent illegal activity, but it also helps patient safety.On the decline -- different years there has been different rates ofdecline. And for some of these categories and for some of the age groups,the change year to year has not been down, it's been flat. Again, that'swhy the overall trend -- again, there are a couple factors to keep in mind. One, fortunately the majority of young people do not use illegal drugs. And so what Dr. Johnston is looking at when he does the research is boththe overall number -- and then looking at changes within that, you end upwith smaller and smaller differences, especially year to year.That's whywe've looked over a number of years to kind of see change, also to makeprogress.In addition, we have seen steeper declines with younger -- the younger agegroup.It is true that the -- and that's a good thing, because the youngeryou start, the more dangerous this is.And I think the other thing I omitted that I think is important here forpeople to understand why it is important what we do here: if you don'tbegin using drugs of abuse, alcohol and cigarettes, up through adolescence,you have a much reduced risk of using afterwards. And if you do useafterwards, you also have a reduced risk of becoming dependent. Now, it'snot true of every person, there are other factors. And I think there's nomore striking example of that than my generation -- the baby boomergeneration, had as a cohort the largest involvement with drugs and alcohol. And now we, in our 50s and 60s, have some of the highest rates ofalcoholism and continuing substance abuse of any generation before orafter.So not only is this good news good today, but this generation will tend tobe less involved with drugs and alcohol and cigarettes for the rest oftheir lives. So this is something that has a durable effect on the futureof the substance abuse problem in the country by the basic common-sense, Ithink, direction of -- keep kids away from this, and more markets(inaudible).But there has been different rates of change in -- but overall, the lastfive years have shown, I think, a pretty remarkable decline, and a declinesustained across a number of dimensions. That's why we're particularlytroubled about prescription drugs, is it hasn't followed that pattern.Q Sorry, let me just write.Don't want to miss that. You can't writeand talk at the same time. Sorry. (Laughter.)So on September 6th at the Press Club when we were talking about the othersurvey, as I recall, that survey showed that the numbers had basicallystagnated in '06; that the nice drops that we had seen had almostcompletely leveled off. And as I recall, what you said was that all of theother gains in other areas of illicit drug use were basically being negatedby rising prescription drug use. And part of your message that day wasthat we were in real trouble, because of prescription use, of not hittingthe President's goals, your goals, for an overall reduction.It's only three months later and we're on the cusp of victory here. So I'ma little bit confused about how to interpret whether we're there or notthere.I understand there are two different studies, I understand themethodology is different, but --DIRECTOR WALTERS: Well, the age groups are also different. This is astudy of 8th, 10th and 12th graders. The survey is talking about -- is anational survey on drug abuse and health, which measures people inhouseholds, age 12 and over. So it goes all the way up to young and old.And part of the discussion, I remember I was talking about, was also, theinitiation rates of this cohort of adolescence in the 8th, 10th and 12thage group are important. But we also see that the highest rates of use areby those who are 18 to 26, 18 to 30. And I think what we were talkingabout at that point was also the trajectory of use by young adults,particularly as they affect, because of the intensity of their use, theover-18 population as a whole.And there, we'd also see an increased useof prescription drugs.And in that case, we isolate the prescription drugs-- because you can take the survey data and take out everything butprescription drugs -- we were talking about that data that showed whathappened, because overall we would have a decline; prescription drug usehad created a kind of flat line.But that was an older cohort, which is -- but they're still seeing the samephenomenon. I think, again, we are seeing the prescription drug problem isnot just a problem of teens, it's also a problem of adults. But, again, weparticularly want to reverse it, obviously, with teens, not only because ofthe importance of initiation at that age, but also because of how dangerousthese drugs are.Q Just to try more to understand the -- I just called it the (inaudible)survey, I don't even know what it's called anymore -- the (inaudible)survey versus this one --DIRECTOR WALTERS: Also, that survey was for -- it's important to point outwhat it's trying to -- I think that I should mention that the survey thatwas released there was for 2006. This is a 2007 survey, so they'redifferent time periods.Q But you -- so if that cohort is 12 -- I just -- for people who don'tget into, like, cohort and how this is statistically analyzed, they readour stories from three months ago saying, we're in danger of not making itbecause prescription drugs use is negating everything.Twelve and older --I mean, I was 12 when I was in 8th grade, so it's -- everybody says, oh,the same group of people. And three months ago we were in real danger ofnot hitting the goals, and today we're hitting the goals.DIRECTOR WALTERS: Well, again --Q I don't get it.DIRECTOR WALTERS: Okay, maybe I could be clear this way. This survey isabout adolescents, and we're talking about trends within adolescents. Iwould say that the household survey that you talk about, in terms of itscategory of 12- to 17-year-olds, which overlaps the same age group, hassimilar trends. It doesn't show exactly the same rates. The "Monitoringthe Future" survey, which was taken in schools, shows -- has consistentlyshown some of the higher rates of reported use than the survey taken in thehousehold, although the trend lines have been the same. There are varioushypotheses for this; I'm not an expert, others can talk about what thedifference is.But we've seen similar trends, downturns, pretty steadily. And they've been going down going back to '75, this is the longestcontinuous survey instrument of its kind. But we've seen similar up-ticks.What we were talking about at the Press Club was also not simplyadolescents, but adults. And the concern is people over 18 -- because wealso are concerned about them -- not seeing the same kind of declines,largely as a result of the parent effect of additional prescription drugabuse in the over-18 population at that time.So maybe I could help you by just saying there is not an inconsistency aslong as you recognize one age group is adolescents, one age group is, kindof, post-adolescent and adult.Q This is for Dr. Volkow. What's the latest in the brain scienceregarding -- I mean, one of the things that we've been talking about is howdifficult it has been to kick the OxyContin addiction -- there weren'treally good treatments available for narcotic addiction -- and also formethamphetamine addiction. What things have changed in the brain science,and what do we know now about treating folks with these types ofaddictions?DR. VOLKOW: Well, I mean, those are very important questions that we'vebeen trying to actually promote research to do it, specifically, the one,what are the treatments for addiction to OxyContin? Addiction to OxyContinis basically addiction to an opiate which, in a way, is similar toaddiction to heroin. And what we're doing now is evaluating -- for whichwe have effective medication interventions, both methadone and (inaudible)are very successful in the treatment of heroin addiction.So currently we are doing a study, a large clinical study, to determine andevaluate specifically the value of (inaudible) for the treatment ofaddiction to opiates analgesics -- and that includes not just OxyContin,but also Vicodin.Now within that line of work, there's something that compounds the problemand which is -- we haven't discussed it -- that what we've seen,particularly in all the group of subjects that become addicted, in manyinstances -- in some of those instances, they have become addicted afterproper prescription of the medication, because they suffer from chronicpain. And the a challenge there for treatment is how do you intervene onan individual that has severe pain, that needs potent analgesics, yet atthe same time is addicted to the medication that is likely to help him orher perform better.And that's a very unique situation that we have not experienced before, sowe're evaluating what may be the best interventions. And as of now,(inaudible) is -- even though the studies have not been done -- is beingwidely utilized for the treatment of patients that are addicted to opiateanalgesics.Q And methamphetamine?DR. VOLKOW: Methamphetamine addiction: We currently do not have anymedication that has proven to be effective in the treatment ofmethamphetamine addiction. We have -- we're initiating several clinicaltrials to evaluate promising medications, but we don't have any specificresults. We're also (inaudible) research to develop a vaccine that willbasically destroy methamphetamine when the person administers it -- it'sjust like any other vaccine -- to interfere with relapsing an individualsick in treatment.That's what we have in the pipeline. What is that we have currently thathas been shown to be effective? Those are behavioral interventions, andthere is a program that has generated a lot of interest because it has verygood success, which is called the Matrix program. It's a multi-prongedapproach that addresses individual as well as group treatmentinterventions; and that's one of them.We also have -- there's alsoevidence of effectiveness of motivation and incentive therapies for thetreatment of methamphetamine addiction.Q So what has been the change in attitudes regarding prescription drugsamong teens? Does the fact that they're -- you know, we're seeing aleveling-off effect of illicit drugs suggest that teens are thinking thatprescription drugs are somehow safer, and that they're able to abuse themmore? And what are the demographics in that? Is it people that are -- youknow, is it in higher-income households, where they're able to afford theseprescription drugs, that teens are abusing these things?DIRECTOR WALTERS: I think we can let Lloyd Johnston afterwards kind oftalk about the demographic data he has on this, because I think there's afair amount of it. What we've seen generally, and in working on preventionmessaging, with this research and other research, is young people havereported that they understand -- this is where I think the efforts ofparents, the media, and others have been helpful -- that so-called streetdrugs are dangerous: they can be dangerous for them to take; they can bedangerous to them just because of what's uncontrolled and may be in them;that the traditional drugs of abuse are something they have learned theyshould avoid in greater numbers, and I think the numbers in this survey andothers reflect that.But they have been told irresponsibly, or they believe that pharmaceuticals-- because they come from a regulated industry, they come from a medicalestablishment -- are safe, and they can actually go, on or their friendshave gone on irresponsible web sites that can suggest combinations of pillsto take for getting high so-called safely.Now, again, these are synthetic opiates, as Nora said.They have a similareffect on the body as heroin. They are powerful, many of them -- they areparticularly dangerous in combination with alcohol, which is not -- whichis a common combination with young people, as well as some adults. Theycan be fatal, in addition to causing seizures and other problems, inaddition to addiction.So, yes, we do need to some education.They think of these pills in adifferent way and, as I said, the occasion to use them is greater because-- they report -- they're in the house. They don't have to find somebodyto give them marijuana or cocaine or meth outside the home.