ANN ARBOR—The proportion of American 10th- and 12th-grade students who reported using the drug ecstasy in the prior 12 months has fallen by more than half just since 2001. The usage rate among eighth-graders is down considerably, as well, over the same two-year interval. That is just some of the encouraging news to emerge from the 2003 Monitoring the Future (MTF) survey of nearly 50,000 students in 392 secondary schools across the country.

Ecstasy rose rapidly in popularity from 1998 through 2001, but in 2001 the study’s investigators detected the beginning of an increase in the proportion of students coming to see ecstasy as a dangerous drug. That perception strengthened further in 2002 as use began to decline, and use dropped more sharply in 2003 as the perceived dangers of ecstasy continued to increase.

“We have been saying for several years that use of this newly popular drug was not going to diminish until young people began to perceive its use as dangerous,” said Lloyd Johnston, the study’s principal investigator. “It now appears that teens are finally getting the word about ecstasy’s potential consequences, probably due to extensive media coverage of the issue and concerted efforts by several organizations active in educating young people about the dangers of ecstasy.”

These organizations include the National Institute on Drug Abuse, the White House Office on National Drug Control Policy, and the Partnership for a Drug-Free America. The latter two organizations launched an anti-ecstasy ad campaign in January 2002.

The availability of ecstasy, as reported by the students in the survey, rose sharply during the 1990s, peaked in 2001, and has fallen back a bit since then. But the proportional decline in availability has been much smaller than the proportional decline in use, suggesting that reduced availability did not play a key role in the recent downturn in use.

The 2003 survey is the 29th in the annual series of surveys of American 12th-graders, and the 13th in the series of eighth- and 10th-graders, who were added to the study in 1991. The MTF study, funded by the National Institute on Drug Abuse through investigator-initiated research grants, was designed and conducted by scientists at the University of Michigan Institute for Social Research. The authors of the report are Lloyd Johnston, Patrick O’Malley, Jerald Bachman, and John Schulenberg—all research professors at the University of Michigan.

Earlier surveys in this series showed that illicit drug use reached its recent peak among teens in 1996 or 1997, depending on grade. Since then, only the eighth-graders have exhibited a gradual, ongoing decline. Use in the upper grades held fairly constant until 2002, when all three grades finally began to show some decline. That decline continued into 2003, with statistically significant drops observed in annual prevalence in eighth- and 10th-grades and a nearly significant drop in 12th-grade. In addition, fewer young people in each grade say that they have ever used an illicit drug.

Because marijuana is by far the most widely used of the illicit drugs, trends in its use tend to drive the index of any illicit drug use. In 2003, marijuana use exhibited its second year of decline in the upper grades and its seventh year of decline among eighth-graders.

Its use has now fallen by three-tenths among eighth-graders since their peak in 1996 and by about two-tenths and one-tenth, respectively, among the 10th- and 12th-graders since their recent peaks in 1997. In 2003, 13 percent, 28 percent, and 35 percent of the eighth-, 10th-, and 12th-graders indicated having smoked marijuana in the prior 12 months.

All three grades showed significant increases in perceived risk of marijuana use this year, for the first time in some years, a fact that possible that the National Youth Anti-Drug Media Campaign by the Office of National Drug Control Policy and the Partnership for a Drug-Free America, which communicates the dangers of marijuana use, has had its intended effect,” Johnston said. “We have definitely seen a change in that direction.” That campaign began to air in October 2002.

The proportions of students using any illicit drug other than marijuana also declined in 2003 among 10th-grade students (significantly) and 12th-grade students (not significantly). owever, use among the eighth-graders–which had fallen by a third in earlier years from the recent peak in 1996–showed no further decline this year. Among the drugs in this general category that help to account for the overall decline in the upper grades are LSD, amphetamines, tranquilizers, and sedatives.

LSD use has been declining in all three grades since 1996, but the decline has been particularly sharp in the past two years. Since 2001, the annual prevalence of LSD use has declined by about four-tenths among eighth-graders (who showed no further improvement this year), six-tenths among 10th-graders, and seven-tenths among 12th-graders. Perceived risk and personal disapproval of LSD use generally have not moved in ways that would explain this downturn in use. Reported availability, however, has declined considerably.

In 2003 overall amphetamine use showed its first decline in recent years in the two upper grades. Among eighth-graders amphetamine use, which had been declining steadily since 1996, showed no further decline this year. Perceived risk associated with amphetamine use has been rising some among 12th-graders (the only ones asked the question) in recent years, perhaps helping to explain the decline in use in the upper grades in 2003. The use of the specific amphetamine Ritalin showed some decline in the lower two grades in 2003, though none of this year’s changes reached statistical significance. Ritalin use is now below recent peak levels in all three grades. Methamphetamine use has been showing a gradual decline over the past several years in all three grades.

The use of tranquilizers also declined in both 10th- and 12th-grades this year. This is the first year of decline for the 12th-graders, following a decade of gradual increase in tranquilizer use. Among 10th-graders it is the second year of decline. By way of contrast, there has been very little change in the considerably lower rates of tranquilizer use among eighth-graders since 1995.

Sedatives (including barbiturates) constitute another class of psychotherapeutic drugs that, like tranquilizers, act as central nervous system depressants. (Data for this class of drug are reported only for 12th-graders.) As was true for tranquilizers, sedatives had shown a decade-long rise among 12th-graders before leveling and possibly beginning to decline for the first time in 2003.

Several classes of drugs showed little systematic change this year, though in most cases they have shown some decline in recent years. These include several “club drugs,” hallucinogens other than LSD (taken as a class), cocaine, crack, heroin, and other narcotics other than heroin (taken as a class).

Rohypnol, GHB (gamma hydroxybutyrate), and ketamine are three of the so-called club drugs. All have relatively low prevalence rates among secondary school students. There were no statistically significant changes in the annual prevalence of use for any of them in 2003. Use of each tends to be at or, for the most part, below their recent peak levels. There was no significant change in 2003 in the annual prevalence of hallucinogens other than LSD, taken as a class.The current rates are below recent peak levels for this class of drugs.

Annual prevalence rates for the use of powdered cocaine and of crack cocaine also are both below their recent peak levels in all three grades. While both forms of the drug exhibited some decline in all grades in 2003, most of these changes are not significant.

Current levels of heroin use are on the order of half what they were at their recent peaks in the mid-1990s; however, little further improvement was observed this year.

The use of narcotic drugs other than heroin, taken as a class, is reported only for 12th-graders. Like most of the other psychotherapeutic drugs discussed earlier (amphetamines, tranquilizers, and sedatives), the illicit use of these analgesic drugs had risen considerably over a decade among 12th-graders. This long-term trend made even the leveling in use in 2003 (at 9.3 percent) a welcome development. Two drugs in this class, however, are showing signs of increase in use, as is discussed next.

Use of the drug OxyContin (a time-released tablet containing oxycodone) was added to the study in 2002 because of rising concerns about its use outside of medical regimen. It is a powerful, long-acting, synthetic narcotic prescribed for its analgesic effects. The annual prevalence rates for OxyContin use without a doctor’s orders in 2003 are 1.7 percent, 3.6 percent, and 4.5 percent for eighth-, 10th-, and 12th-grade students. All three grades showed some increase over the rate of use in 2002, though none reached statistical significance. “Considering the addictive potential of this drug, these are disturbingly high rates of use,” Johnston said, “and they contrast with heroin’s annual prevalence rate of less than 1 percent at all three grades, for instance.”

Vicodin is another synthetic narcotic drug used for pain control (it contains the generic drug hydrocodone) and is sometimes prescribed in dental practice. Its prevalence rate is considerably higher than OxyContin, at 2.8 percent, 7.2 percent, and 10.5 percent in grades eight, 10, and 12, respectively. It, too, showed some increase in all three grades in 2003, though none of them reached statistical significance.

Inhalants are a class of drugs defined by form (fumes) and mode of administration (inhalation), rather than by their chemical or psychoactive properties. They encompass a range of substances, including glues, aerosols, butane, paint thinner, and nail polish remover. Use of inhalants has consistently been highest among eighth-graders, probably because these types of products are cheap and easy to obtain. Following a long and substantial decline in the use of inhalants by students in all three grades, use by eighth-graders increased significantly this year.

Between 1995 and 2002, eighth-graders’ annual prevalence fell by four-tenths, from 12.8 percent to 7.7 percent, as an increasing proportion of students came to see inhalant use as dangerous. However, eighth-graders’ use rose to 8.7 percent in 2003. While not a major turnaround, this increase could suggest the need for renewed attention to this class of substances. Perceptions of the dangers of inhalant use have declined over the past two years among both eighth- and 10th-graders, quite possibly explaining the reversal in their use.

Last year, the survey results from 2002 showed a decline in the 30-day prevalence of alcohol use, as well as a decline in occasions of heavy drinking, in all three grades. This year, only the 12th-graders showed any further decline in 30-day prevalence of drinking (not statistically significant). Occasions of heavy drinking (having five or more drinks in a row sometime in the past two weeks) continued to decline slightly in all three grades, though none reached statistical significance. This year’s halting of declines in eighth-graders’ use of several substances is of some concern. “The eighth-graders have been the harbingers of change observed later in the upper grades,” Johnston said. “So, the fact that they are no longer showing declines in their use of a number of drugs could mean that the declines now being observed in the upper grades also will come to an end soon.”

In the past, the eighth-graders have been the first to show change in their use of marijuana, hallucinogens other than LSD, crack, cocaine powder, amphetamines, tranquilizers, and even cigarettes. Thus, their turnaround in inhalant use this year and the leveling in their use of hallucinogens other than LSD, amphetamines and methamphetamine, tranquilizers, and 30-day alcohol use are a bit troubling.

“One concept that we have offered to the understanding of drug epidemics is that of ‘generational forgetting’,” Johnston said. “By this we mean that even though one generation or cohort of young people may come to appreciate the hazards of a drug, those young people who follow after them may not possess that knowledge. They may not have lived through the series of events in a particular historical period that gave rise to that knowledge in previous cohorts, and therefore they may be less deterred from using that drug. It is possible that what we are observing with today’s eighth-graders is an early signal that generational forgetting is about to take place again, as it did in the early 1990s. Therefore, while most of the news from the survey this year is good news, it is worth attending to early warning signs of possible trouble ahead.” Monitoring the Future has been funded under a series of competing, investigator-initiated research grants from the National Institute on Drug Abuse. Surveys of nationally representative samples of American high school seniors were begun in 1975, making the class of 2003 the 29th such class surveyed. Surveys of eighth- and 10th-graders were added to the design in 1991, making the 2003 nationally representative samples the 13th such classes surveyed. The sample sizes in 2003 are 17,000 eighth-graders located in 141 schools, 16,200 10th-graders located in 129 schools, and 15,200 12th-graders located in 122 schools, for a total of 48,500 students in 392 schools overall. The samples are drawn to be representative of students in private and public secondary schools across the coterminous United States, selected with probability proportionate to estimated class size, to yield separate, nationally representative samples of students from each of the three grade levels.

The findings summarized here will be published in the forthcoming volume: Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2004). “Monitoring the Future national results on adolescent drug use: Overview of key findings, 2003.” (NIH Publication No. [yet to be assigned].) Bethesda MD: National Institute on Drug Abuse. It and many other publications from the study may be found on the study’s Web site, www.monitoringthefuture.org.