Need for cannabis cessation programs

1
Some Highlights from the 2005 Ontario Student
Drug Use Survey FOCUS/ODAP Feb 7
2
Outline

• OSDUS highlights
• Things we need to watch
• Things we need to do
• Things we need to remember
• Things we have learned
• Things we need to remember
• Things we need to learn

3
OSDUS History

• 1968-1975 Fours surveys conducted among Toronto
  students.
• 1977-1997 Province-wide every 2 years, G7, 9,
  11, 13 (OAC).
• 1999 Sample expanded to G7-OAC.
• 2003, 2005 G7-G12, sampled more classes in
  secondary schools.
• OSDUS is the longest ongoing school survey in
  Canada 2nd longest internationally

4
2005 Participation

• 42 Public and Catholic School Boards
• 137 Schools
• 445 Classes
• 7,726 Students (grades 7 to 12)
• 3,969 Students in grades 7, 9, and 11
• (for long-term trends)
• 72 Student Response Rate

5
Percentage Reporting Lifetime and Past Year Drug
Use, Grades 7 to 12, 2005 OSDUS
6
7 Sex Differences in Drug Use, 2005
7.6 vs 5.6
27.9 vs 25.1
25.1 vs 20.2
2.6 vs 1.7
1.6 vs 0.9
1.4 vs 0.7
1.2 vs 0.5
7
Ottawa-Carleton Renfrew Prescott
Russell Stormont, Dundas Glengary Lanark
Leeds Grenville Hastings Prince Edward
Frontenac Lennox Addington
Ontario Ministry of Health 7 Planning Regions
N
Northumberland Victoria Haliburton
Peterborough Durham York Simcoe
Algoma Cochrane Sudbury (RM) Sudbury (TD)
Muskoka Manitoulin Parry Sound
Nipissing, Timiskaming Thunder Bay Kenora
Rainy River
E
CE
CW
Halton Peel Wellington Dufferin Waterloo
TO
SW
CS
Niagara Hamilton-Wentworth Brant
Haldimand-Norfolk
Essex Kent Lambton Elgin Oxford
Middlesex Bruce Grey Perth Huron
8
Drug Use in Toronto (n1172) vs. Ontario, 2005
OSDUS
4.0 vs 6.7
20.1 vs 26.5
2.9 vs 4.8
14.8 vs 22.7
1.6 vs 0.9
9
Drug Use in South-West PH Region (n821) vs.
Ontario, 2005 OSDUS
3.0 vs 5.3
3.1 vs 1.7
10
Drug Use in Central-South PH Region (n373) vs.
Ontario, 2005 OSDUS
11.2 vs 6.7
7.7 vs 4.8
9.5 vs 4.5
9.1 vs 4.4
3.5 vs 2.2
4.7 vs 2.0
3.2 vs 1.6
3.3 vs 1.1
22.0 vs 14.4
2.2 vs 0.9
1.5 vs 0.5
11
Drug Use in Central-West PH Region (n1671) vs.
Ontario, 2005 OSDUS
7.5 vs 5.3
2.3 vs 1.3
12
Drug Use in Central-East PH Region (n1215) vs.
Ontario, 2005 OSDUS
3.7 vs 4.8
0.9 vs 1.6
13
Drug Use in East PH Region (n1229) vs. Ontario,
2005 OSDUS
2.8 vs 4.5
2.2 vs 4.4
1.0 vs 1.6
8.1 vs 14.1
14
Drug Use in North PH Region (n1245) vs. Ontario,
2005 OSDUS
8.6 vs 6.7
33.0 vs 26.5
7.5 vs 4.8
4.8 vs 2.4
32.8 vs 22.7
3.4 vs 1.6
19.9 vs 14.4
3.3 vs 1.0
15
Changes in Drug Use
16
2005 vs 2003(Grades 7 to 12)
There were 11 decreases between 2003 and 2005

• cigarettes (from 19 to 14)
• alcohol (from 66 to 62)
• LSD (from 2.9 to 1.7)
• PCP (from 2.2 to 1.1)
• other hallucinogens (from 10 to 7)
• methamphetamine (from 3.3 to 2.2)
• heroin (from 1.4 to 0.9)
• Ketamine (from 2.2 to 1.3)
• barbiturates (from 2.5 to 1.7)
• any illicit drug, including cannabis (from 32
  to 29)
• any illicit drug, excluding cannabis (from 15
  to 12)

17
Short-Term Trends, 1999-2005 (Grades 7 to 12)

• There were 15 decreases between 1999 and 2005

cigarettes alcohol glue solvents LSD PCP other
hallucinogens methamphetamine
heroin barbiturates stimulants Rohypnol steroids
(lifetime use) any illicit drug, including
cannabis any illicit drug, excluding cannabis
18
Long-Term Trends, 1977-2005(Grades 7, 9, 11 only)
19
4 Drug Use Patterns

• The OSDUS long-term trend data reveal 4 dominant
  patterns of drug use between 1977 and 2005

20
Pattern 1
Decreases during the 1980s, increases during the
1990s, continual decreases after 1999, reaching
an all-time low in 2005 ? cigarettes ? LSD

21
Long-Term Drug Use Trends (OSDUS 1977-2005)
Pattern 1
22
Pattern 2

• The only drug that is not lower in 2005 compared
  to its peak year of use is cocaine.
• Cocaine use decreased during the 1980s and early
  1990s. Since then, use increased and currently
  remains elevated.

23
Long-Term Drug Use Trends (OSDUS 1977-2005)
Pattern 2
24
Pattern 3
Use that is lower in 2005 compared to the peak
year of use in 1979 ? alcohol ?
barbiturates ? cannabis ? stimulants ?
glue ? tranquillizers ? heroin
25
Long-Term Drug Use Trends (OSDUS 1977-2005)
Pattern 3
26
Pattern 4
Use that is lower in 2005 compared to the peak
year of use in 1999 ? PCP ? other
hallucinogens ? solvents ? methamphetamine
27
Long-Term Drug Use Trends (OSDUS 1977-2005)
Pattern 4
28
Early Onset of Use
29
Early Onset Cigarettes
Grade of First Whole Cigarette Smoked among All
7th-Graders, OSDUS 1981-2005

• Fewer 7th-graders today started smoking at an
  early age
• Less than 2 of 7th-graders in 2005 smoked
  their first cigarette by grade 4 (age 9) vs 5 in
  2001, 7 in 1997, 8 in 1993, and 16 in 1981.

30
Early Onset Alcohol
Grade of First Alcoholic Drink among All
7th-Graders, OSDUS 1981-2005

• Fewer 7th-graders today started drinking at an
  early age
• 29 of 7th-graders in 2005 used alcohol by
  grade 6 (age 11) vs 42 in 2003, 47 in 1997, and
  50 in 1981.

31
Early Onset Cannabis
Grade of First Cannabis Use among All
7th-Graders, OSDUS 1981-2005

• Fewer 7th-graders today used cannabis at an early
  age
• About 3 of 7th-graders in 2005 used cannabis
  by the end of grade 7 (age 12) vs 8 in 2003, 3
  in 1993, and 9 in 1981.

32
Drug-Specific Highlights
33
Binge Drinking Episodes

• In 2005, 23 of students (36 of drinkers)
  consumed 5 or more drinks on one occasion during
  the 4 weeks before the survey. This rate has
  declined over the short-term (since 1999, when it
  was at 28).
• Long-Term Binge drinking decreased during the
  early 1990s (all-time low in 1993 at 15),
  increased up until 1999 (peak year), and has
  since decreased .

34
Binge Drinking in the Past 4 Weeks by Sex, Grade
and Region, OSDUS 2005
35
Binge Drinking in the Past 4 Weeks, OSDUS
1977-2005 (Grades 7, 9, 11)
36
Frequency of Binge Drinking in the Past 4 Weeks,
OSDUS 1979-2005 (Grades 7, 9, 11)
37
AUDIT Alcohol Use Disorders Identification Test
(WHO)
38
Hazardous Drinking (AUDIT8)

• In 2005, 16 of students (25 of drinkers)
  reported drinking at hazardous or harmful levels,
  a percentage representing about 158,800 students
  across Ontario.
• The rate of hazardous drinking has not changed
  over the short-term (since 1999).

39

• Hazardous drinking significantly varies
• between males and females (18 vs 14)
• by grade (varying from 2 of 7th-graders to 30
  of 12th-graders) and
• by region, with students in Toronto (9) least
  likely to drink hazardously, and Northern
  students most likely (22).

40
Hazardous Drinking (AUDIT 8) by Sex, Grade and
Region, OSDUS 2005
41
Types of AUDIT Symptoms by Sex and Grade, OSDUS
2005
42
Cigarettes
43
Past Year Cigarette Smoking by Sex, Grade and
Region, OSDUS 2005
44
Cigarette Smoking Trends

• The 2005 estimate (14) is significantly lower
  than that found in 2003 (19), 2001 (23) and
  1999 (28).
• Over the long-term, smoking is currently at its
  lowest point since the study began in 1977.

45
Past Year Smoking, OSDUS 1977-2005 (Grades 7, 9,
11)
46
Lifetime Smoking Status, OSDUS 1991-2005 (Grades
7, 9, 11)
47
Cannabis
48
Past Year Cannabis Use by Sex, Grade and Region,
OSDUS 2005
49
Cannabis Use Trends

• Cannabis use in 2005 (26.5) is not significantly
  different from 2003 (29.6), 2001 (28.6), or
  1999 (28.0).
• Long-term Cannabis use decreased between 1979
  and 1991 (10), increased up until 1999, and
  remains at an elevated level.

50
Past Year Cannabis Use, OSDUS 1977-2005 (Grades
7, 9, 11)
51
Cannabis Frequency

• 15 of students used cannabis 6 or more times
  during the past year.
• 3 of students used cannabis daily during the 4
  weeks before the survey (representing about
  33,200 students).
• Among cannabis users, 12 used daily during the 4
  weeks before the survey.

52
Frequency of Cannabis Use in the Past Year among
Users, OSDUS 1979-2005 (Grades 7, 9, 11)
53
Trends in Daily Cannabis Use among Users

• Daily cannabis use among users was significantly
  higher in 2003 (14) compared to 1999 (8), and
  remains elevated in 2005 at 12.
• Daily cannabis use has increased over the
  long-term, with the current rate significantly
  higher than that found in 1987 (4).

54
Cannabis Use Problems, 2005

• 12 of students (45 of cannabis users) report at
  least one of three problem-use indicators.
• Among cannabis users
• -34 report attempts to reduce use
• -25 report sustained daily use
• -9 report uncontrolled use

55
Cannabis Dependence, 2005

• Cannabis users who report uncontrolled cannabis
  use and sustained daily use or attempts to reduce
  use may have a dependence problem.
• About one-in-twelve (8) users may be dependent
  on cannabis.
• There are no significant differences by sex,
  grade or region.

56
CRAFFT scale of drug problems
57
CRAFFT scale 2 symptoms
58
Things we need to watch
59
Cocaine
60
1. Cocaine Trends different from other drugs
61
2. 7th-grader trends
62
3. Perceived risk
63
4. Cocaine US vs OSDUS
64
4. Cocaine US vs OSDUS
65
Wheres the meth?
66
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Not all epidemics diffuse into adolescent
populationNot all US epidemics diffuse into
Canada
69
Student Drug Use vs Other Indicators
EnforcementIndicators 6
Treatment Indicators 4-10
Pop. of Drug-Using Adolescents Aged lt20 yrs
Emergency Room Indicators lt 10
Deaths 2
70
Not all epidemics diffuse into mainstream youth
population

• Meth expansion seems to be more abuser-driver
  than youth-driven
• Other youth-driven expansions
• Ecstasy and club drugs
• Hallucinogens
• Other drugs more abuser- market-driven
• crack

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Cocaine US vs OSDUS
73
Things we need to do
74
Need for cannabis cessation programs
75
Frequency of cannabis use is increasing

• Daily use increasing 13 of users (3 of all
  students) used daily compared to about 4 (0.5
  of all students) during the early 1990s
• Intensity rate increasing (daily rate/12m rate)
  1987.04 1990s .07 2005 .13

76
Significant percentage report attempts at cutting
down

• 34 of users report attempts to cut down their
  use during the past 12 months
• 9 of all students N87,800

77
Need more attention given to drugged-driving
78
Drugs and Driving Items

• How often in the past 12 months have you
  driven within an hour of using marijuana or
  hashish?
• How often in the past 12 months have you
  driven within an hour of drinking two or more
  drinks of alcohol?

79
Past year cannabis driving, licensed drivers,
G10-G12, 2005
80
Past year drugs and driving, licensed drivers,
G10-G12, OSDUS, 2005 (n2,277)
25.7
81
Past year cannabis driving, 2001-2005
82
Need more attention given to passenger involvement
83
1. More students exposed as passengers than as
drivers

• Drinking-driving (G10-G12 drivers)
• 13.6 ? 36,000
• Cannabis-driving (G10-G12 drivers)
• 20.0 ? 53,000
• Alcohol-involved passenger (G7-G12)
• 28.8 ? 259,000
• Drug-involved passenger (G7-G12)
• 21.5 ? 217,000

84
2. Passenger involvement correlated with other
drug problems
85
Programming needs to go beyond the student
86
School matters
87
School matters

• School drug problems
• use by student use in school
• Substantial differences between schools in
  alcohol-related problems, even after adjusting
  for student-level and environmental factors
• Rehm, J., Monga, N., Adlaf, E., Taylor, B.,
  Bondy, S. J., Fallu, J.-S. (in press). School
  matters Drinking dimensions and their effects on
  alcohol related problems among Ontario secondary
  school students. Alcohol and Alcoholism.
• Kairouz, S., Adlaf, E. M. (2003). Schools,
  students and heavy drinking A multilevel
  analysis. Addiction Research and Theory, 11(6),
  427-439.

88
Alcohol and tobacco are key public health issues
for adolescents and should always remain the main
target of programming
89
Alcohol and tobacco are key

• Absolute numbers are large
• Binge 22.7 220,100
• Daily cigarettes 8.6 83,000
• Cannabis 26.5 257,900
• Ecstasy 4.5 43,300
• Meth 2.2 21,300
• Ice 0.9 8,100

90
Alcohol and tobacco are key

• 2. Behaviours most likely to continue into
  adulthood
• 3. alcohol and tobacco are most related to
  morbidity, mortality and economic costs

91
Things we need to remember
92
Multiple drug use is the normAre there really
__ drug users?
93
Multiple drug use is the norm

• No use 36
• Alcohol only 33
• Tobacco only lt .5
• Cannabis only 0.7
• Stimulants only 0.5
• Hallucinogens only lt .5
• Depressants only lt .5
• Multiple user 27

Caution needed when planning drug-specific
programs
94
With declining prev, prevention likely to be more
difficult
95
Both relative and absolute numbers are important
96
AUDIT by region
Similar relative rates () not necessarily equal
to absolute numbers
97
Most drug use is recreational
98
Frequency of Drug Use During the Past Year Among
Users, Grades 7 to 12, 2005
99
Things we have learned
100
Perceived risk is associated with prevalence of
use
101
Move together
102
Move together
103
Move together
104
Move together
105
But associated how?
Risk perception Disapproval
?
Use
Risk perception Disapproval
?
Use
Risk perception Disapproval
Accuracy of reporting
?
106
But, no evidence that trends in drug use are
artifactual
107
Cannabis use, disapproval questionnaire
sensitivity
108
Drug use in cyclical
109
Common risk factors exist for both substance use
and mental health problems
110
Health Risk Profile 9 Outcomes
111
Risk Factors 12
112
Robust Risk Factors
113
Moderate Risk Factors
114
Weaker Risk Factors
115
Why Toronto lower?
116
Drug Use in Toronto (n1172) vs. Ontario, 2005
OSDUS
4.0 vs 6.7
20.1 vs 26.5
2.9 vs 4.8
14.8 vs 22.7
1.6 vs 0.9
117
Immigrant Status
118
Ontario in Context
119
Ontario near or below the Canadian average
120
Lifetime Use, YSS, G7-G9, 2002
121
Ontario vs US
122
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Ontario vs Europe
126
Lifetime cannabis use, 2003, 15-16 year olds,
ESPAD
41
41
39
127
Lifetime use high, but

• Lifetime use not increasing
• 43 ? 41 similar to
• 41 ? 38 UK
• 37 ? 39 Ireland, unlike
• 22 ? 44 Czech Rep
• 19 ? 27 Italy
• 4 ? 16 Hungary

128
and

• Decline in past month use larger in Ontario
• 31 ? 23 vs
• 24 ? 20 UK
• 19 ? 17 Ireland

129
Things we need to learn
130
Need to better understand interplay between
community and school
131
Interplay of community and school?
?
?
H
L
L
H
L
L
H
H
Low drug use community
High drug use community
132
Need to better understand onset
133
2005 OSDUS Drug Report Availability

• www.camh.net/research/osdus.html
• (1) Detailed Drug Report
• (2) Highlights Drug Report

134
END
135
Extra
136
Figure 4.1 Overview of Mental Health Indicators
and Problems, OSDUS 2003, Grades 7 to 12
Problems include (1) psychological distress (2)
hazardous drinking (3) drug problem and (4)
delinquent behaviour.
4 problems --- 3
Problems
3 problems 7
2 problems 10
1 problem --- 28
None of the 4 problems --- 52
Indicators
School fighting --- 18
Weapon carrying --- 9 Low self-esteem ---10 MH
visit --- 11 Suicide ideation --- 12 Poor
health --- 13 3 delinquent acts --- 14
Bullied others --- 30 Psychological distress ---
31 Been bullied --- 32
Pathological gambling 4 Depression risk --- 6
137
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138
Cocaine Trends different from other drugs
139
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3. Perceived risk