Adolescent substance use and abuse

Pediatric Resident Academic Half Day June 7, 2012 Ellie Vyver, MD, FRCPC Division of Adolescent Medicine Adolescent substance use and abuse

Objectives • To examine substance abuse in the larger context of social determinants of health • To learn about adolescent susceptibility to the effects of substances • To have an understanding of risk and protective factors as well as resiliency • To be familiar with national, province and local rates of substance use • To develop an approach to the adolescent using substances

NAME THAT DRUG

The Chief Public Health Officer’s Report on the State of Public Health in Canada, 2011: Youth and Young Adults – http://publichealth.gc.ca/CPHOreport

SUMMARY • Canadian youth are leading healthy lives • Subpopulations like aboriginal youth, street involved youth, or sexual minorities are more vulnerable to particular health or socio-economic issues

Cost of Substance Abuse • Results of the Costs of Substance Abuse in Canada 2002 study released in 2006 • Abuse of tobacco, alcohol and illegal drugs cost Canadians about $40 billion ($18 billion in 1992) • Cost to Alberta was $4.4 billion ($1.6 billion in 1992) • Tobacco $1.8 billion for AB (Canada $17 billion) • Alcohol $1.6 billion for AB (Canada $14.6 billion • Illegal drugs $1 billion for AB (Canada $8.2 billion)

Cost of Substance Abuse • Costs by category for Alberta: • Indirect costs (productivity losses): 63% • Direct health care costs: 23% • Direct law enforcement costs: 11% • Other direct costs: 3%

Developmental Tasks of Adolescence • Development of self-esteem and a healthy identity • Emancipation from parents to autonomous behaviors • Formation of a sexual identity • Meaningful social and peer relationships • Seeking vocational goals • Establishing moral and ethical values

Adolescent Brain Development and Susceptibility • Period of significant brain development • Increase in white matter volume • M>F • Reflects increased myelination • Increase in gray matter volume in preadolescence followed by decrease • Changes in frontal lobe involved in development of executive functioning • Emotional regulation • Planning and organizing • Response inhibition

Giedd et al., Brain development during childhood and adolescence: a longitudinal MRI study. Nat Neurosci 1999;2:861

Gogtay N., Giedd JN., Lusk L., et al. Dynamic mapping of human cortical development during childhood through early adulthood. Proceedings of the National Academy of Science 2004;101(21):8172-8179

Dopamine • Synthesis in Preadolescent < Adolescent < Adult • Large increase in levels and activity during adolescence • Large role in reward circuitry of the brain that fuels drug addiction

Hippocampus • Increases significantly in size during adolescence • Levels of dopamine in the hippocampus show large increase • Involved in new memory formation

Risk and Protective Factors • Terms used to identify aspects of individuals or their environments that make development of a given problem more or less likely Health Canada, 1999

Risk Factors • Defined as either life events or experiences that are statistically associated with an increase in problematic behaviour such as substance use

Protective Factors • Defined as the life events or experiences that mitigate the effects of risk factors and reduce the likelihood of problematic behaviour • Increase RESILIENCY

Resiliancy The ability to overcome adversity

Risk and Protective Factors • Can be categorized into five different domains: • Individual • Family • Peers • Schools • Community

Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE: Monitoring the Future national survey results on drug use, 1975–2006. Volume I: Secondary school students. Bethesda, MD: National Institute on Drug Abuse; 699. (NIH Publication No. 07-6205)

TRENDS

Top 3 Substances • ALCOHOL • CANNABIS • TOBACCO

ALCOHOL

National Alcohol Use Data

Alberta Data for Alcohol Use

CANNABIS

National Cannabis Use Data

How do Alberta Youth Compare? • The majority (83.7%) of students in Grades 7 to 12 report that they are not currently using cannabis • 16.3% of students indicate that they have used cannabis in the past 12 months • Males (16.7%) and females (16.0%) are equally likely to report using cannabis • Older students are more likely to use cannabis. • Highest use in Calgary compared to rest of province

TOBACCO

Alberta Youth and Tobacco • Overall, rates of smoking among students in Grades 7 to 12 are low • Most students (95.3%) are not current smokers. • Older students are more likely to smoke • Among all students, 69.7% reported they had never tried smoking tobacco. • Equal proportions of males and females are non-smokers (95.4% and 95.2% respectively) • The percentage of all students who had ever smoked a cigarette, even just a few puffs, increased from 10.0% among students in Grade 7 to 47.8% in Grade 12 • Calgary has the lowest rate of current smokers (5.2%)

Illicit Drugs

Illicit Drug Use in 15-24 y.o. • Past-year use of at least one of cocaine or crack, speed, hallucinogens, ectasy, and heroin decreased from 11.3% in 2004 to 7.0% in 2010. • The rate of past year use of any drug excluding cannabis is almost nine times higher than that of adults (7.9% vs. 0.8%)

Alberta Youth and Illicit Drugs • Majority of Alberta students (78.7%) have not used illicit drugs (excluding cannabis) • Illicit drugs most frequently used are MDMA or ecstasy (3.7%) and hallucinogens (4.0%) • Males (19.1%) and females (23.6%) have similar rates of illicit drug use (excluding cannabis) • Increase in the proportion who use illicit drugs (excluding cannabis) as grade increases. • 8.9% in Grade 7 • 27.4% in Grade 12 • Calgary has one of the highest rates of illicit drug use in the province

SALVIA

Salvia • Salvia divinorum • Herb found in Southern Mexico; leaves are very potent • Atypical psychedelic • "la pastora" / "the shepherdess", "the leaves of the shepherdess", "diviner's mint“, "diviner's sage“ • Smoked or leaves chewed • Often tried once and not again as can cause very dramatic and frightening hallucinations

Adolescent substance use and abuse