Most substance use numbers, including treatment gap, hold steady in national survey

Opioid use did not show substantial increases in 2016, but the prominence of illegally manufactured fentanyl and its analogs means the opioid crisis continues to grow more deadly. Marijuana use among youths nationally has not increased, but adults ages 26 and older are using at a higher rate. These are among the mixed bag of findings and conclusions drawn from last week's release of data from the 2016 National Survey on Drug Use and Health (NSDUH).

The survey also illustrated a prevalent treatment gap in substance use services that consistently appears to outpace the unmet need for care in mental health. In 2016, only 10.6% of individuals ages 12 and older who needed substance use treatment received services in a specialty facility. In comparison, nearly two-thirds of the more than 10 million adults with past-year serious mental illness received mental health services in 2016.

The NSDUH is an annual survey of more than 67,000 people ages 12 and older in the U.S., and the Substance Abuse and Mental Health Services Administration (SAMHSA) last week released the report of key substance use and mental health indicators as part of the September commemoration of National Recovery Month.

Opioid, marijuana use

The 2016 survey concluded that an estimated 11.8 million people nationwide misused opioids in the past year, with 11.5 million of those individuals engaging in prescription opioid misuse. Just over half of those who misused pain medication said they obtained the most recent drugs they used from a friend or relative.

In remarks delivered upon release of the survey data, Health and Human Services (HHS) Secretary Thomas E. Price, MD, stated that while current numbers for heroin use far exceed what was seen from 2002-2013, they do not appear to be worsening from the past couple of years.

“As all who toil in this area know, the opioid crisis is a deeply complicated story,” Price said. “But the fact that we are not seeing this scourge spread any further than it has is a real testament to the work of communities across this nation.”

Overall use of marijuana in the 12-and-older population was higher in 2016 than in previous years, but use among youths ages 12 to 17 is lower than it was in most years in the 2009-2014 period. Most of the increased overall use is attributable to increases in the population ages 26 and older.

Kevin Sabet, co-founder of Project SAM (Smart Approaches to Marijuana), tells Addiction Professional that supporters of marijuana legalization have been miscasting this reported national decline in youth use. He emphasizes that these NSDUH numbers are national and don't reflect state-specific findings from NSDUH and other surveys showing that, for example, Colorado has the nation's highest past-month use of marijuana in the 12-to-17 age group.

“Youth use is down nationwide, yes, but this says nothing about legalization,” Sabet says. “Also troublingly, heavy use is up nationwide and 18-to-25 use is skyrocketing.”

Marijuana and prescription drug use account for most of the illicit drug use overall in the United States, the NSDUH data confirm. However, alcohol remains the substance with the most widespread impact overall. Alcohol is the most prevalent substance used among the 20 million people in the U.S. with a past-year substance use disorder.

Additionally, a total of 16.3 million Americans in 2016 reported past-month heavy alcohol use (binge drinking on 5 or more of the past 30 days), and 65.3 million reported past-month binge drinking (at least one occasion of five or more drinks for men and four or more for women). Accurate comparisons with heavy drinking data from earlier years cannot be made because the national standard for binge drinking levels changed with the 2015 NSDUH.

Underage drinking rates in 2016 generally held steady from 2015 levels and remain lower than rates in the 2002-2014 period.

“Alcohol may kill more slowly than opioids, but it still does,” Marvin Ventrell, executive director of the National Association of Addiction Treatment Providers (NAATP), tells Addiction Professional.

Illness and treatment

The report stated that the most common illicit drug use disorder involved marijuana use, with numbers nearly double those for opioid use. The survey found that overall, an estimated 21 million people needed substance use treatment in 2016, with 1 in 13 individuals overall and 1 in 7 young adults needing services.

Ventrell says the ever-present gap between those needing services and those receiving specialty care means “we are still not addressing this as the health care issue that it needs to be.” He adds that it is difficult to imagine the nation achieving major progress in closing the treatment gap “absent a major shift in policy.”

Regarding mental health, around 4.2% of U.S. adults had a past-year serious mental illness in 2016. The prevalence of serious mental illness has remained relatively steady since 2010, but these illnesses are becoming more prominent in the young-adult population. The percentage of young adults with serious mental illness was higher in 2016 than in any year since 2008, according to the survey. In addition, the percentage of young adults who report serious thoughts of suicide is rising.

Comments from federal leaders on the importance and effectiveness of treatment for behavioral illnesses demonstrate an increasingly broader view of the components essential for recovery. “Addiction does not have to be a death sentence—recovery is possible for most people when the right services and supports are in place, including treatment, housing, employment, and peer recovery support,” said Richard Baum, acting director of the Office of National Drug Control Policy (ONDCP). The truth is that there is no one path to recovery because everyone is different. And frankly, it doesn't matter how someone gets to recovery.”