(Nonmedical Use of Ritalin and Adderal by US Youth, 2014)
"• Between 1982 and 1992, among 12th graders levels of amphetamine use in the past 12 months (other than use that was ordered by a physician) fell by nearly two thirds, from 20.3% to 7.1%. Levels among college students fell even more over the same interval, from 21.1% to 3.6%. During the relapse phase in the drug epidemic in the 1990s, annual amphetamine use increased by about half among 8th and 10th graders between 1991 and 1996, and also increased among 12th graders and college students between 1992 and 1996. After 1996 the age groups diverged, with amphetamine use declining gradually and substantially among 8th graders—where use is now a fraction of what it was in 1996 — but continuing to rise among 12th graders (and eventually 10th graders), college students, and young adults until about 2002. The declines continued in the upper grades through about 2008 but through 2013 for 8th graders. Since 2009, annual prevalence has increased among 12th graders (from 6.6% to 8.1% in 2014), perhaps as a result of more students using amphetamines to help their academic work. Among students in college, amphetamine use rose even more sharply from 5.7% in 2008 to 10.1% in 2014, likely for the same reason. Young adults, who include the college students, showed less of an increase over the same interval, from 5.3% in 2008 to 8.0% in 2014. The pattern of cross-age-group change suggests a cohort effect at work for amphetamine use. Since the late 1990s there has been a greater difference between use among 8th graders and use by older students, suggesting that an age effect has emerged, possibly due to the older students becoming more likely to use amphetamines to aid their academic performance. (“To help me study” was the highest endorsed reason 12th graders gave for amphetamine use in 2012 and the third highest in 2014.)
"Among 12th graders, the increase in nonmedical use of amphetamines (and a concurrent decrease in disapproval) began in 1993; this followed a sharp drop in perceived risk a year earlier (which, as we have noted for a number of drugs, often serves as a leading indicator). Following a period of decline, perceived risk among 12th graders increased gradually from 1995 through 2009.¹
"• Use of the stimulant drug Ritalin outside of medical supervision showed a distinct increase around 1997 — with annual prevalence among 12th graders going from 0.1% in 1992 to 2.8% in 1997 — and then stayed level for a few years (see Appendix E, Table E-22). Because of its increasing importance, a differently structured question was introduced for Ritalin use in 2001 (2002 in the follow-ups of college students and young adults). This new question, which we prefer to the original, does not use a prior branching question and produced somewhat higher prevalence levels. Results from the new question suggest an ongoing decline in Ritalin use, with prevalence levels in 2014 less than half of what they were when first measured in 2001-02.
"• Another stimulant used in the treatment of the symptoms of attention deficit hyperactivity disorder (ADHD) is the amphetamine drug Adderall. A new question on its non-medical use was introduced in 2009; annual prevalence levels in 2009 through 2014 were higher than those for Ritalin in all five populations. This suggests that Adderall may have to some degree replaced the use of Ritalin and may help to account for the declines that we have been observing for the latter drug. Annual prevalence of Adderall changed rather little between 2009 and 2014 in 8th and 10th grades, although the levels seem to be drifting down. In 12th grade, however, annual prevalence has risen from 5.4% in 2009 to 7.6% in 2012, followed by non-significant declines over the next two years. The absolute prevalence levels in 2014 are fairly high, particularly among 12th graders (6.8%), young adults (7.8%), and college students (9.6%)."

"• Nonmedical use of psychotherapeutics includes nonmedical use of any prescription-type pain relievers, tranquilizers, stimulants, or sedatives. Over-the-counter substances are not included. In 2013, there were approximately 2.0 million persons aged 12 or older who used psychotherapeutics nonmedically for the first time within the past year, which averages to about 5,500 initiates per day. The number of new nonmedical users of psychotherapeutics in 2013 was lower than the estimates for prior years from 2002 through 2012 (ranging from 2.3 million to 2.8 million).
"• In 2013, the numbers of initiates were 1.5 million for pain relievers, 1.2 million for tranquilizers, 603,000 for stimulants, and 128,000 for sedatives (Figure 5.6).
"• The number of new nonmedical users of pain relievers in 2013 (1.5 million) was lower than the numbers in 2002 through 2012 (ranging from 1.9 million to 2.5 million) (Figure 5.6). The number of past year initiates for nonmedical use of tranquilizers has been fairly stable from 2002 to 2013 (ranging from 1.1 million to 1.4 million). The number of initiates for nonmedical use of stimulants in 2013 was similar to the numbers in 2003, 2005, and in 2007 to 2012 (ranging from 602,000 to 715,000), but was lower than the numbers in 2002, 2004, and 2006 (ranging from 783,000 to 846,000). The number of initiates for nonmedical use of sedatives in 2013 was similar to the numbers in 2002, 2003, 2007 to 2009, 2011, and 2012 (ranging from 159,000 to 209,000), but was lower than the numbers in 2004 to 2006 and in 2010 (ranging from 240,000 to 267,000).
"• In 2013, the average age at first nonmedical use of any psychotherapeutics among recent initiates aged 12 to 49 was 22.4 years. Average ages at first nonmedical use were 21.6 years for stimulants, 21.7 years for pain relievers, 25.0 years for sedatives, and 25.4 years for tranquilizers. All of these 2013 estimates were similar to the corresponding estimates in 2012.
"• In 2013, the number of new nonmedical users of OxyContin® aged 12 or older was 436,000, which was similar to the estimates for prior years from 2004 through 2012. The average age at first use of OxyContin® among past year initiates aged 12 to 49 was similar in 2012 and 2013 (22.0 and 23.6 years, respectively)."

"• Among young adults aged 18 to 25, the rate of current nonmedical use of psychotherapeutic drugs in 2013 (4.8 percent) was similar to the rates in 2011 (5.0 percent) and 2012 (5.3 percent), but it was lower than the rates in 2002 to 2010 (ranging from 5.5 to 6.5 percent) (Figure 2.9). The rate of current nonmedical use of pain relievers among young adults in 2013 (3.3 percent) was lower than the rates in 2012 (3.8 percent) and in 2002 to 2010 (ranging from 4.1 to 5.0 percent), but it was similar to the rate in 2011 (3.6 percent)."

"In the United States, there are indications of an increase in NPS use among certain user groups between 2009 and 2013; the prevalence of lifetime use of a 'novel psychoactive substance' among the population aged 12-34 was 1.2 per cent in 2013.²³⁵ There are signs of declining use of synthetic cannabinoids among secondary school students in the United States. The prevalence of past-year use of synthetic cannabinoids among twelfth-grade students decreased from 11.4 per cent in 2011 to 5.2 per cent in 2015.²³⁶ This is associated with an increase, over the same period, in the perceived risk of taking synthetic cannabinoids among the same group. The use of NPS with stimulant effects (reported as “bath salts“) among twelfth graders remained stable at 1 per cent in 2015. The prevalence of the use of synthetic cannabinoids among eighth, tenth and twelfth graders has declined to the lowest levels since the collection of such data began. However, the large amount of synthetic cannabinoids seized between 2012 and 2014 (more than 93 tons) and the large number of calls to poison centres for problems related to the use of synthetic cannabinoids (3,682 in 2014 and 7,779 in 2015)²³⁷ indicate the continued presence and use of this NPS group in the United States."

"• The number and percentage of persons aged 12 or older who were current users of hallucinogens in 2013 (1.3 million or 0.5 percent) were similar to those in 2012 (1.1 million or 0.4 percent), but were higher than in 2011 (1.0 million or 0.4 percent) (Figure 2.2)."

Alcohol and Tobacco

"• Slightly more than half (52.2 percent) of Americans aged 12 or older reported being current drinkers of alcohol in the 2013 survey, which was similar to the rate in 2012 (52.1 percent). This translates to an estimated 136.9 million current drinkers in 2013.
"• Nearly one quarter (22.9 percent) of persons aged 12 or older in 2013 were binge alcohol users in the 30 days prior to the survey. This translates to about 60.1 million people. The rate in 2013 was similar to the rate in 2012 (23.0 percent).
"• In 2013, heavy drinking was reported by 6.3 percent of the population aged 12 or older, or 16.5 million people. This percentage was similar to the rate of heavy drinking in 2012 (6.5 percent)."

"Lifetime alcohol users aged 21 or older had a significantly higher rate of past year illicit drug use (13.7 percent) compared with lifetime nondrinkers (2.7 percent). In addition, lifetime alcohol users had significantly higher rates of past year use across all illicit drug categories, with the exception of inhalants (Table 1). Nonmedical use of pain relievers was the illicit drug used most often by lifetime nondrinkers, whereas lifetime alcohol users reported using marijuana most frequently."

"Global estimates suggest that past-month prevalence of tobacco use (25 per cent of the population aged 15 and above) is 10 times higher than past-month prevalence of illicit drug use (2.5 per cent). Annual prevalence of the use of alcohol is 42 per cent (the use of alcohol being legal in most countries), which is eight times higher than annual prevalence of illicit drug use (5.0 per cent). Heavy episodic weekly drinking is eight times more prevalent than problem drug use. Drug use accounts for 0.9 per cent of all disability-adjusted life years lost at the global level, or 10 per cent of all life years lost as a result of the consumption of psychoactive substances (drugs, alcohol and tobacco)."

"Illicit drug use has increased across the country, dramatically so for opium, heroin and other opiates. In four years, the number of regular opium users in Afghanistan grew from 150,000 to approximately 230,000 ? a jump of 53 per cent. The numbers are even more alarming for heroin. In 2005, the estimate of regular heroin users in the country was 50,000, compared to approximately 120,000 users in 2009, a leap of 140 per cent. Overall, the annual prevalence of regular opiate use is estimated to be 2.7 per cent of the adult population1 (between 290,000 and 360,000 persons). Opium is by far the most commonly used opiate with an estimated prevalence of about 1.9 per cent of the adult population. Heroin prevalence is estimated to be about 1.0 per cent of the adult population and other opiates users2 are estimated to make up about 0.5 per cent of the adult population."