"Hallucinogens

"The percentage of 12th grade students using hallucinogens in the past 12 months has varied little between a narrow window of 4% and 5% over the past decade and in 2024 was 4%. In 10th grade, a drop in use during the pandemic in 2021 has persisted, and the prevalence of past 12-month use in 2024 was 2%. In 8th grade, declines in use have plateaued since around 2014, in part because prevalence has hovered at 1% since that time and has little room to fall further.

"Prevalence of past 12-month ketamine use among 12th grade students has been below 2% for the past decade and in 2024 stood at 1%. This 'club drug' was added to the survey in 2000. It showed little change in its usage levels through 2002. Since then, use has declined in all three grades. Because of the very low levels of use of this drug by 2011, questions about its use were dropped from the questionnaires administered to 8th and 10th graders."

"In 2024, lifetime prevalence of anabolic steroid use was 1.4% or lower in all grades. In general, lifetime, past 12-month, and past 30-day use have decreased, sometimes unevenly, since highs in the early 2000s.

"Anabolic steroids, sometimes used for muscle development including in body building, were rendered illegal to purchase or sell without a prescription in the Anabolic Steroids Control Act of 1990. Prevalence of use fell among 12th graders for a couple of years thereafter, but then increased some. Use for all grades peaked around 2002 and have since declined substantially."

"Creatine is not a hormone or a drug but a nutrient found in the skeletal muscle of most animals. It is used to reduce the recovery time of muscles, to increase muscle mass, and to thereby enhance performance for high-intensity, short duration exercises. It is readily available over the counter, which undoubtedly helps to explain the substantial levels of use we have found among teens.

"Androstenedione, a precursor to testosterone, is a performance enhancing substance that was scheduled by the Drug Enforcement Administration early in 2005, making its sale and possession no longer legal.

"In 12th grade, past 12-month prevalence declined to 1% in 2024 and lost most of the increase that took place earlier, when it surged to 1.9% in 2022 from 0.6% in 2021. The use level is now similar to pre-pandemic levels.

"Increasing the Substantial Gains That Took Place During the Pandemic

"Continuing Decreases for Three Most Common Drugs Used by Students in 2024

"Our study has several limitations. First, cannabis exposure was poorly reported in the included studies, which prevented our meta-analysis from assessing it. Second, a significant portion of included studies was at moderate to high risk of bias, primarily due to a lack of information regarding missing data. Concerns were also raised about the risk of misclassification of exposure, particularly in studies from medical databases, which have a low sensitivity for non-medical drug use.

"Main findings

"24 studies evaluated the occurrence of MACE in the context of exposure to cannabis, including one to medical cannabis and none to other cannabinoids. The quantitative analysis suggests a positive association between cannabis use and MACE. Findings from the sensitivity analysis restricted to cohort studies were consistent with the primary analysis.

"In this population-based study, individuals newly prescribed SOS typically had more comorbidities than people receiving methadone, with higher rates of alcohol use disorder, HIV, hepatitis C, opioid toxicity, infections, and recent engagement in OAT. After matching, we found reduced rates of clinical and health systems outcomes over time among individuals commencing SOS or methadone. In comparative analyses, people receiving SOS had higher rates of opioid toxicities, emergency department visits, inpatient hospitalisations, and incident infections compared with methadone recipients.