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Background: Marijuana use has been decreasing in the past several years among adolescents, though variation in the extent and rate of decrease across racial/ethnic groups is inadequately understood.Methods: The present study utilized nationally-representative data in Monitoring the Future from 2006 to 2015 to examine trends over time in past 30-day marijuana use. We examine whether differences in trends over time by race and ethnicity also differ by individual-level, school-level, and state-level factors. Sample included 131,351 8th grade students, 137,249 10th grade students, and 123,293 12th grade students; multi-level models and difference-in-differences tests were used.Results: In 10th grade, Black students had a positive linear increase in marijuana use (est=0.04, SE=0.01, p<0.001), and the magnitude of the increase was significantly greater than among non-Hispanic White students (est=0.38, SE=0.009, p<0.001). The increase trend among Black students was greater among those in large class sizes. In 12th grade, all racial ethnic groups except non-Hispanic Whites demonstrated a linear increase in prevalence across time. The magnitude of the increase among Hispanic students was greater among those in urban areas and large class sizes. The magnitude of the increase among Black students was greater in states with a medical marijuana law before 2006 (est=0.06, SE=0.03, p=0.02), among other state-level covariates.Conclusion: Together these results suggest that the next stage of public health approaches to reducing the harms associated with adolescent drug use should attend to shifting demographic patterns of use among adolescents and ensure that services and programmatic approaches to adolescent prevention are applied equitably. [ABSTRACT FROM AUTHOR]

Background: Historical shifts have taken place in the last twenty years in marijuana policy. The impact of medical marijuana laws (MML) on use of substances other than marijuana is not well understood. We examined the relationship between state MML and use of marijuana, cigarettes, illicit drugs, nonmedical use of prescription opioids, amphetamines, and tranquilizers, as well as binge drinking.Methods: Pre-post MML difference-in-difference analyses were performed on a nationally representative sample of adolescents in 48 contiguous U.S. states. Participants were 1,179,372U.S. 8th, 10th, and 12th graders in the national Monitoring the Future annual surveys conducted in 1991-2015. Measurements were any self-reported past-30-day use of marijuana, cigarettes, non-medical use of opioids, amphetamines and tranquilizers, other illicit substances, and any past-two-week binge drinking (5+ drinks per occasion).Results: Among 8th graders, the prevalence of marijuana, binge drinking, cigarette use, non-medical use of opioids, amphetamines and tranquilizers, and any non-marijuana illicit drug use decreased after MML enactment (0.2-2.4% decrease; p-values:<0.0001-0.0293). Among 10th graders, the prevalence of substance use did not change after MML enactment (p-values: 0.177-0.938). Among 12th graders, non-medical prescription opioid and cigarette use increased after MML enactment (0.9-2.7% increase; p-values: <0.0001-0.0026).Conclusions: MML enactment is associated with decreases in marijuana and other drugs in early adolescence in those states. Mechanisms that explain the increase in non-medical prescription opioid and cigarette use among 12th graders following MML enactment deserve further study. [ABSTRACT FROM AUTHOR]

Background: This study sought to specify (1) the position of nonmedical prescription opioids (NMPO) in drug initiation sequences among Millennials (1979-96), Generation X (1964-79), and Baby Boomers (1949-64) and (2) gender and racial/ethnic differences in sequences among Millennials.Methods: Data are from the 2013-2014 National Surveys on Drug Use and Health (n = 73,026). We identified statistically significant drug initiation sequences involving alcohol/cigarettes, marijuana, NMPO, cocaine, and heroin using a novel method distinguishing significant sequences from patterns expected only due to correlations induced by common liability among drugs.Results: Alcohol/cigarettes followed by marijuana was the most common sequence. NMPO or cocaine use after marijuana, and heroin use after NMPO or cocaine, differed by generation. Among successively younger generations, NMPO after marijuana and heroin after NMPO increased. Millennials were more likely to initiate NMPO than cocaine after marijuana; Generation X and Baby Boomers were less likely (odds ratios = 1.4;0.3;0.2). Millennials were more likely than Generation X and Baby Boomers to use heroin after NMPO (hazards ratios = 7.1;3.4;2.5). In each generation, heroin users were far more likely to start heroin after both NMPO and cocaine than either alone. Sequences were similar by gender. Fewer paths were significant among African-Americans.Conclusions: NMPOs play a more prominent role in drug initiation sequences among Millennials than prior generations. Among Millennials, NMPO use is more likely than cocaine to follow marijuana use. In all generations, transition to heroin from NMPO significantly occurs only when both NMPO and cocaine have been used. Delineation of drug sequences suggests optimal points in development for prevention and treatment efforts. [ABSTRACT FROM AUTHOR]