1. Substance Abuse Trends in Maine Presented by Tim Diomede March 2012 Hornby Zeller Associates, Inc.

2. Purpose of the SEOW Purpose of the CESN Dual Purposes of SEOW/CESN  Promote systematic, data- driven decision-making  Guide effective and efficient use of prevention resources  Identify substance abuse patterns  Establish and track substance abuse trends  Detect emerging substances and trends

3. Today’s Focus: State Epi Profile  Data Review and Key Findings  Consumption  Consequences  Contributing Factors  Mental Health  Treatment

4. Data Sources  Alcohol Epidemiologic Data System (AEDS)  Behavioral Risk Factor Surveillance System (BRFSS)  Maine Department of Public Safety (DPS), Uniform Crime Reports (UCR)  Maine Department of Transportation (MDOT), Fatality Analysis Reporting System (FARS)  Maine Health Data Organization (MHDO)  Maine Integrated Youth Health Survey (MIYHS) including reweighted 2009 data  Maine Office of the Chief Medical Examiner  National Survey on Substance Use and Health (NSDUH)  Northern New England Poison Center (NNEPC)  Office of Data, Research and Vital Statistics (ODRVS)  Pregnancy Risk Assessment Monitoring System (PRAMS)  Prescription Monitoring Program (PMP)  Treatment Data System (TDS)  Youth Risk Behavior Surveillance System (YRBSS)

5. Recap from Previous Reports:  Substances of concern: alcohol (high-risk drinking), marijuana, and prescription drugs  Population of concern:18 to 25 year-olds  Notable consequences: alcohol-related crashes, hospitalizations, and poisonings  Treatment admissions for alcohol have been decreasing while synthetic opioids are increasing

6. Findings of Interest State Profile

7. Consumption

8. Alcohol Use: Youth Source: YRBSS, 2001-2011  Past Month usage among Maine high school students has been steadily decreasing since 2001!

9. Alcohol Use: Youth  Past month binge drinking among high school students dropped from 19% in 2009 to 17% in 2011. Source: MIYHS 2009, 2011

10. Alcohol Use: Adults Source: BRFSS 2001-2010  Past month drinking among adults in Maine has remained relatively stable since 2001.

11. Alcohol Use: Adults  Heavy drinking among young adults has dropped substantially since 2008! Source: BRFSS 2001-2010

12. Marijuana Use: Youth Source: YRBSS 2001- 2011  Marijuana past month usage among Maine High School students dropped from 2001 to 2005 and seems to have reached a plateau at 21%.

13. Marijuana Use: Adults  18-25 year olds are much more likely to use marijuana in the past month.  Marijuana usage among adults in Maine has remained fairly stable since 2002-03.  Most recent data shows slight uptick in usage among adults. Source: NSDUH 2002-03 – 2008-09

14. Early Initiation of Substance Use: Alcohol Source: YRBSS 2001-2011  Early initiation has been linked to riskier consumption patterns in adulthood  Proportion of youth starting to drink early has decreased since 2001

15. Early Initiation of Substance Use: Marijuana  The proportion of High School students who reported trying marijuana for the first time before the age of 13 decreased between the years of 2001 and 2011 from 12 % to 7 % Source: YRBSS 2001-2011

16. Prescription Drug Use: Youth Source: MIYHS 2009, 2011  Past lifetime as well as past month misusage of prescription drugs among Maine High School students has decreased from 2009 to 2011

17. Prescription Drug Use: Adults  Misuse of pain relievers among adults has remained relatively stable since 2003  18-25 year olds reported the highest percentage (14%) for misusing pain relievers Source: NSDUH 2003-04 to 2008-09

18. Cocaine Use: Youth Source: MIYHS 2009, 2011  Lifetime Cocaine use among Maine High School Students has decreased from 10% in 2009 to 7% in 2011

19. Cocaine Use: (twelve and older)  Past year use of cocaine has remained relatively stable since 2003  18 to 25 year olds reported highest rate of past year cocaine use (8%) Source: NSDUH 2003-04 to 2008-09

20. Inhalant Use: Youth Source: YRBSS 2001-2011  Past lifetime inhalant use among Maine High School students remained stable from 2001 to 2007  Reported inhalant use has decreased from 15% in 2009 to 11 % in 2011

21. Consequences

22. Pregnancy and Substance Use Source: PRAMS, 2004-2010  Remained fairly stable over the past decade.  Almost 1 in 5 pregnant women reported smoking during their last trimester.  8% reported drinking in their last trimester.

23. Pregnancy and Substance Use Source: TDS, 2007-2011  Since 2005, about 5% of women seeking treatment were pregnant (262)  52% sought treatment for synthetic opiates, increasing steadily since 2007

24. Fatal Motor Vehicle Crashes Source: MDOT, 2005-2010  Alcohol has been consistently involved in 5 percent of total motor vehicle crashes (not shown here)  In 2010, alcohol was involved in 45 out of 161 total fatal crashes (28%).

25. Alcohol Related Crashes by Age Source: MDOT, 2007-2010  In 2010, 21 to 24 year olds had the highest alcohol related crash rates.  Overall, alcohol related crash rates appear to be trending downward across all age ranges.

26. Hospital Admissions: Inpatient Source: MHDO 2006-2009  In 2009, alcohol was the primary substance associated with inpatient admissions related to substance use (686), followed by opiates (216)

27. Hospital Admissions: Outpatient  Outpatient hospital visits related to Opiates (including prescription narcotics, methadone, and heroin) have steadily been increasing since 2006

28. Overdose Deaths Due to Drugs Source: Sorg, Marcella H. “Report from Maine, CEWG June 2011.” (2011). *Deaths related to pharmaceutical or illicit overdose are not mutually exclusive.  Since 2001, total overdose deaths have been increasing  Overdose deaths due to pharmaceuticals (such as methadone, oxycodone, and benzodiazepines) have been rising dramatically since 1997

29. Contributing Factors

30. Youth Access to Alcohol Source: MIYHS 2009, 2011  In 2011, two out of three Maine High school students reported it would easy for them to get alcohol.

31. Youth Access to Alcohol  One in three Maine High School students who consumed alcohol in the past month reported that someone had given it to them. Source: MIYHS 2009, 2011

32. Youth Access to Drugs Source: MIYHS 2009, 2011  Students who reported they thought it was easy to get marijuana were seven times more likely to use in the past month. (not depicted)  In 2011, 57% of high school students felt it would be easy to get marijuana.

33. Youth Access to Drugs  In 2011, almost one in four Maine High School students reported being sold offered, or given an illegal drug on school property  Increased from 21% in 2009 to 24% in 2011 Source: MIYHS 2009, 2011

34. Perceived Risk of Harm: Alcohol Source: MIYHS 2009, 2011  High School students perceiving risk of regular alcohol use has decreased from 2009 to 2011  In 2011, two out of five High School students did not think regular alcohol use was harmful

35. Perceived Risk of Harm: Marijuana Source: MIYHS 2009, 2011  High School students perceiving risk of regular marijuana use decreased from 61% in 2009 to 56% in 2011  Almost half of Maine High School students felt there was little to no risk of harm

36. Perceived Enforcement: Parents and Police Source: MIYHS 2009, 2011  In 2011, 44% of Maine High School Students thought they would be caught by their parents for drinking (an increase since 2009)  Students who reported that a kid would be caught by the police for drinking decreased from 16% in 2009 to 15% in 2011

37. Perception of Adult Attitudes: Alcohol Source: MIYHS 2009, 2011  In 2011, 86% of High School students reported that they thought their parents felt it was wrong for them to drink on a regular basis  Students who reported that adults in their community think it is wrong for youth to use alcohol increased from 73% in 2009, to 75% in 2011

38. Perception of Adult Attitudes: Marijuana  Students who reported their parents would feel it would be wrong for them to smoke marijuana decreased from 87% in 2009 to 84% in 2011  Students who thought adults in their community would feel it would be wrong for them to smoke marijuana decreased from 80% in 2009 to 77% in 2011 Source: MIYHS 2009, 2011

39. Mental Health, Suicide and Co-occuring Disorders

40. Mental Illness, Depression and Anxiety Source: NSDUH 2008-09  In 2008-09, 35% of young adults (18 to 25) reported experiencing any mental illness in the past year, compared to 19% of adults ages 26 and older. *Any mental illness is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a substance use disorder, that met the criteria found the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

41. Depression: Adults Source: BRFSS 2008-2010  In 2010, more than 1 out 5 adults in Maine reported having ever been diagnosed with depression  17% of adults reported having ever been diagnosed with anxiety

42. Depression: Youth  In 2011, the proportion of high school students who reported feeling sad or helpless during the past year increased slightly, from 22% in 2009 to 23% in 2011 Source: MIYHS 2009, 2011

43. Mental Health and Alcohol Use Source: MIYHS 2009, 2011  in 2011, 13% of high school students reported that they seriously considered suicide in the past year, 9% reported that they planned for it and 8% reported actually attempting suicide

44.  in 2011, 15% of high school students who had consumed alcohol in the previous 30 days reported they had planned suicide and 12% reported that they attempted suicide in the past year  High school students who consumed alcohol in the past month were more than two times as likely to have planned or attempted suicide Source: MIYHS 2009, 2011 Mental Health and Alcohol Use

45. Mental Health and Treatment Source: TDS, 2007-2011  In 2011, more than half of all substance abuse treatment admissions also had a diagnosed mental health disorder  This proportion has increased by 7 percentage points since 2007

46. Treatment Admissions for Substance Abuse

47. Source: TDS, 2011 Treatment Admissions by Substance: Primary  The overall number of Mainers seeking treatment has been declining since 2007, from 14,843 to 11,380 in 2011 (not depicted)  In 2011 there were 4,421 admissions for alcohol as the primary substance, followed by synthetic opioids (3,630) and marijuana (1,094)

48. Treatment Admissions by Substance: Secondary  Marijuana leads secondary admissions with 31%, followed closely by synthetic opioids at 28%, followed by alcohol (13%) and cocaine (10%)  Synthetic opioids make up the second largest proportions for both primary and secondary admissions

49. Conclusion Alcohol Alcohol is the most used substance in Maine Overall decline among alcohol use (lifetime and 30 day use) among Mainers Among high school students who had consumed alcohol, close to one-third reported starting before the age of 13 Young adults are the most likely age group to binge drink and to drink heavily Alcohol was involved in 28% of fatal crashes in 2010 21-24 year olds have the highest rates of alcohol related motor vehicle crashes and crash fatalities Alcohol is the primary presenting factor in most substance abuse treatment admissions in Maine

50. Conclusion Prescription Drugs 7% of high school students had misused prescription drugs in the past month 14% of young adults ages 18-25 misused pain relievers within the past year Prescription drug misuse continues to have a large impact on treatment and hospitalizations in Maine Other illicit Drugs The most commonly used illegal drug in Maine is marijuana 22% of high school students in Maine have used marijuana in the past 30 days More than one-fifth of current High School users started using marijuana before the age of 13 26% of young adults (18-25) used marijuana in the past month, and15% think smoking marijuana once per month poses great risks Overall, perception of harm and wrongness of Marijuana use has decreased

51. Conclusion Mental Health One-fifth of adults in Maine report having ever been diagnosed with depression Young adults are more likely to experience any mental illness in the past year than older adults (one in three) About one in ten high school students considered or planned for suicide in 2011 Over half of all substance abuse treatment admissions in 2011 also involved a mental health disorder

52. Questions/Comments? Timothy Diomede SEOW Coordinator/Data Analyst Office of Substance Abuse Timothy.Diomede@maine.gov (207) 287-2596 http://www.maine.gov/dhhs/osa/data/cesn/index.htm