Adolescent Admissions to Substance Abuse Treatment
Trends in Heroin Admissions and Medication-Assisted Opioid Therapy
Polydrug Abuse
Racial/Ethnic Subgroups

This chapter highlights topics that are of current or special interest. It is important to note that percentages in charts, narrative lists, and percentage distributions in tables may not add to 100 percent due to rounding.

• Adolescent substance abuse 2002-2012

TEDS data indicate that admissions to substance abuse treatment aged 12 to 17 remained steady (from 157,914 to 157,184) between 2002 and 2003, but declined by 24 percent (to 120,239) between 2003 and 2012 [Table 3.1a]. In 2012, 89 percent of adolescent treatment admissions involved marijuana as a primary or secondary substance, and 41 percent of these marijuana-involved admissions were referred to treatment through the criminal justice/DUI source [Table 3.4].

• Heroin admissions and medication-assisted opioid therapy 2002-2012

The number of TEDS admissions for primary heroin abuse was relatively stable over this period, with 285,041 admissions in 2002 and 285,451 admissions in 2012 [Table 3.5].

The proportion of heroin admissions whose treatment plans included medication-assisted opioid therapy (opioid therapy using methadone or buprenorphine) declined from 35 percent in 2002 to 28 percent in 2012 [Table 3.7].¹

• Polydrug abuse

Polydrug abuse (the use of more than one substance) was more common among TEDS admissions than was abuse of a single substance [Table 3.8].

• Racial/ethnic subgroups

TEDS data indicate that substance abuse patterns differed widely among racial/ethnic subgroups; however, alcohol was the predominant substance for all racial/ethnic groups except persons of Puerto Rican origin, where the predominant substance was heroin [Table 2.2].

Adolescent Admissions to Substance Abuse Treatment

Tables 3.1a and 3.1b and Figure 19. The number of adolescent admissions aged 12 to 17 remained steady between 2002 and 2003, then declined by 24 percent from 2003 to 2012.

• Two primary substances—marijuana and alcohol—accounted for between 83 and 89 percent of adolescent admissions from 2002 to 2012.
  
• Marijuana admissions increased from 63 percent of adolescent admissions in 2002 to 76 percent in 2012; however, the total number of adolescent marijuana admissions decreased by 9 percent (from 99,632 to 91,106) between 2002 and 2012.
  
• Alcohol admissions declined from 21 percent of adolescent admissions in 2002 to 13 percent in 2012.
  
• Methamphetamine/amphetamine admissions increased from 4 percent in 2002 to 6 percent in 2005, but then decreased to 3 percent in 2012.
  
• Opiate admissions represented 1 to 2 percent of adolescent admissions from 2002 to 2008 but rose to 3 percent in 2009 where it remained in 2012..
  
  • Opiates other than heroin² represented 32 percent of adolescent opiate admissions in 2002 but rose to 59 percent in 2012.
    
• Cocaine accounted for between 2 and 3 percent of adolescent admissions between 2002 and 2008. Beginning in 2009, cocaine accounted for 1 percent of adolescent admissions.
• All other substances combined accounted for about 2 percent of adolescent admissions between 2002 and 2012.

Table 3.2. In 2012, overall, 72 percent of adolescent admissions were male, a proportion heavily influenced by the 77 percent of marijuana admissions that were male. The proportion of female admissions was greater than 40 percent for most other substances. Adolescent admissions reporting a primary substance of methamphetamine/amphetamines were the only adolescent admissions that had a higher proportion of females to males (55 vs. 45 percent).

Forty-five percent of adolescent admissions were non-Hispanic White, 26 percent were of Hispanic origin, 20 percent were non-Hispanic Black, and 10 percent were of other racial/ethnic groups.

Table 3.3. The number of adolescent admissions increased with age; 1 percent were 12 years old, increasing to 32 percent who were 17 years old. Among admissions for inhalants, 17 percent were aged 12 or 13. Among admissions for heroin and for opiates other than heroin, 63 percent and 48 percent, respectively, were age 17.

In 2012, 44 percent of adolescent admissions were referred to treatment through the criminal justice/DUI source, 18 percent were self- or individual referrals, and 15 percent were referred through schools.

Table 3.4 and Figure 20. An admission was considered marijuana-involved if marijuana was reported as a primary, secondary, or tertiary substance. In 2002, 45 percent of all adolescent admissions were marijuana involved and referred to treatment by the criminal justice/DUI source, and 37 percent were marijuana involved but referred by other sources. By 2012, the proportion referred by the criminal justice/DUI source had decreased to 41 percent, while the proportion referred by other sources had increased to 48 percent. The proportions nearly converged in 2007 and 2009.

Adolescent admissions not involving marijuana that were referred by the criminal justice/DUI source fell from 9 percent in 2002 to 4 percent in 2012. Admissions not involving marijuana that were referred from other sources were fairly stable, fluctuating between 7 and 11 percent of adolescent admissions.

Trends in Heroin Admissions and Medication-Assisted Opioid Therapy

General measures of heroin abuse among treatment admissions aged 12 and older were relatively consistent from 2002 through 2012. Primary heroin abuse accounted for 13 to 16 percent of TEDS admissions in every year from 2002 through 2012 [Table 1.1b]. In 2012, injection was the preferred route of administration for 71 percent of primary heroin admissions, inhalation for 24 percent, and smoking for 4 percent [Table 2.4]. The majority of primary heroin admissions from 2002 to 2012 were 20 to 34 years of age (41 to 43 percent from 2002 through 2007 and 55 percent in 2012) [Table 3.5].

However, these measures conceal substantial changes in the age, race/ethnicity, and route of administration of some subpopulations among heroin-using admissions.

Table 3.5 and Figure 21. TEDS data show an increase in heroin admissions among young non-Hispanic White adults. Among non-Hispanic Blacks, however, admissions have declined except among older admissions.

• In 2002, more than 1 in 5 heroin admissions (24 percent) were non-Hispanic White aged 20 to 34. By 2012, more than 2 in 5 primary heroin admissions (45 percent) belonged to this subgroup. The proportion of primary heroin admissions who were non-Hispanic White aged 35 to 44 fell from 13 percent to 10 percent in the same period, while the proportions of non-Hispanic White admissions aged 12 to 19 and older than 45 remained constant, at 2 to 3 percent and 7 to 8 percent, respectively.
  
• In contrast, the proportion of primary heroin admissions that were non-Hispanic Black aged 20 to 34 fell from 5 percent to 2 percent between 2002 and 2012, while the proportion aged 35 to 44 fell from 10 percent to 4 percent. However, the proportion of non-Hispanic Black admissions aged 45 and older remained between 9 and 11 percent from 2002 through 2012. Non-Hispanic Black admissions aged 12 to 19 accounted for one-tenth of 1 percent or less of all primary heroin admissions.
  

Table 3.6 and Figure 22. Route of administration of heroin was closely linked to age. Injection increased among young adults; inhalation increased among those 45 and older.

• In 2002, 1 in 4 primary heroin admissions (26 percent) were injectors aged 20 to 34 and nearly 1 in 5 (19 percent) were injectors aged 35 to 44. By 2012, more than 2 in 5 primary heroin admissions (44 percent) were injectors aged 20 to 34, but the proportion that were injectors aged 35 to 44 had dropped to 12 percent.
• The proportion of primary heroin admissions who were inhalers aged 20 to 34 fell from 13 percent in 2002 to 8 percent in 2012, while the proportion who were inhalers aged 45 and older rose from 6 percent in 2002 to 9 percent in 2012.

Table 3.7 and Figures 23 and 24. Planned use of medication-assisted opioid therapy (opioid therapy using methadone or buprenorphine) declined among TEDS admissions for heroin abuse between 2002 and 2012.

• Table 3.7 and Figure 23. In 2002, 35 percent of primary heroin admissions overall had treatment plans that included medication-assisted opioid therapy, although the proportion varied by route of administration—39 percent each of heroin injectors and heroin smokers, and 32 percent of heroin inhalers. By 2012, only 28 percent of primary heroin admissions had treatment plans that included medication-assisted opioid therapy, with 26 percent being heroin injectors, 29 percent being smokers, and 32 percent being inhalers (see footnote 1 above).
  

• Figure 24. Older heroin admissions were most likely to have medication-assisted opioid therapy planned. In 2002, opioid therapy was planned for 48 percent of admissions aged 45 and older, 37 percent of those aged 35 to 44, 28 percent of those aged 20 to 34, and 15 percent of those aged 12 to 19. The proportions fell for all age groups, and by 2012, opioid therapy was planned for 40 percent of primary heroin admissions aged 45 and older, 30 percent of those aged 35 to 44, 22 percent of those aged 20 to 34, and 13 percent of those aged 12 to 19.
  

Polydrug Abuse

Polydrug abuse (the use of more than one substance) was more common among TEDS admissions than was abuse of a single substance.

Table 3.8 and Figure 25. Polydrug abuse was reported by 56 percent of TEDS admissions aged 12 or older in 2012. Marijuana, alcohol, and cocaine were the most commonly reported secondary and tertiary substances.

Abuse of alcohol as a primary, secondary, or tertiary substance was characteristic of a majority of treatment admissions. Thirty-nine percent of all treatment admissions were for primary alcohol abuse, and 18 percent of admissions for primary drug abuse reported that they also had an alcohol problem. Overall, 57 percent of all treatment admissions reported alcohol as a substance of abuse.

• Alcohol, opiates, and methamphetamine/amphetamines were reported more often as primary substances than as secondary or tertiary substances. Thirty-six percent of all admissions involved opiate abuse, with 26 percent reporting primary abuse and 10 percent reporting secondary or tertiary abuse. Twelve percent of all admissions reported methamphetamine/amphetamine abuse, with 7 percent reporting primary abuse and 5 percent reporting secondary or tertiary abuse.
  
• Marijuana and cocaine were reported more often as secondary or tertiary substances than as primary substances. Marijuana was reported as a primary substance by 17 percent of all admissions, but was a secondary or tertiary substance for another 21 percent, resulting in 38 percent of all treatment admissions reporting marijuana as a substance of abuse. Cocaine was a primary substance for 7 percent of admissions, but was a secondary or tertiary substance for an additional 14 percent. Thus 21 percent of all treatment admissions involved cocaine abuse.

Table 3.9. This table details the most common substance combinations for selected primary substances. For example, for primary alcohol admissions, 55 percent reported abuse of alcohol alone, 15 percent reported abuse of alcohol and marijuana but no other drugs, and 5 percent reported primary abuse of alcohol with abuse of cocaine and marijuana as secondary and tertiary substances.

Racial/Ethnic Subgroups

Table 2.3b and Figures 26-31. TEDS data indicate that substance abuse patterns differed widely among racial/ethnic subgroups. Among admissions of Hispanic origin, substance abuse patterns differed according to country of origin. Patterns also differed between men and women within subgroups.

• Among non-Hispanic Whites [Figure 26], alcohol was the primary substance reported by 44 percent of male admissions and 34 percent of female admissions.
  
  • Opiates and marijuana were the most frequently reported illicit drugs among non-Hispanic White male admissions (29 percent and 14 percent, respectively), followed by methamphetamine/amphetamines (7 percent) and cocaine (4 percent).
    
  • Among non-Hispanic White female admissions, opiates were the primary illicit drug (36 percent), followed by methamphetamine/amphetamines (11 percent), marijuana (10 percent), and cocaine (5 percent).

• Among non-Hispanic Blacks [Figure 27], 38 percent of male admissions reported alcohol as the primary substance. Among non-Hispanic Black female admissions, alcohol (30 percent) was more frequently reported as a primary substance than was cocaine (22 percent).
  
  • Marijuana and cocaine were the most commonly reported illicit substances for non-Hispanic Black male admissions (30 percent and 15 percent, respectively), followed by opiates (13 percent).
  • For non-Hispanic Black female admissions, other primary substances were marijuana and cocaine (24 percent and 22 percent, respectively).
    
  • Methamphetamine/amphetamines were reported by about 1 percent and 2 percent, respectively, of non-Hispanic Black male and female admissions.
    

• Among persons of Mexican origin [Figure 28], alcohol was the primary substance reported by 42 percent of male admissions, but among female admissions, methamphetamine/amphetamines were reported as a primary substance as frequently as was alcohol (29 percent each).
  
  • Marijuana (27 percent) was the most commonly reported illicit substance for male admissions of Mexican origin, followed by methamphetamine/amphetamines (14 percent) and opiates (13 percent).
    
  • For female admissions of Mexican origin, other commonly reported primary substances were marijuana (22 percent) and opiates (15 percent).
    

• Among admissions of Puerto Rican origin [Figure 29], opiates were the main primary substances at treatment admission for both men and women (44 percent and 37 percent, respectively), followed by alcohol (29 percent and 26 percent, respectively).
  
  • For both male and female admissions of Puerto Rican origin, other primary substances were marijuana (16 percent and 19 percent, respectively) and cocaine (8 percent and 11 percent, respectively).
    
  • Admissions for primary methamphetamine/amphetamine abuse were 1 percent for women of Puerto Rican origin and less than 1 percent for men of Puerto Rican origin.
    

• American Indians and Alaska Natives together accounted for 2 percent of all TEDS admissions [Table 2.2] [Figure 30]. Among American Indian/Alaska Native admissions, 68 percent of men and 52 percent of women entered treatment because of primary alcohol abuse.
  
  • Marijuana was the most frequently reported illicit substance for American Indian or Alaska Native male admissions (14 percent), followed by opiates (10 percent), methamphetamine/amphetamines (5 percent), and cocaine (2 percent).
    
  • Opiates and marijuana were the most frequently reported illicit substances for American Indian or Alaska Native female admissions (19 percent and 12 percent, respectively), followed by methamphetamine/amphetamines (11 percent) and cocaine (3 percent).

• Asians and Pacific Islanders accounted for 1 percent of all TEDS admissions [Table 2.2]. Among this group [Figure 31], alcohol was the primary substance reported by 39 percent of male admissions and 32 percent of female admissions.
  
  • Marijuana and methamphetamine/amphetamines were the most commonly reported illicit drugs for Asian or Pacific Islander male admissions (23 percent and 18 percent, respectively), followed by opiates (13 percent) and cocaine (4 percent).
    
  • For Asian or Pacific Islander female admissions, methamphetamine/amphetamines were the most commonly reported illicit substance (25 percent), followed by marijuana (18 percent), opiates (15 percent), and cocaine (4 percent).

TO TABLES

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