BUFFALO, N.Y. — The times are changing, and so are drug and alcohol use trends among American youth.

These shifts in illicit substance use will compel primary care physicians to monitor new products and how they are used, two University at Buffalo researchers write in this month’s issue of American Family Physician.

“It is important to improve our understanding of adolescent substance use in order to better address the health needs and risk factors in this vulnerable population,” said Jessica Kulak, the paper’s lead author.

Treatment for Substance Use Disorder has traditionally been provided by a specialist, or someone outside of the primary care setting.

“Integration of care services may help to change societal norms around substance use – both by decreasing stigma associated with substance use, as well as increasing physicians’ preparedness, knowledge and confidence in preventing and intervening on patients’ substance experimentation and use,” Kulak said.

Kulak is now an assistant professor in the Department of Health, Nutrition and Dietetics at SUNY Buffalo State. She wrote the paper when she was a postdoctorate fellow at the Primary Care Research Institute in the Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences at UB. Kulak received her doctorate in community health and health behavior from UB’s School of Public Health and Health Professions.

The types of illicit substances that American youth are using have changed drastically over the past decade, with decreases in alcohol use, including binge drinking, being offset by increases in e-cigarettes, marijuana and opioids.

“The increase in vaping is of concern, particularly the use of JUUL, which delivers high concentrations of nicotine and may also be used with marijuana,” said paper co-author Kim Griswold, professor of family medicine and psychiatry in the Jacobs School at UB.

“Community physicians can be helpful in providing fact-based information for their adolescent patients,” Griswold said.

Kulak and Griswold conducted a literature review of studies that cited the results from the Youth Risk Behavior Survey and Monitoring the Future, two major data sources on the prevalence rates for substance use.

“Taken together, the results really underscored the shifts in societal norms for several substances,” Kulak said.

“For example, there have been decreases in society’s perception of how risky cannabis is, and as a result, use has increased. Similarly, youth who perceive low risk of using e-cigarettes, or low addiction potential, are more likely to use e-cigarettes.”

While it remains somewhat unclear, it seems logical that risk perceptions influence the use of other substances, including the non-medical use of prescription drugs, Kulak added, mentioning codeine cough syrup mixed with soda or alcohol, a concoction known as “lean” or “Purple Drank.”

“The types of products and the ways in which they are used have changed drastically. It is important for health care providers to remain up to date on emerging products and have some understanding of how they are used, and who they are used by, so as to better tailor prevention and intervention initiatives,” Kulak said.

Among the findings recent previous research has uncovered:

• E-cigarettes were the most commonly used nicotine-delivery product among high school students in 2017.
• Approximately 27 percent of adolescents aged 13 to 18 who drink alcohol mix it with energy drinks.
• Seventeen percent of adolescents have taken prescription drugs without a doctor’s prescription.
• For teens older than 15, hospitalizations for heroin and methadone poisoning increased 161 percent and 950 percent, respectively.

“We need to have a better understanding of the risk and protective factors for this type of use and experimentation, particularly as it relates to the primary care system,” Kulak said.

In addition, physicians should be aware of state and federal confidentiality laws pertaining to minors, Griswold points out.

“Because adolescents may fear that their personal information may be divulged to parents or other authorities, confidentiality in adolescent health care is a significant concern,” she added.