OSDUHS Highlights. Drug Use Among Ontario Students

Transcription

1 OSDUHS Highlights Drug Use Among Ontario Students

2 OSDUHS Highlights Drug Use Among Ontario Students CAMH Research Document Series No. 42 Angela Boak Hayley A. Hamilton Edward M. Adlaf Robert E. Mann

3 OSDUHS Highlights Drug Use Among Ontario Students ISBN: (PRINT) ISBN: (PDF) ISBN: (HTML) ISBN: (epub) Printed in Canada Copyright 2015 Centre for Addiction and Mental Health Individuals and school or health organizations are invited to reproduce, in part or in whole, the contents of this report. Citation is appreciated. Suggested citation for this report: Boak, A., Hamilton, H. A., Adlaf, E. M., & Mann, R. E., (2015). Drug use among Ontario students, : OSDUHS highlights (CAMH Research Document Series No. 42). Toronto, ON: Centre for Addiction and Mental Health. This publication may be available in other formats. For information about alternate formats or other CAMH publications, or to place an order, please contact Sales and Distribution: Toll-free: Toronto: publications@camh.ca Online store: Website: CAMH 5277b /

4 Acknowledgements A study of this magnitude requires the ongoing cooperation and support of many individuals and groups alike. Over the years, several people have provided invaluable input into this study. Current colleagues who provided support include Anca Ialomiteanu, Anita Dubey, Bruna Brands, Tony Ivanoff, Susan Steinback, and Stacey Penaloza. Former colleagues include Margaret Sheppard, Carolyn Liban, Hau Lei, Michael Goodstadt, and Frank Ivis. The sampling plan was designed by P. Peskun and C.M. Lamphier of York University. In 1999, the survey was redesigned by Michael Ornstein of York University. The sampling design, fieldwork, data entry, and data file preparation were conducted by the Institute for Social Research, York University, and we especially thank Stella Park, David Northrup, Hugh McCague, John Pollard, and Michael Ornstein for their input throughout the project. We would also like to extend our deepest thanks to the Ontario Tobacco Research Unit, the Problem Gambling Institute of Ontario, St. Michael s Hospital Injury Prevention Unit, and the seven Ontario public health units/departments (Durham Region Health Department; York Region Public Health; Simcoe Muskoka District Health Unit; Peel Public Health; Niagara Region Public Health; Brant County Health Unit; and North Bay Parry Sound District Health Unit) who collaborated with us during the 2015 OSDUHS. We also owe a debt of gratitude to a pioneer. We would not be in the enviable position of having such rich historical data without the work and foresight of Reginald G. Smart. Most importantly, the high level of cooperation by Ontario school boards, school board research review committees, school principals, parents, and students has played a major role in ensuring the representativeness and success of this project. We gratefully acknowledge the support of all. This study was supported, in part, by the Ontario Ministry of Health and Long-Term Care (MOHLTC). The views expressed here are those of the authors and do not necessarily reflect those of the MOHLTC. Angela Boak Hayley A. Hamilton Edward M. Adlaf Robert E. Mann

5 Table of Contents Introduction... 1 Methods... 2 Results... 4 Overview of Drug Use in Past Year Drug Use... 4 Lifetime Drug Use... 4 Trends in Drug Use... 7 Drug Use in 2015 vs Trends... 7 Long-Term Trends, (Grades 7, 9, 11 only)... 9 Tobacco and Alternative Smoking Devices Tobacco Cigarettes Smokeless (Chewing) Tobacco Waterpipe (Hookah) Electronic Cigarettes Cannabis Oil/Liquid/Wax in an Electronic Cigarette (Grades 9 12) Alcohol Any Alcohol Use in the Past Year Binge Drinking Drunkenness Alcohol Mixed with an Energy Drink Hazardous or Harmful Drinking (Grades 9 12) Cannabis Cannabis Use in the Past Year Daily Cannabis Use Cannabis Dependence (Grades 9 12) Synthetic Cannabis ( Spice, K2 ) Nonmedical Use of Prescription Drugs and Over-the-Counter Drugs Prescription Opioid Pain Relievers Prescription ADHD Drugs Over-the-Counter Cough or Cold Medication Used to Get High High-Caffeine Energy Drinks Any Drug Use (Grades 9 12) Any Drug Use Including Cannabis Any Nonmedical Prescription Drug Use New Users and Early Initiation New Users Early Initiation Among 7th Graders, Age at Initiation of Smoking, Drinking, and Cannabis Use, Consequences and Harms Riding with a Driver Who Had Been Using Alcohol or Drugs Driving a Motor Vehicle After Drinking Alcohol (Drivers in Grades 10 12) Driving a Motor Vehicle After Using Cannabis (Drivers in Grades 10 12) Drug Use Problem (Grades 9 12) Alcohol and Other Drug Treatment (Grades 9 12)... 22

6 Attitudes and Perceptions Perceptions of Risk of Harm and Disapproval Drug Availability Source of Cigarettes, Alcohol, and Cannabis Permission to Drink Alcohol at Home (Grades 9 12) School and Neighbourhood Intoxication at School Getting Drugs at School Exposure to Drug Selling Overview by Ontario Local Health Integration Networks (LHIN) Areas Overview of Drug Use in the Greater Toronto Area (GTA) Summary and Discussion Appendix Tables Table A1. Definitions of Terms Used in the Report Table A2. Percentage of Students Using the Drug in the Past Year, OSDUHS Table A3. Percentage of Students Using the Drug in the Past Year, OSDUHS... 45

7 Introduction The purpose of the Ontario Student Drug Use and Health Survey (OSDUHS) is to examine epidemiological trends in student drug use, mental health, physical health, gambling, and other risk behaviours, as well as identifying risk and protective factors. The OSDUHS, which has run for 39 years, is the longest ongoing surveillance program of alcohol and other drug use, and other health related behaviours among adolescent students in Canada, and one of the longest in the world. Repeated cross-sectional surveys such as the OSDUHS fit into a population health framework promoted by Health Canada and the World Health Organization, which is an evidence-based approach requiring the surveillance of a broad set of health indicators and determinants in the general population. Some objectives of the OSDUHS are to provide trustworthy and timely data regarding: current alcohol, tobacco, and other drug use by students, and trends since 1977; current mental health, physical health, and well-being indicators, and trends since 1991; population and sub-population changes in health indicators over time; risk and protective factors that correlate with these indicators; the uptake of risk behaviours and problems during adolescence, which affect the burden of disease in adults; and emerging issues facing today s youth, such as use of emerging drugs or new forms of risk behaviours. In this Highlights Report, we summarize the prevalence and patterns of tobacco, alcohol, and other drug use among Ontario students in grades 7 through 12 in We also provide data on trends since Trend results are provided for two analytical groups of students: those in grades 7 through 12, and those in grades 7, 9, and 11 only. The first group is used to assess current drug use and relatively recent trends ( ), and the second is used to assess long-term trends ( ). The 2015 OSDUHS included new questions * addressing the following issues: use of electronic cigarettes in the past year; use of electronic cigarettes for the very first time in the past year; perceived risk of harm from using electronic cigarettes regularly; use of cannabis oil/liquid/wax in an electronic cigarette; parental permission to drink at home; and usual source of cannabis. A more comprehensive report on the survey s drug use findings, as well as a complete description of methodology, can be found in the detailed report entitled Drug Use Among Ontario Students, : Detailed OSDUHS Findings (available in PDF at The OSDUHS also includes mental and physical health indicators and other risk behaviours, and these results will be published in the companion mental health and well-being report in the summer of History of the OSDUHS The Centre for Addiction and Mental Health s OSDUHS is the longest ongoing survey of students in Canada. Beginning in 1977, the OSDUHS surveyed Ontario students in grades 7, 9, and 11. In 1999, the OSDUHS was further expanded to include students in grade 7 through 13/OAC. In 2003, 13th graders were excluded from the sampling plan, and the number of classes surveyed in secondary schools was increased. During the past three decades, the OSDUHS has surveyed thousands of students every two years, and to date over 100,000 students in Ontario have participated. The study s history is underscored by considering that most of the 12th graders surveyed in 1977 are now in their 50s. * Please see the detailed drug use report for results on all new questions OSDUHS Drug Use Highlights 1

8 Methods Sampling Design The survey s target population the population we are attempting to draw conclusions about comprised all 7th to 12th graders enrolled in Ontario s four publicly funded school systems (i.e., English language public, English language Catholic, French language public, and French language Catholic). Students excluded from the survey s target population were those enrolled in private schools, those who were home-schooled, those institutionalized for correctional or health reasons, those schooled on First Nations reserves, military bases, or in the remote northern region of Ontario. Although our target population represents students in publicly funded schools, it captures the vast majority (92) of Ontario children and adolescents aged years. The 2015 OSDUHS employed a stratified (region by school level), two-stage (school, class) cluster sample design, and oversampled schools in northern Ontario and in seven public health regions. School Selection (Stage 1) The 2015 OSDUHS school sample selection occurred as follows: i) Schools were selected from Ontario s Ministry of Education s 2011/2012 enrolment database (most recently available at the time). ii) Within each of the region-by-school level strata, a probability proportionate-to-size (PPS) selection of schools was drawn (i.e., larger schools had a greater probability of Since 1981, the Institute for Social Research (ISR) at York University has assisted with the survey design, selected the sample, and administered the survey in schools on behalf of CAMH. being selected). iii) If a selected school declined to participate, or if it had closed, a replacement school from the same stratum was randomly selected. Class Selection (Stage 2) Within each recruited school, a gradestratified list of all eligible classes was used to randomly sub-sample one class per grade with equal probability. In elementary/middle schools, two classes were randomly selected one 7th-grade class and one 8th-grade class. In secondary schools, four classes were randomly selected, one in each grade between 9 and 12 from either a list of classes in a required subject (e.g., English), or a required period (e.g., homeroom). If a selected class could not participate, a replacement class from the same school and same grade was randomly re-selected, time permitting. Classes excluded as being out of scope were special education classes, English as a Second Language (ESL) classes, and classes with fewer than five students. All students in the selected classes who provided a signed consent form were eligible to participate. Procedures The 2015 OSDUHS protocol was approved by the Research Ethics Boards at CAMH, and York University, as well as 30 school board research review committees. All participating schools were provided with active parental consent forms, which were available in seven languages (English, French, Spanish, Portuguese, Russian, Mandarin, and Korean). Well in advance of the survey date, 2015 OSDUHS Drug Use Highlights 2

9 each school distributed the consent forms to students, who, in turn, sought the signature of one parent/guardian if they were under age 18 (students aged 18 and older did not require parental consent). Students themselves were also required to provide a signature of assent. Those who did not return a dual-signed consent form on or before the survey date were not allowed to participate. The survey was administered by trained ISR field staff in the classrooms between November 2014 and June Students were reminded that participation was voluntary and anonymous, and were instructed not to write their names on the questionnaires. They were also instructed to skip any question they did not understand. Students wrote their answers directly on the questionnaire. The ISR field staff collected all questionnaires after the survey. The OSDUHS Questionnaire In addition to alcohol and other drug use, the OSDUHS questionnaire covers an array of topics related to mental and physical wellbeing. The general outline of the topics covered in the survey is as follows: demographics, family and school life, alcohol, tobacco, and other drug use, beliefs and attitudes about drug use, vehicle-related questions, mental health indicators (e.g., suicidality, symptoms of anxiety and depression), physical health indicators (e.g., physical activity, healthy weight, injuries), bullying, gambling and gambling problems, video game playing problems, and aggressive and other problem behaviours. To include as many topics as possible in a fixed class period, while minimizing the burden on students, we employed four versions of the questionnaire, depending on school level. As in past cycles, we used split ballot modularized questionnaires whose item content was distributed according to questionnaire form (Form A vs. Form B). Elementary school (ES) students (grades 7 and 8) completed shorter questionnaires (a shorter Form A and a shorter Form B) than the secondary school (SS) students (grades 9 12). The elementary school questionnaires excluded the following topics: the use of cocaine, crack, heroin, methamphetamine, hallucinogens, club drugs, new synthetic drugs, and prescription tranquillizers, drug use problem screeners, gambling problem screener, and driving-related behaviours. About half of the items in each form were designated as core, that is, items common to all four forms (and thus answered by all students). A French version of Form A (ES and SS) was used in French-language schools. The 2015 questionnaires are available at Final Sample Size and Data Analysis The final complete sample size in 2015 was 10,426 students in grades 7 12 (59 of eligible students) from 750 classes in 220 schools in 43 school boards. This sample represents about 961,500 students in grades 7 12 in Ontario s publicly funded schools. This report provides drug use findings according to sex, grade, and region subgroups. The statistical significance of subgroup differences in 2015 was tested using bivariate second-order design-adjusted Rao-Scott Pearson chi-square tests at the p<.05 level of significance. All survey estimates were weighted, and variance and statistical tests were corrected for the sampling design. The regional results are based on the following four design-based regions: City of Toronto; Northern Ontario (Parry Sound District, Nipissing District and farther north); Western Ontario (Peel District, Dufferin County and farther west); and Eastern Ontario (Simcoe County, York County and farther east). See Table A1 for more definitions of terms used in this report OSDUHS Drug Use Highlights 3

10 Results Overview of Drug Use in 2015 Past Year Drug Use As seen in Figure 1 and Table 1, the most commonly used drug is alcohol, with 45.8 of students in grades 7 through 12 reporting use (excluding just a sip to try it) during the 12 months before the survey. Consumption of highly caffeinated energy drinks is also quite prevalent, as about one-third (34.8) of students report past year use, followed by cannabis, with 21.3 reporting past year use. About 11.7 report using electronic cigarettes (with or without nicotine), which is a higher prevalence than regular tobacco cigarettes (8.6). One-in-ten students (10.0) report the nonmedical (NM) use of prescription opioid pain relievers, such as codeine, Percocet, Percodan, Demerol, or Tylenol #3 in the past year. The remaining drugs are used by less than 10 of students. Questions about the use of certain illicit drugs were asked of secondary students only (grades 9 12). Among this subset of illicit drugs, ecstasy (MDMA) ranks highest with about 5.4 of secondary students reporting use in the past year, followed by psilocybin ( mushrooms ) at 3.2. Use of methamphetamine, heroin, and mephedrone ( bath salts ) is extremely rare, as their past year prevalence estimates fall below 1. Over one-third (36.9) of secondary students report using any drug (other than tobacco, alcohol or caffeine) during the past year. About one-in-eight (12.1) secondary students report using at least one prescription drug nonmedically (without a doctor s prescription) during the past year. Figure 2 shows the past year prevalence estimates for elementary students (grades 7 and 8) and secondary students separately. Not only do younger students have lower prevalence estimates than older students, the drug ranking differs slightly as well. Lifetime Drug Use Estimates for lifetime use (Figure 1) show that alcohol and cannabis are the most common drugs students in grades 7 12 have ever used. Over three-quarters (67.9) of students have ever tried alcohol (this includes sips) and about one-quarter (23.9) have ever tried cannabis. More students have tried electronic cigarettes (22.6) than regular tobacco cigarettes (19.1) in their lifetime. About 14.3 of students have tried a waterpipe (hookah) and 12.0 have used prescription opioid pain relievers (e.g., codeine, Percocet, Percodan, Demerol, Tylenol #3) nonmedically in their lifetime. The remaining drugs were used by less than 10 of students during their lifetime OSDUHS Drug Use Highlights 4

11 Figure 1. Percentage Reporting Lifetime and Past Year Drug Use, 2015 OSDUHS Grades 7-12 Alcohol Cannabis Electronic Cigarettes Opioid Pain Relievers (NM) Tobacco Cigarettes Waterpipe (Hookah) OTC Cough/Cold Medication Smokeless Tobacco Inhalants (Glue, Solvents) ADHD Drugs (NM) Salvia Divinorum Synthetic Cannabis ('Spice') Ecstasy Mushrooms/Mescaline Cocaine Tranquillizers/Sedatives (NM) Jimson Weed LSD Methamphetamine Mephedrone ('Bath Salts') Heroin Crack Lifetime Use Past Year Use Grades 9-12 only s Lifetime Use Past Year Use Notes: NM=nonmedical use, without a doctor's prescription; OTC=over-the-counter; ADHD=Attention-Deficit Hyperactivity Disorder; s=suppressed estimate; suppressed estimates for any use of modafinil Figure 2. Percentage Reporting Past Year Drug Use by Grade Level, 2015 OSDUHS High-Caffeine Energy Drinks Alcohol Opioid Pain Relievers (NM) OTC Cough/Cold Medication Inhalants (Glue, Solvents) Electronic Cigarettes Smokeless Tobacco Grades 7 & 8 Alcohol High-Caffeine Energy Drinks Cannabis Electronic Cigarettes Tobacco Cigarettes Opioid Pain Relievers (NM) Waterpipe (Hookah) Smokeless Tobacco OTC Cough/Cold Medication Ecstasy Mushrooms/Mescaline Cocaine ADHD Drugs (NM) Tranquillizers (NM) Salvia Divinorum Inhalants (Glue, Solvents) Jimson Weed Synthetic Cannabis ('Spice') LSD Methamphetamine Mephedrone ('Bath Salts') Heroin Grades Notes: (1) NM = nonmedical use, without a doctor's prescription; (2) estimates for tobacco cigarettes, waterpipe, cannabis, synthetic cannabis ('spice'), salvia, and ADHD drugs among Grades 7 & 8 were suppressed due to unreliability; (3) estimates for crack and modafinil among Grades 9-12 were suppressed due to unreliability 2015 OSDUHS Drug Use Highlights 5

12 Table 1. Percentage Reporting Past Year Drug Use by Sex, Grade, and Region, 2015 OSDUHS (n=10,426) Drug Use Among Grades 7 12 Total Est. # Males Females G7 G8 G9 G10 G11 G12 Toronto North West East Alcohol , * * High-Caffeine Energy Drinks , * * Cannabis , s s * Binge Drinking (Past Month) , s s * * Electronic Cigarettes , * s s * * Opioid Pain Relievers (NM) , * Tobacco Cigarettes , s s * * Waterpipe (Hookah) , s s * OTC Cough/Cold Medication , s Smokeless (Chewing) Tobacco , * s s * * Inhalants (Glue or Solvents) , s * * ADHD Drugs (NM) , s s * s Salvia Divinorum , * s s s s * s s Synthetic Cannabis ( Spice, K2 ) , s s s * Drug Use Among Grades 9 12 Ecstasy (MDMA) , * Cannabis Oil in an Electronic Cigarette , * s * Mushrooms (Psilocybin) or Mescaline , * s * Cocaine , s * s Tranquillizers/Sedatives (NM) , * * 1.5 s Jimson Weed , s s s s s s LSD , * Methamphetamine (incl. Crystal Meth.) 1.1 7, s s s s 0.7 s 0.8 s Mephedrone ( Bath Salts ) 0.7 4,600 s s s s s s s s s s Heroin 0.5 3,300 s s s s s s s s s s Any NM Use of a Prescription Drug , * Any Drug Use Excluding Cannabis , * Any Drug Use Including Cannabis , * Notes: the estimated number of students was derived using survey weights and is based on a population of 961,500 students in Ontario s publicly funded schools; not asked of 7th and 8th graders; * statistically significant sex or grade difference (p<.05), not controlling for other factors; s=estimate suppressed due to unreliability; estimate for alcohol excludes a sip ; estimates for tobacco cigarettes, electronic cigarettes, and waterpipe excludes smoking a few puffs; OTC=over-the-counter drug used to get high ; NM= nonmedical use, without a doctor s prescription; Any NM Use of a Prescription Drug refers to nonmedical use of opioids, Attention-Deficit-Hyperactivity-Disorder (ADHD) drugs, or tranquillizers/sedatives; Any Drug Use Including Cannabis refers to use of any one of 18 drugs (excludes alcohol, tobacco and electronic cigarettes, waterpipe, and high-caffeine energy drinks); estimates for crack and modafinil (NM) were suppressed due to unreliability (extremely low values) OSDUHS Drug Use Highlights 6

13 Trends in Drug Use Drug Use in 2015 vs Of the 24 drugs monitored in both the 2013 and 2015 survey cycles, only ecstasy shows a statistically significant increase in past year prevalence (among secondary students only). Three drugs show a significant decrease in past year prevalence between these two years: opioid pain relievers (nonmedical use), cough and cold medication (used to get high), and high-caffeine energy drinks. No other drug shows a statistically significant change in past year prevalence between 2013 and Prescription Opioids (NM) OTC cough cold/ medication (NM) 2013 Past Year Use 2015 Past Year Use Energy Drinks Ecstasy Trends Only past year nonmedical use of ADHD drugs shows a slight, yet statistically significant, increase since 1999 (from 1.0 to 2.1). Most drugs monitored in the OSDUHS have shown decreases in annual prevalence during the past decade or so. (See Table A2 for drug use estimates from ) Drugs that decreased among grades 7 12: tobacco cigarette smoking significantly decreased from 28.4 in 1999 to 8.6 in 2015 alcohol (from 66.0 to 45.8) cannabis (from 28.0 to 21.3) inhalants (from 8.9 to 2.8) salvia divinorum (decreased from 4.4 in 2009 to 1.6) high-caffeine energy drinks (decreased from 49.5 in 2011 to 34.8) opioid pain relievers (nonmedical use decreased from 20.6 in 2007 to 10.0). Drugs that decreased among grades 9 12 only: LSD (from 8.8 in 1999 to 1.5 in 2015) mushrooms/mescaline (from 17.1 to 3.2) methamphetamine (from 6.3 to 1.1) cocaine (from 5.7 in 2003 to 2.5) crack (from 3.2 to <0.5) ecstasy (from 7.9 in 2001 to 5.4) heroin (from 2.1 to 0.5) steroids (lifetime use from 4.3 to 1.2) an index measuring the nonmedical use of any prescription drug decreased from 23.5 in 2007 to 12.1 in 2015 (due to the decrease in prescription opioids) an index measuring any drug use of nine drugs, including cannabis, monitored since 1999 significantly decreased from 39.2 to 29.0 in 2015 a second index similar to that above, but excluding cannabis, decreased from 22.8 in 1999 to 9.1 in Drugs that remained stable during this period, or since they were first monitored, include smokeless (chewing) tobacco, waterpipe, synthetic cannabis ( spice, K2 ), jimson weed, mephedrone ( bath salts ), tranquillizers, and modafinil OSDUHS Drug Use Highlights 7

14 Figure 3. Overview of Past Year Drug Use Trends, OSDUHS (Grades 7 12) Cigarettes Smokeless Tobacco Alcohol Binge (past month) Cannabis Inhalants Salvia Prescr. Opioids (NM) Cough/Cold Med. (NM) ADHD Drugs (NM) Energy Drinks Figure 4. Overview of Past Year Drug Use Trends, OSDUHS (Grades 9 12 only) Mushrooms/Mesc. Jimson Weed Cocaine Ecstasy Heroin LSD Methamphetamine Crack Tranquillizers (NM) Notes: suppressed estimates for crack in 2015, and for heroin in 2011 and 2013; NM=nonmedical use 2015 OSDUHS Drug Use Highlights 8

15 Long-Term Trends, (Grades 7, 9, 11 only) The long-term drug use trends are limited to grades 7, 9, and 11 because only these grades were included in the surveys prior to Many past year prevalence estimates for drugs monitored since 1977 show a common pattern of use: a peak in the late 1970s, a decline in use during the late 1980s or early 1990s, a second peak in the late 1990s or early 2000s, followed by another decline. (See Table A3 for long-term drug use estimates.) The long-term changes can be further categorized into the following five patterns: The first pattern (Figure 5) displays the past year use of cigarettes, alcohol, LSD, and methamphetamine. Prevalence for these drugs has reached an all-time low in recent years. The second pattern (Figure 6) shows that prevalence in 2015 is significantly lower than the peaks seen in the late 1970s and late 1990s (2003 for cocaine), and current use is similar to the lows seen in the early 1990s This pattern is evident for binge drinking, inhalants, mushrooms/ mescaline, and cocaine. The third pattern (Figure 7) is similar to the second pattern, with one important difference current use is significantly higher compared with the low levels of use seen in the early 1990s. This pattern is evident for cannabis. The fourth pattern (Figure 8) shows only one peak in the late 1990s or early 2000s (or the late 1970s for tranquillizers), a decline during the 2000s, and stability in recent years. This pattern is evident for ecstasy, crack, and tranquillizers/ sedatives (NM). The fifth pattern (Figure 9) applies to past year heroin use, which has been very low and stable for decades. Figure 5. Pattern 1: Long-Term Drug Use Trends, OSDUHS 80 Cigarettes Alcohol 20 LSD Methamphetamine Note: estimates for LSD and methamphetamine exclude Grade 7 students 2015 OSDUHS Drug Use Highlights 9

16 Figure 6. Pattern 2: Long-Term Drug Use Trends, OSDUHS 40 Binge Drinking Inhalants Mushrooms Cocaine Notes: (1) binge drinking refers to drinking 5 or more drinks on one occasion at least once in the past month; (2) estimates for mushrooms and cocaine exclude Grade 7 students Figure 7. Pattern 3: Long-Term Drug Use Trends, OSDUHS 40 Cannabis OSDUHS Drug Use Highlights 10

17 Figure 8. Pattern 4: Long-Term Drug Use Trends, OSDUHS 20 Ecstasy Crack Tranquillizers Notes: (1) estimates exclude Grade 7 students; (2) crack not asked about prior to 1987; (3) ecstasy not asked about prior to 1991 Figure 9. Pattern 5: Long-Term Drug Use Trends, OSDUHS 20 Heroin Note: estimates exclude Grade 7 students 2015 OSDUHS Drug Use Highlights 11

18 Tobacco and Alternative Smoking Devices Tobacco Cigarettes As shown in Figure 10, 8.6 of students in grades 7 12 report smoking tobacco cigarettes in the past year. This percentage represents about 82,700 students across Ontario. Males (9.1) and females (8.2) are equally likely to smoke tobacco cigarettes. The prevalence of smoking is extremely low among 7th and 8th graders. Smoking significantly increases by grade between 9th grade (3.8) and 12th grade (15.3). Among the four regions, students in the North (11.8) and East (10.8) are most likely to smoke compared with students in Toronto and the West (about 7). Smokeless (Chewing) Tobacco About 6.3 of students in grades 7 12 report using smokeless tobacco in the past year. This percentage represents about 58,200 students in Ontario. Males (9.7) are significantly more likely than females (2.7) to use smokeless tobacco. There is significant grade variation, with students in grades 11 and 12 most likely to use (about 11). There is significant regional variation, with students in Toronto (3.0) least likely to use smokeless tobacco compared with students in the other three regions (about 5-9). Waterpipe (Hookah) About 8.3 of students in grades 7 12 report using a waterpipe in the past year. This percentage represents about 76,200 students across Ontario. Males (9.0) and females (7.5) are equally likely to use a waterpipe. Use of a waterpipe significantly increases with grade, ranging from 5.3 among 9th graders to a peak of 14.4 among 12th graders. There are no significant regional differences. Electronic Cigarettes About 11.7 of students in grades 7 12 report using an electronic cigarette (any type) in the past year. This percentage represents about 107,800 students in Ontario. Males (14.5) are significantly more likely than females (8.7) to use electronic cigarettes. There is significant grade variation showing that use increases with grade level, peaking in 11th grade at There is significant regional variation showing that students in the East (17.0) are most likely to use electronic cigarettes compared with students in the other three regions (about 9-12) OSDUHS Drug Use Highlights 12

19 What are electronic cigarettes? Electronic cigarettes (also known as vaporizers, e-pens, vapes ) are batteryoperated devices that create a mist or vapour by heating a liquid solution. The vapour is inhaled to simulate the act of smoking. The liquid is available in a variety of flavours and may or may not contain nicotine. Electronic cigarettes come in a range of shapes and sizes some look almost identical to a regular tobacco cigarette. Cannabis Oil/Liquid/Wax in an Electronic Cigarette (Grades 9 12) About 5.1 of students in grade 9 12 report using cannabis oil, liquid, or wax in an electronic cigarette in the past year. This percentage represents about 35,300 high school students in Ontario. Males (6.3) are significantly more likely than females (3.8) to use cannabis in an electronic cigarette. There is significant grade variation, with students in 11th and 12 grade most likely to use. There are no significant regional differences. Figure 10. Percentage Reporting Past Year Use of Electronic Cigarettes, Tobacco Cigarettes, Waterpipe, and Smokeless Tobacco, 2015 OSDUHS (Grades 7 12) Electronic Cigarettes 11.7 Tobacco Cigarettes 8.6 Waterpipe (Hookah) 8.3 Smokeless (Chewing) Tobacco OSDUHS Drug Use Highlights 13

20 Alcohol Any Alcohol Use in the Past Year Just under half (45.8) of all students report drinking alcohol during the 12 months before the survey. This estimate excludes those who only had a sip of alcohol, but does include those who drank only on a special occasion. This percentage represents about 439,200 students in grades 7 12 across Ontario. Males (46.6) and females (44.9) are equally likely to drink alcohol. Drinking significantly increases with grade, from a low of 8.6 among 7th graders to a high of 72.4 among 12th graders. Binge Drinking As shown in Figure 11, 17.6 of students report binge drinking at least once during the four weeks before the survey. This percentage represents about 168,100 students in grades 7 12 across Ontario. Males (18.7) and females (16.4) are equally likely to binge drink. Binge drinking is lowest among 7th graders (suppressed estimate) and climbs to a high of 32.6 among 12th graders. There are significant differences among the four regions, with students in the North (22.4) most likely to binge drink. There is significant regional variation, with Toronto students (38.9) least likely, and students in the North (52.1) most likely, to drink alcohol. Figure 11. Percentage Reporting Past Month Binge Drinking by Sex, Grade, and Region, 2015 OSDUHS Total M F G9 G10 G11 G12 TO N W E Notes: (1) vertical 'whiskers' represent 95 confidence intervals; (2) horizontal band represents 95 CI for total estimate; (3) estimates for Grades 7 and 8 were suppressed; (4) significant differences by grade and region (p<.05), no significant difference by sex 2015 OSDUHS Drug Use Highlights 14

21 Drunkenness An estimated 15.9 of students report becoming drunk at least once during the four weeks before the survey, representing about 151,900 students in grades 7 12 in Ontario. Males (16.0) and females (15.9) are equally likely to report drunkenness in the past month. Reported drunkenness is lowest among 7th graders (suppressed estimate) and climbs to a high of 29.4 among 12th graders. There are significant difference among the four regions, with Toronto students (12.1) least likely, and Northern and Eastern students most likely, to report drunkenness (about 19). Alcohol Mixed with an Energy Drink The percentage of students who report drinking alcohol mixed with an energy drink at least once in the past year is This estimate represents about 129,100 students in grades Hazardous or Harmful Drinking (Grades 9 12) The World Health Organization s Alcohol Use Disorders Identification Test (AUDIT) screening tool was used to assess hazardous or harmful drinking in the past 12 months. Hazardous drinking refers to an established pattern of drinking that increases the likelihood of future physical, social, and mental health problems, whereas harmful drinking refers to a pattern of drinking that is already causing harms. One-in-five (19.8) secondary students drink hazardously or harmfully. This represents about 138,500 high school students in Ontario. Males (19.2) and females (20.4) are equally likely to drink hazardously or harmfully. There is significant grade variation, ranging from a low of 5.5 among 9th graders to a 29.4 among 12th graders. Students in the North (26.9) are most likely to report hazardous/harmful drinking, whereas students in Toronto (14.1) are least likely. Males (15.2) and females (12.8) are equally likely to drink alcohol mixed with an energy drink. Drinking alcohol with an energy drink is lowest among 7th graders (suppressed estimated) and increases to a peak of 23.2 among 12th graders. There are significant differences among the four regions, with students in the East region (19.5) most likely to drink alcohol mixed with an energy drink OSDUHS Drug Use Highlights 15

22 Cannabis Cannabis Use in the Past Year As shown in Figure 12, 21.3 of students report using cannabis at least once during the 12 months before the survey, representing about 203,900 students in grades 7 12 in Ontario. Males (22.0) and females (20.5) are equally likely to use cannabis. Use significantly increases with grade, to a high of 37.2 among 12th graders. There are no significant regional differences. Daily Cannabis Use About 2.1 use cannabis on a daily basis, representing about 20,000 students. There is no significant difference between males (2.3) and females (1.9). Cannabis Dependence (Grades 9 12) The Severity of Dependence Scale (SDS) was used to estimate the percentage of students in grades 9 through 12 who may have a cannabis dependence problem (e.g., symptoms of loss of control and withdrawal). About 2.2 report symptoms of cannabis dependence, representing about 14,900 high school students in Ontario. Synthetic Cannabis ( Spice, K2 ) Synthetic cannabis (also known as spice, K2, or K3 ) refers to a wide variety of herbal mixtures that contain plant material, preservatives, fragrance, and chemicals that fall into the cannabinoid family. About 1.3 of students report using synthetic cannabis at least once during the past 12 months, representing about 12,100 students in grades Figure 12. Percentage Reporting Past Year Cannabis Use by Sex, Grade, and Region, 2015 OSDUHS Total M F G9 G10 G11 G12 TO N W E Notes: (1) vertical 'whiskers' represent 95 confidence intervals; (2) horizontal band represents 95 CI for total estimate; (3) estimates for Grades 7 and 8 were suppressed; (4) significant difference by grade (p<.05), no significant differences by sex or region 2015 OSDUHS Drug Use Highlights 16

23 Nonmedical Use of Prescription Drugs and Over-the-Counter Drugs Prescription Opioid Pain Relievers Prescription opioids (such as Percocet, Percodan, Tylenol #3, Demerol, OxyContin/OxyNEO, and codeine) are powerful pain relievers. In addition to suppressing pain, these drugs may also cause a relaxed or euphoric feeling. Opioids can be dangerous when used without medical supervision. One-in-ten (10.0) students report using a prescription opioid pain reliever nonmedically (i.e., without their own prescription) at least once in the past year. This estimate represents about 95,000 students in grades There is no significant difference between males (9.6) and females (10.4). Use significantly increases with grade, peaking in 12th grade at There are no significant regional differences. Prescription ADHD Drugs Ritalin and Concerta (methylphenidate), Adderall and Dexedrine (dextroamphetamine) are stimulant drugs used to treat Attention Deficit/Hyperactivity Disorder (ADHD) in children. However, some use these drugs for various nonmedical purposes including appetite suppression, wakefulness, increased focus, and euphoria. About 2.1 report using an ADHD drug for nonmedical purposes at least once in the past year. This represents about 19,900 Ontario students in grades Males (2.1) and females (2.0) are equally likely to use an ADHD drug nonmedically. There is significant grade variation, with 11th and 12th graders most likely to use (about 3-4). There are no significant regional differences. Over-the-Counter Cough or Cold Medication Used to Get High Some over-the-counter (OTC) cough/cold medications containing the drug dextromethorphan (DXM) are used to get high. When abused, DXM takes on qualities of a dissociative drug such as ketamine, producing feelings of detachment, distorting perceptions, and impairing motor coordination. About 6.4 report using an OTC cough/cold medication to get high at least once in the past year, representing about 60,600 students in grades 7 12 in Ontario. There is no significant difference between males (6.7) and females (6.1). There are no significant grade differences. There are no significant regional differences. High-Caffeine Energy Drinks One-third (34.8) of students in grades 7 12 report drinking an energy drink (e.g., Red Bull, Rockstar) at least once in the past year. This estimate represents about 326,800 Ontario students. Males (40.6) are significantly more likely than females (28.6) to use energy drinks. Use significantly increases with grade, from 19.2 among 7th graders up to 45.9 among 12th graders. There are no significant regional differences OSDUHS Drug Use Highlights 17

24 Any Drug Use (Grades 9 12) Any Drug Use Including Cannabis Here we present a composite index measuring past year use of at least one of the following 18 drugs asked about in the 2015 survey: cannabis, synthetic cannabis, inhalants, LSD, mushrooms/mescaline, jimson weed, salvia divinorum, cocaine, crack, methamphetamine, heroin, ecstasy, mephedrone ( bath salts ), tranquillizers (NM), modafinil (NM), other prescription opioid pain relievers (NM), ADHD drugs (NM), and over-the-counter cough/cold medication. Excluded from this index are tobacco and electronic cigarettes, waterpipe, alcohol, and high-caffeine energy drinks. Among secondary students, 36.9 report using at least one drug in the past year (Figure 13). This estimate represents about 254,300 students in grades There is no significant difference between males and females. Any Nonmedical Prescription Drug Use Here we present a composite index measuring past year nonmedical use of at least one of the following prescription drug classes: opioid pain relievers, ADHD drugs, or tranquillizers/ sedatives. Nonmedical use is defined as use without one s own prescription. About 12.1 of high school students report using a prescription drug nonmedically in the past year. This estimate represents about 85,300 students. There is no significant difference between males (11.6) and females (12.7). Nonmedical use of a prescription drug significantly increases with grade, from 7.3 among 9th graders to 15.0 among 12th graders. There are no significant regional differences. Drug use significantly increases with grade. There are no significant regional differences. Figure 13. Percentage Reporting Past Year Use of Any Drug Including Cannabis, by Sex, Grade, and Region, 2015 OSDUHS Total M F G9 G10 G11 G12 TO N W E Notes: (1) vertical 'whiskers' represent 95 confidence intervals; (2) horizontal band represents 95 CI for total estimate; (3) significant difference by grade (p<.05), no significant differences by sex or region 2015 OSDUHS Drug Use Highlights 18

25 New Users and Early Initiation New Users About 6.3 of students smoked a whole tobacco cigarette for the first time during the 12 months before the survey (representing about 58,400 students). There is significant grade variation in first-time use of cigarettes in the past year, peaking in 11th grade (Figure 14). About 15.7 of students used an electronic cigarette (any type) for the first time during the 12 months before the survey (about 145,300 students). First use significantly increases with grade, peaking in 11th and 12th grade. One-in-five (19.0) students tried alcohol for the first time in the past year (about 175,000 students). First use of alcohol increases steadily between grades 7 and 9, and then decreases slightly in the older grades. One-in-ten (9.6) tried cannabis for the first time in the past year (about 88,400 students). First use increases steadily between grades 7 and 10, remains stable in grade 11, and then decreases in grade 12. Early Initiation Among 7th Graders, Early initiation of tobacco cigarette smoking shows a downward trend over time, with fewer 7th graders today reporting smoking at an early age compared with 7th graders decades ago. Most notably, an extremely low percentage (less than 0.5) of 7th graders in 2015 reported smoking their first whole cigarette before the end of grade 6 (ages 11/12), compared with 9 in 2003, 27 in 1997, and 41 in Early initiation of alcohol use has also decreased over time. For example, about 14 of 7th graders in 2015 tried alcohol before the end of grade 6 compared with 31 in 2007, 42 in 2003, and 50 in Early initiation of cannabis use (trying for the first time before the end of grade 6) was at 7 in Early use decreased by 1989 (1), increased again in 1997 and remained elevated until 2003 (5). In 2015, the estimate is much lower (less than 0.5). Figure 14. Percentage Reporting First-Time Use of the Substance in the Past Year, by Grade, 2015 OSDUHS 40 Tobacco Cigarettes Alcohol Electronic Cigarettes Cannabis Grade Notes: Grade 7 and Grade 8 estimates for tobacco cigarettes were suppressed; Grade 7 estimate for cannabis was suppressed 2015 OSDUHS Drug Use Highlights 19

26 Age at Initiation of Smoking, Drinking, and Cannabis Use, Here we present the average (mean) age at initiation for cigarette, alcohol, and cannabis use among grade 12 users (ages 17/18). We select 12th graders because this is the oldest grade in the study and therefore this group is nearing the end of adolescence. We restrict our analysis to past year users because our focus is on ongoing use rather than experimental behaviour. As shown in Figure 15, the average initiation age for cigarette smoking increased considerably since The average initiation age for drinking alcohol has increased since The average initiation age for cannabis use has increased slightly since In 2015 the average age at first cigarette smoking (smoking one whole tobacco cigarette) among grade 12 smokers was age The average age at first alcoholic drink among grade 12 drinkers was 14.8, and the average age at first drunkenness among grade 12 drinkers was The average age at first cannabis use among grade 12 users was Figure 15. Average Age at First Tobacco Cigarette Among 12th-Grade Smokers, First Alcoholic Drink Among 12th-Grade Drinkers, and First Cannabis Use Among 12th-Grade Users, OSDUHS 17 First Cigarette First Alcohol First Cannabis 16 Age OSDUHS Drug Use Highlights 20

27 Consequences and Harms Riding with a Driver Who Had Been Using Alcohol or Drugs About 15.3 of students in grades 7 12 rode in a vehicle at least once in the past year with a driver who had been drinking (representing about 146,400 students in Ontario). About 12.3 of students in grades 7 12 rode with a driver who had been using drugs at least once in the past year (representing about 117,700 students in Ontario). Males and females are equally likely to ride in a vehicle with a driver who had been drinking, or using drugs. The likelihood of riding in a vehicle with a driver who had been drinking, or using drugs, significantly increases with grade. There are no significant regional differences regarding the likelihood of riding with a driver who had been drinking, or using drugs. Figure 16. Percentage Reporting Riding in a Vehicle with a Driver Who Had Been Drinking Alcohol and Riding in a Vehicle with a Driver Who Had Been Using Drugs, 2015 OSDUHS Driving a Motor Vehicle After Drinking Alcohol (Drivers in Grades 10 12) About 5.1 of drivers (with a G-Class licence) in grades drove within an hour of consuming two or more alcoholic drinks at least once in the past year (representing about 15,300 adolescent drivers in Ontario). Male drivers (6.4) are significantly more likely than female drivers (3.4) to drink and drive. There are no significant differences by grade, or by region. Driving a Motor Vehicle After Using Cannabis (Drivers in Grades 10 12) About 9.8 of students in grades with a driver s licence report driving after using cannabis at least once in the past year. This represents about 29,500 adolescent drivers in Ontario. Male drivers (11.6) are significantly more likely than female drivers (7.6) to use cannabis and drive. There are no significant differences by grade, or by region (est. 146,400 students) 12.3 Figure 17. Percentage of Drivers in Grades Reporting Driving a Motor Vehicle After Drinking Alcohol and After Using Cannabis, 2015 OSDUHS (est. 117,700 students) Passenger -- Driver Used Alcohol Passenger -- Driver Used Drugs (est. 29,500 drivers) (est. 15,300 drivers) 0 Drinking-Driving Cannabis Use-Driving 2015 OSDUHS Drug Use Highlights 21