Highlights from the 2009 Ontario Student Drug Use and Health Survey OSDUHS Drug Use Report

2. AGENDA Introduction & Overview of OSDUHS Results � Donna Beatty Alcohol & Illict Drugs - Geri Roberts Tobacco & Cannabis � Jody Hamilton LHIN Area Results � Geri Roberts Opportunities: Future & Prevention � Jody Hamilton Question & Answer � Dr. Robert Mann, Angela Boak, Program Consultants � Donna, Jody, Geri. Wrap Up � Donna Beatty

3. OSDUHS History 1968-1975: four surveys conducted among Toronto students 1977-1997: province-wide every 2 years; grades 7, 9, 11, and 13 (OAC) 1999-2009: sample expanded to grades 7 to 12; sampled more classes in secondary schools OSDUHS is the longest ongoing school survey in Canada, and the 2nd longest in North America

4. OSDUHS Samples 1977-1979 20 Boards 87-104 Schools 4684-4794 Students 1981-1997 20-31 Boards 137-227 Schools 3270-4737 Students 1999-2007 37-43 Boards 106-137 Schools 4211-7726 Students 2009 47 Boards 181 Schools 9112 Students

5. 2009 Design surveyed students in grades 7 to 12 in public and Catholic schools active parental consent procedure used the sample is representative of over 1 million Ontario students

6. 4 Regions by Design Toronto Northern Ontario: Parry Sound District, Nipissing District and farther north Western Ontario: Peel District, Dufferin County and farther west Eastern Ontario: Simcoe County, York County and farther east

7. 2009 Participation 47 public and Catholic school boards 181 schools 573 classes 9,112 students in grades 7 to 12 4,424 students in grades 7, 9, and 11 (for long-term trends) 65% student response rate

8. OSDUHS Topic Coverage Demographics Family Life, School Life Mental Health Indicators Physical Health Indicators Delinquent Behaviours Violence at School Bullying Gambling Activities & Problem Video Gaming Problem

9. OSDUHS Topic Coverage Drug Use alcohol, tobacco, cannabis glue, solvents LSD, PCP, psilocybin/mescaline, jimson weed, salvia divinorum cocaine, crack, methamphetamine, crystal methamphetamine, heroin, ecstasy, GHB, Rohypnol�, ketamine OxyContin� and other prescription opioids, prescription ADHD drugs and other stimulant pills, prescription tranquillizers OTC sleeping medication, OTC cough/cold medication

10. OSDUHS Topic Coverage Problem Use: alcohol problem (AUDIT) cannabis problem (SDS) general drug use problem (CRAFFT) Vehicles: drinking and driving cannabis use and driving passenger with a driver who used alcohol and drugs Perceptions: risk, disapproval, and availability of certain drugs School Context: classes at school about alcohol, cannabis intoxication at school were sold, offered, given drugs at school

11. New Drug-Related Topics in 2009 use of salvia divinorum use of certain over-the-counter cough/cold medication to �get high� source of cigarettes contraband cigarette smoking

12. Key Findings Presented overview of drug use in 2009 ten-year trends (1999-2009) long-term trends (1977-2009) early initiation of drug use drug-specific highlights perceptions of risk, disapproval & availability drug use in 2009 according to the Ontario LHINs

13. Overview of Drug Use in 2009

14. Summary of Key Findings Drinking alcohol is down among students (58%) Major concerns: Alcohol, Cannabis, Binge Drinking, Non Medical Use of Prescription Drugs One in Four Ontario students is a binge drinker Drinking and Driving - there are a substantial number of young people who use alcohol & drive, (12%) & are at risk of injury. 23% students report being in a vehicle driven by someone who had been drinking Cannabis Use remains stable at 25%. It is reported that 17% of students use cannabis & drive (17%). 18% students report being in a vehicle driven by someone who had been using drugs Non medical use of Prescription Drugs (Tylenol #3, Percocet, Oxycontin) remain a concern Tobacco use is steady at 12%

15. Percentage Who Reported Past-Year Drug Use, 2009 OSDUHS (Grades 7-12)

16. Frequency of Drug Use During the Past Year Among Users, 2009 OSDUHS (Grades 7-12)

17. Sex Differences in Past-Year Drug Use Males were more likely than females to use: - alcohol - cannabis - cigarettes - other hallucinogens - saliva divinorum - methamphetamine - heroin

18. Regional Differences from the Provincial Average Students in the Western and Eastern regions did not differ from the province as a whole on any drug use estimate. Toronto students were above average for use of inhalants and OTC cough/cold mediation; they were below average for alcohol use, binge drinking, cigarette smoking, cannabis use, and NM stimulant use. Northern students were above average for alcohol use, binge drinking, cigarette smoking, cannabis use, salvia use, NM stimulant use, and NM OxyContin use.

19. Regional Differences in Past-Year Use

20. Changes in Past-Year Drug Use Over Time

21. 2009 vs. 2007 (Grade 7 to 12) No drug use measure showed a significant change in 2009 compared to 2007

22. Ten-Year Trends, 1999-2009 (Grades 7 to 12) Many decreases seen in 2009 compared to 1999 rates: alcohol cigarettes hallucinogens glue & solvents methamphetamine crack heroin stimulants pills (NM) ecstasy (compared to 2001 peak) Rohypnol (compared to 2001 peak)

23. Long-Term Trends, 1977-2009 (Grades 7, 9, 11 only)

24. General Long Term Patterns The OSDUHS long-term drug data reveal a common pattern in past-year prevalence rates between 1977 and 2009: a peak in use during the late 1970s, a decline in use during the late 1980s to early 1990s, followed by a second peak in the late 1990s or early 2000s.

25. No Substance Use At All in the Past Year, 1977-2009 (Grades 7, 9, 11 only)

26. Long-Term Trends Among 7th-Graders Another way to assess whether students today are using drugs at an earlier age than in the past is to examine the long-term trends in prevalence among the 7th-graders � the youngest students in our sample.

27. Percentage of 7th-Graders Who Reported Smoking, Drinking, and Cannabis Use During the Past Year, 1977-2009

28. Average Age of Initiation for Smoking, Drinking, and Cannabis Use Among 11th-Grade Users, 1981-2009 In 2009: Among Grade 11 smokers, the average age of first cigarette smoking was 13 years Among Grade 11 drinkers, the average age of first drink of alcohol was 13 years Among Grade 11 drinkers, the average age of first getting drunk was 14 years Among Grade 11 cannabis users, the average age of first cannabis use was 14 years

29. Students today are not starting to smoke, drink, or use cannabis at a younger age than did their counterparts decades ago�

30. Average Age of First Cigarette Among 11th-Grade Smokers, First Drink Among 11th-Grade Drinkers, and First Cannabis Use Among 11th-Grade Users, OSDUHS 1981-2009

31. Alcohol Use in 2009 In 2009, 58% of 7th- to 12th-graders reported drinking during the past year (representing about 591,000 Ontario students), and 61% reported ever drinking in their lifetime. Past-year drinking significantly differed between males (60%) and females (56%). Drinking also varied by grade (from 23% of 7th-graders to 83% of 12th-graders), and region, with Toronto students (45%) least likely to drink and Northern students (64%) most likely.

32. Past-Year Alcohol Use Trends The prevalence of past-year drinking did not significantly change since 2007 among grades 7 to 12. However, the 2009 estimate is currently lower than the 1999 estimate (66%). Long-Term Trends (among grades 7, 9, and 11 only): decreased over the 1980s and early 1990s, increased in the late 1990s (but did not reach the peaks seen in the late 1970s), and decreased again in recent years.

33. Early Alcohol Use Fewer 7th-graders today tried alcohol at an early age: 31% of all 7th-graders in 2009 drank alcohol by grade 6 (age 11) vs. 42% in 2003, 47% in 1997, and 50% in 1981.

34. Binge Drinking in 2009 About 25% of students in grades 7 to 12 reported drinking 5 or more drinks on one occasion at least once during the past month (this represents about 250,000 Ontario students). Past-month binge drinking did not significantly differ between males (26%) and females (23%). Binge drinking varied by grade (from 3% of 7th-graders to 49% of 12th-graders), and region, with Toronto students (16%) least likely to binge drink and Northern students (32%) most likely.

35. Past-Month Binge Drinking Trends Among grades 7 to 12, binge drinking did not significantly change over the past decade (the 1999 estimate was 28%). Long-Term Trends (among grades 7, 9, and 11 only): binge drinking declined to a low in 1993 (at 15%), increased over the late 1990s to a peak in 1999. Although it has slightly declined again since then, the rate in 2009 was still higher than the low found in 1993.

36. Hazardous/Harmful Drinking The WHO�s Alcohol Use Disorders Identification Test (AUDIT) is a 10-item screener used to identify those who drink hazardously or harmfully. Such people are at an increased risk for physical problems, social problems and alcohol dependence, and they may be currently experiencing problems.

37. Hazardous/Harmful Drinking (Total Sample) About 21% of all students in grades 7 to 12 were drinking hazardously/harmfully in 2009 (this represents about 211,000 Ontario students). Males and females were equally likely to report hazardous/harmful drinking. There was significant variation by grade, with a large increase in each grade between grade 7 and grade 12 (from 3% up to 42%). There was significant variation among the regions, with Toronto students (12%) least likely to drink hazardously/harmfully.

38. Coexisting Alcohol and Mental Health Problems In 2009, 8% of all students reported both hazardous/harmful drinking and elevated psychological distress (symptoms of anxiety and depression). This represents about 85,000 students in Ontario. Females were more likely than males to indicate coexisting problems, and older students were more likely than younger students. There were no significant regional differences.

39. Drinking and Driving The percentage of licensed drivers in grades 10-12 who reported driving within an hour of consuming 2 or more drinks was 12% in 2009 (this represents about 34,000 students with a licence). There has been no significant change since 1999. Long-Term Trends: drinking and driving has declined significantly since 1977 (e.g., 45% of 11th-grade drivers vs. 8% in 2009).

40. Frequency of Drinking and Driving in the Past Year Among 11th-Grade Drivers, OSDUHS 1977-2009

41. Rode in a Vehicle with a Driver who was Drinking About 23% of all students (about 219,000 students in Ontario) reported being a passenger at least once in the past year with a driver who had been drinking alcohol. This estimate is significantly lower than that from 2001 (31%). There was no significant sex difference. There were significant increases by grade. There were no significant regional differences.

42. Non-Medical Use of Prescription Opioid Pain Relievers

43. Any Illicit Drug Use (includes NM Prescription Drug Use) in the Past Year Defined as past year use of at least one of the following 24 drugs asked about in the 2009 survey: cannabis, glue, solvents, LSD, PCP, other hallucinogens, cocaine, crack, methamphetamine, crystal methamphetamine, heroin, ecstasy, GHB, Rohypnol�, ketamine, jimson weed, salvia divinorum, OxyContin� (NM), other prescription opioid pain relievers (NM), ADHD drugs (NM), other stimulants (NM), tranquillizers/sedatives (NM), over-the-counter sleeping medication, or over-the-counter cough/cold medication

44. Non-Medical (NM) OxyContin� Use OxyContin�, specifically, was first asked about in the 2005 survey cycle. In 2009, about 2% of students reported NM use in the past year. This estimate represents about 16,700 students in Ontario. The 2009 estimate was similar to that from 2007 (2%), and from 2005 (1%). no sex difference in 2009 use increased with grade Northern students were most likely to use

45. Percentage Who Reported NM OxyContin� Use in the Past Year by Sex, Grade and Region, 2009 OSDUHS

46. Non-Medical (NM) Opioid Pain Reliever Use Starting in 2007, students were asked about the general class of prescription opioids. The question referred to: Percocet�, Percodan�, Tylenol No. 3�, Demerol�, OxyContin�, or codeine. In 2009, about 18% of students used an opioid pain reliever non-medically in the past year. This represents about 180,000 students in the province. The 2009 estimate was not statistically different than the 2007 estimate (21%). females were more likely than males to use 7th and 8th graders were least likely no significant regional differences

47. Percentage Who Reported NM Opioid Pain Reliever Use in the Past Year by Sex, Grade and Region, 2009 OSDUHS

48. Over-the-Counter Cough or Cold Medication (with dextromethorphan)

49. Use of Cough/Cold Medication to �Get High� Starting in 2009, students were asked about using certain OTC cough/cold medications specifically in order to �get high� (e.g., Robitussin DM�). About 7% of students used this type of medication to get high in the past year (represents about 71,000 Ontario students). This prevalence was among the highest of all the substances asked about in the 2009 survey. no significant sex difference no significant grade differences Toronto students most likely to use

50. Percentage Who Reported NM Use of OTC Cough/Cold Medication by Sex, Grade and Region, 2009 OSDUHS

51. Cigarettes

52. Smoking in 2009 About 12% of all students report smoking cigarettes in the past year (representing about 119,000 students in Ontario). Past-year smoking significantly differed between males (13%) and females (11%). There was significant variation by grade (from 1% of 7th-graders to 20% of 12th-graders), and by region, with students in the North (18%) most likely to smoke.

53. Percentage Who Reported Cigarette Smoking in the Past Year by Sex, Grade and Region, 2009 OSDUHS

54. Smoking Trends The 2009 estimate (12%) for past-year cigarette smoking is similar to 2007 (12%), but significantly lower than that found a decade ago in 1999 (28%). Long-Term Trends (among grades 7, 9, 11 only): smoking peaked in the late 1970s and late 1990s, and substantially decreased over the past decade to record lows.

55. Early Cigarette Smoking Fewer 7th-graders today tried smoking at an early age: 2% of all 7th-graders in 2009 smoked their first whole cigarette by grade 6 (age 11) vs. 9% in 2003, 27% in 1997, and 41% in 1981.

56. Cigarette Smoking in the Past Year by Sex, Grade, and Region, 1977-2009 OSDUHS (Grades 7, 9, 11 only)

57. Lifetime Smoking Status, 1991-2009 (Grades 7, 9, 11 only)

58. Cannabis

59. Cannabis Use in 2009 In 2009, 26% of 7th- to 12th-graders reported using cannabis at least once during the past year (representing about 261,000 Ontario students), and 30% reported using cannabis in their lifetime. Past-year cannabis use significantly differed between males (29%) and females (22%). There was significant grade variation, ranging from 1% of 7th-graders up to 46% of 12th-graders. There was significant regional variation, with Toronto students (20%) least likely to use and Northern students (32%) most likely.

60. Percentage Who Reported Cannabis Use in the Past Year by Sex, Grade and Region, 2009 OSDUHS

61. Past-Year Cannabis Use Trends The prevalence of cannabis use in 2009 was not significantly different than the estimate from 2007 (26%) or that from 1999 (28%). Long-Term Trends (grades 7, 9, 11 only): current cannabis use is lower than the peaks found in the late 1970s and in the late 1990s/early 2000s, but remains higher than the low rates found in the late 1980s/early 1990s.

62. Early Cannabis Use Fewer 7th-graders today tried cannabis at an early age: 2% of all 7th-graders in 2009 tried cannabis for the first time by grade 7 (age 12) vs. 8% in 2003, and 9% in 1981.

63. Cannabis Use in the Past Year by Sex, Grade, and Region, 1977-2009 OSDUHS (Grades 7, 9, 11 only)

64. Cannabis and Driving in 2009 The percentage of licensed drivers in grades 10-12 who reported driving within an hour of consuming 2 or more drinks was 17% in 2009 (this represents about 48,500 students with a licence). The 2009 estimate was not statistically different from that found in 2007 (16%), or from the first year of tracking in 2001 (20%).

65. Perceptions of Risk, Disapproval & Availability

66. Percentage Who Reported �Great Risk� of Harm and �Strongly Disapprove� of Drug Using Behaviours, 2009 OSDUHS (Grades 7-12)

67. Trends in the Perceptions of Risk Associated with Drug Use, 1999-2009 Over the past decade, the perceptions of risk associated with trying cocaine, trying LSD, trying ecstasy, and smoking 1 or 2 cigarettes daily have increased (among grades 7-12). Perceived risk of using marijuana, either regularly or just to try it, did not significantly change over the past decade.

68. Percentage Who Reported it is �Fairly Easy� or �Very Easy� to Obtain the Drug, 2009 OSDUHS (Grades 7-12)

69. Trends in the Perceived Availability of Drugs, 1999-2009 Perceptions of availability of alcohol, cannabis, cocaine, LSD, and ecstasy were significantly lower in 2009 compared to the respective 1999 estimates (among grades 7-12).

70. Drug Use Among High School Students (Grades 9-12 only) According to the Local Health Integration Networks (LHINs)

72. Definition of a LHIN Local Health Integrated Networks (http://www.lhins.on.ca) created by the Ontario government in March 2006,�the 14�not-for-profit corporations, are governed by boards of directors who were appointed by the province, they work with local health providers and community members to determine the health service priorities of�our regions they do not directly provide services their mandate is to plan for, integrate and fund the following health care services: Hospitals; Community Care Access Centres; Community Support Services; Long-term Care; Mental Health and Addictions Services; & Community Health Centres.

73. Some LHINs were merged due to small sample sizes: Erie St. Clair & South West (merged) Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central Central East & North Simcoe Muskoka (merged) South East Champlain North East & North West (merged)

74. Erie St. Clair & South West LHINs vs. Ontario This merged LHIN area was above the provincial average on: - alcohol use - binge drinking - hazardous/harmful drinking - use of hallucinogens other than LSD/PCP - riding with a driver who had used drugs

75. Drug Use in Erie St. Clair & South West LHINs (n=308) vs. Ontario, 2009 OSDUHS (Grades 9-12 only)

76. Waterloo Wellington LHIN vs. Ontario This LHIN was above average on: - LSD or PCP use - other hallucinogen use (e.g., �magic mushrooms�) - salvia divinorum use - NM OxyContin use - cannabis use & driving

77. Drug Use in Waterloo Wellington LHIN (n=457) vs. Ontario, 2009 OSDUHS (Grades 9-12 only)

78. Hamilton Niagara Haldimand Brant LHIN vs. Ontario This LHIN was above average on: - cannabis use - glue or solvent use (inhalants)

79. Hamilton Niagara Haldimand Brant LHIN (n=496) vs. Ontario, 2009 OSDUHS (Grades 9-12 only)

80. Central West LHIN vs. Ontario This LHIN was below average on: - riding with a driver who had been drinking alcohol

81. Drug Use in Central West LHIN (n=230) vs. Ontario, 2009 OSDUHS (Grades 9-12 only)

82. Mississauga Halton LHIN vs. Ontario This LHIN was below average on: - NM use of OTC cough/cold medication

83. Drug Use in Mississauga Halton LHIN (n=436) vs. Ontario, 2009 OSDUHS (Grades 9-12 only)

84. Toronto Central LHIN vs. Ontario This LHIN was above average on: - NM use of OTC cough/cold medication

85. Drug Use in Toronto Central LHIN (n=226) vs. Ontario, 2009 OSDUHS (Grades 9-12 only)

86. Central LHIN vs. Ontario This LHIN was above average on: - cannabis use & driving This LHIN was below average on: - alcohol use - NM use of stimulant pills

87. Drug Use in Central LHIN (n=741) vs. Ontario, 2009 OSDUHS (Grades 9-12 only)

88. Central East & North Simcoe Muskoka LHINs vs. Ontario This merged LHIN area was below average on: - binge drinking - salvia divinorum use - ecstasy use - methamphetamine/crystal meth. use - riding with a driver who had been drinking

89. Drug Use in Central East & North Simcoe Muskoka LHINs (n=1,040) vs. Ontario, 2009 OSDUHS (Grades 9-12 only)

90. South East LHIN vs. Ontario This LHIN was above average on: - ecstasy use - NM use of stimulants pills - NM use of OTC cough/cold medication

91. Drug Use in South East LHIN (n=256) vs. Ontario, 2009 OSDUHS (Grades 9-12 only)

92. Champlain LHIN vs. Ontario This LHIN did not significantly differ from the province on any measure.

93. Drug Use in Champlain LHIN (n=1,156) vs. Ontario, 2009 OSDUHS (Grades 9-12 only)

94. North East & North West LHINs vs. Ontario This merged LHIN area was above average on: - alcohol use - binge drinking - cannabis use - cigarette smoking - salvia divinorum use - hallucinogen use (e.g., �magic mushrooms�) - cocaine/crack use - NM use of stimulant pills - NM use of OxyContin�

95. Drug Use in North East & North West LHINs (n=437) vs. Ontario, 2009 OSDUHS (Grades 9-12 only)

96. Summary & Positive Findings

97. Some positive findings�. The prevalence of past year cigarette smoking in 2009 was among the lowest on record. While the majority of students are considered to be current drinkers, the past-year prevalence of alcohol use in 2009 was significantly lower than the rate a decade ago in 1999. The magnitude of the decline in drinking has been even greater over the long-term.

98. Some positive findings�. Drinking and driving among licensed students remained stable over the past decade. However, the 2009 rate was markedly lower than rates seen in the late 1970s and early 1980s. The percentage of all students who reported riding in a vehicle with a driver who was drinking alcohol significantly decreased between 2001 and 2009 (from 31% down to 23%).

99. Some positive findings�. The percentage of all students who reported riding in a vehicle with a driver who was using drugs significantly decreased between 2003 and 2009 (from 23% down to 18%). Many illicit drugs showed declines in use in 2009 compared to a decade ago (e.g., hallucinogenic �magic mushrooms�, solvents, ecstasy).

100. Some positive findings�. Use of methamphetamine and crystal methamphetamine has not diffused into the student population. The age of initiation for drinking alcohol, smoking cigarettes, and using cannabis has not decreased over time. In fact, the data showed that the average age of first cigarette and first alcoholic drink increased over the past decade.

101. Some positive findings�. The perceptions of risk and the disapproval of trying cocaine and trying ecstasy were higher in 2009 compared to recent years. Thus, students today seem to be more aware of the potential for physical harm these drugs can cause. The perceived availability of alcohol, cannabis, cocaine, LSD, and ecstasy has significantly decreased in recent years. Thus, these drugs are reportedly becoming more difficult to obtain.

102. Some public health concerns� A significant proportion (12% or about 119,000 students) reported smoking cigarettes. Further, the yearly declines in smoking seen in previous survey cycles ceased in 2009, as the rate was similar to that found in 2007. Binge drinking remained elevated in 2009, as one-quarter of students reported doing so in the month before the survey. Almost half of 12th-graders reported binge drinking.

103. Some public health concerns� One-in-five students drank hazardously/harmfully � that is, they drank in such a way as to be at increased risk for current or future physical and social problems, or alcohol dependence. One-in-six licensed students reported driving after using cannabis at least once in the past year. This estimate is higher than the proportion that reported drinking and driving.

104. Some public health concerns� One-in-four students reported being a passenger in a vehicle driven by someone who had been drinking. One-in-six students reported being a passenger in a vehicle driven by a driver who had been using drugs. One-in-three 12th-graders reported these behaviours.

105. Some public health concerns� One-in-six students used a prescription opioid pain reliever without a doctor�s prescription. These are potent drugs that can be dangerous when used without medical supervision. Almost three-quarters of users reported obtaining these drugs from home. A sizeable proportion of students reported using OTC cough/cold medication with dextromethorphan to �get high�

106. Implications for Prevention Address the non-medical use of prescription drugs and over-the-counter drugs Prime period to begin education and programming is between grades 7 and 9 Information should be drug-specific Drug availability affects use, therefore policy matters

107. OSDUHS Reports www.camh.net/research/osdus.html detailed & highlights reports on drug use detailed & highlights reports on mental health and well-being (from the 2007 survey)