SAMHSA’s annual mental health, substance use data provide roadmap for future action

Aug. 21, 2019
Drug Policy Alliance responds to new report

The Substance Abuse and Mental Health Services Administration  has released the 2018 National Survey on Drug Use and Health (NSDUH). The annual survey is the nation’s primary resource for data on mental health and substance use among Americans.

“This year’s National Survey on Drug Use and Health contains very encouraging news: The number of Americans misusing pain relievers dropped substantially, and fewer young adults are abusing heroin and other substances,” said Health and Human Services Secretary Alex Azar in a prepared statement. “At the same time, many challenges remain, with millions of Americans not receiving treatment they need for substance abuse and mental illness.”

Among the findings of the 2018 NSDUH:

  • The number of individuals reporting pain reliever misuse decreased from 2017 by 11 percent, with fewer than 10 million Americans now reporting misuse.
  • Heroin-related opioid use disorder decreased significantly among young adults 18-25 years of age.
  • Additionally, young adults have shown improvement with respect to other drug misuse – including declines in use of cocaine, prescription stimulants, methamphetamine and hallucinogens.
  • Use of illicit substances by pregnant women decreased significantly from 2017; this trend also extended to their use of tobacco and alcohol.
  • Marijuana use, in general, appears to be an issue of note. It continues to be the most widely used illicit drug. Frequent marijuana use, in both youth (aged 12-17 years) and young adults, appears to be associated with risk for opioid use, heavy alcohol use, and major depressive episodes.
  • Co-occurring issues must be addressed. Approximately 9.2 million adults are living with co-occurring mental and substance use disorders. Further, those who have any mental illness or serious mental illness are significantly more likely to use cigarettes, illicit drugs, and marijuana; to misuse opioid pain relievers; and to engage in binge alcohol use – compared with individuals without mental illness. Those who misuse substances (regardless of substance) are significantly more likely to experience serious mental health conditions.
Sheila Vakharia, PhD, Deputy Director of the Drug Policy Alliance’s Department of Research and Academic Engagement, responded to the report with the following analysis:
  • Youth rates of marijuana use remain mostly unchanged in recent years, while being consistently lower than they were before many states began to legalize medical and adult use.
  • Although the number of people with opioid use disorder who received evidence-based treatments such as methadone and buprenorphine increased in 2018, the survey’s findings suggest that only half of the people with opioid use disorder received these treatments at all. When people do not have access to these medications through the healthcare system, they often turn to other sources to self-medicate and manage withdrawal symptoms. Access to methadone and buprenorphine can cut one’s overdose risk in half; in the midst of this overdose crisis it is essential that we double-down our efforts to increase access to these life-saving medications in communities across the country.
  • Although there are slight variations in stimulant and opioid use trends, it is difficult to draw too many conclusions about them more broadly. This is mainly because the data does not account for fentanyl—which is the opioid currently driving overdose deaths, and it excludes data on homeless and unstably housed people as well as those who are incarcerated or hospitalized—all populations who use these substances at higher rates than the general population and who continue to be disproportionately impacted by the overdose crisis.