August 20, 2009

Substance Abuse Treatment Admissions for Smoked Substances: 1992 to 2007

Individuals using illicit drugs can often choose among several routes of administration, depending on the drug being used. Cocaine, for example, can be inhaled directly (“snorted”), smoked, or injected, and the effects and the duration of the high vary by the method of use selected. Each method, however, has an attendant set of potential health consequences, ranging from lung or heart damage to the risk of HIV and/or Hepatitis C infections.¹ It is important for treatment providers to understand the shifting patterns of use of smoked substances and to be cognizant of the possible health consequences in order to provide appropriate interventions.

The frequency of use of smoked substances among admissions to substance abuse treatment can be examined using the Treatment Episode Data Set (TEDS). Using TEDS, this report examines changes in the drug use and demographic characteristics of substance abuse treatment admissions for smoked substances between 1992 and 2007.

In 1992, 20 percent of admissions reported that they smoked their primary substance of abuse, increasing to 32 percent in 2007. Among these admissions, cocaine/crack was the most commonly smoked substance in 1992 while marijuana was the most commonly smoked substance in 2007 (Figure 1). Cocaine/crack decreased from two thirds of smoked admissions in 1992 to less than one third in 2007 (66 vs. 30 percent). Among admissions for smoked substances, marijuana increased from less than one third in 1992 to one half in 2007 (30 vs. 50 percent). Between 1992 and 2007, methamphetamine increased from about 1 percent of admissions who smoked their primary drug to 17 percent of such admissions.

Among male admissions for smoked substances, admissions for cocaine/crack declined from 60 percent in 1992 to 27 percent in 2007 (Figure 2). There was a similar decline during this time—from 76 to 37 percent—among female admissions for smoked substances who reported cocaine/crack. However, from 1992 to 2007, the percentage of admissions for smoked substances who smoked marijuana or methamphetamine increased among both males (marijuana—35 to 56 percent; methamphetamine—1 to 14 percent) and females (marijuana—20 to 38 percent; methamphetamine—1 to 22 percent).

The average age of admissions for smoked marijuana remained relatively stable across time (25 years in 1992 compared to 24 years in 2007). Similarly, the distribution of smoked marijuana admissions by age group remained relatively stable. Age group distribution among smoked cocaine/crack admissions, however, changed substantially in the years between 1992 and 2007 (Figure 3). In 1992, 57 percent of smoked cocaine/crack admissions were between the ages of 25 and 34; by 2007, 41 percent were between the ages of 35 and 44. Substantial decreases were observed in the percentage of smoked methamphetamine admissions in the three youngest age cohorts and substantial increases were observed in the two oldest age cohorts.

Figure 3. Percentage of Smoked Substance Admissions, by Age Group: 1992 and 2007

Source: 1992 and 2007 SAMHSA Treatment Episode Data Set (TEDS).

Figure 3 Table. Percentage of Smoked Substance Admissions, by Age Group: 1992 and 2007

Age Group	Cocaine/Crack		Marijuana/Hashish		Methamphetamine		Other
	1992	2007	1992	2007	1992	2007	1992	2007
Source: 1992 and 2007 SAMHSA Treatment Episode Data Set (TEDS).
Under 18 years	1	<1	24	31	9	3	8	6
18 to 24 years	18	8	30	31	31	24	20	26
25 to 34 years	57	22	33	23	48	38	42	32
35 to 44 years	21	41	11	10	11	25	22	21
45 years or older	3	29	2	5	1	10	8	15

The percentage of admissions for smoked substances in 1992 and 2007 differed by racial/ethnic group. Primary abuse of smoked cocaine/crack by non-Hispanic White admissions decreased from 42 percent in 1992 to 25 percent in 2007 (Table 1). Non-Hispanic Black admissions for smoked cocaine/crack also decreased during this time, from 87 to 49 percent. Non-Hispanic Black admissions for smoked marijuana increased substantially from 1992 (11 percent) to 2007 (47 percent). The percentage of admissions for smoked methamphetamine increased substantially from 1992 to 2007 among non-Hispanic Whites, Hispanics, Asians/Pacific Islanders, American Indians/Alaska Natives, and other racial/ethnic groups. Admissions for smoked substances in 2007 were more likely to be for marijuana than for cocaine/crack among non-Hispanic Whites (52 vs. 25 percent), Hispanics (52 vs. 16 percent), Asians/Pacific Islanders (40 vs. 10 percent), American Indians/Alaska Natives (56 vs. 16 percent), and other racial/ethnic groups (48 vs. 17 percent).

There is a common perception that smoking drugs is “safer” than other methods of drug use in that it limits the user’s exposure to certain types of infections, such as HIV and Hepatitis C, which are more commonly associated with injection drug use. Nevertheless, the addictive effects of a smoked drug are similar to those of an injected drug, and both carry the risk of abuse and dependence. Similarly, there is a misconception that smoking a drug such as marijuana is less harmful than smoking tobacco, but research has shown that smoking marijuana not only can lead to addiction but the effects on the user’s lungs and respiratory system are similar to those seen in tobacco smokers. Behavioral interventions have been shown to be effective for decreasing cocaine and marijuana use and preventing relapse. The findings in this short report highlight the continued importance of prevention and treatment efforts aimed at smoked substances.

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (August 20, 2009).The TEDS Report: Substance Abuse Treatment Admissions for Smoked Substances: 1992 to 2007. Rockville, MD.

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