Alcohol and Other Substance Use Before and During the COVID-19 Pandemic Among High School Students — Youth Risk Behavior Survey, United States, 2021

Results

In 2021, substance use was common among U.S. high school students and varied by substance. Approximately one third of students (30%) reported current use of alcohol or marijuana or prescription opioid misuse. Among current use measures, alcohol (22.7%) and marijuana (15.8%) were the most commonly reported substances used by U.S. high school students (Table 1). Current binge drinking was reported by 10.5% and current prescription opioid misuse by 6.0%. Among lifetime use measures, 47.4% of U.S. high school students reported alcohol use, 27.8% marijuana use, 12.2% prescription opioid misuse, 8.1% inhalant use, and 6.5% synthetic marijuana use. Among lifetime use measures, ecstasy (2.9%), cocaine (2.5%), methamphetamine (1.8%), injection drug use (1.4%), and heroin (1.3%) were less commonly reported.

Trend data were available for all substance use measures except current prescription opioid misuse. All substance use measures with available trend data decreased linearly over the period assessed (2009–2021 for most substances, 2015–2021 for lifetime synthetic marijuana use, and 2017–2021 for current binge drinking and lifetime prescription opioid misuse). From 2019 to 2021, prevalence of current substance use decreased for alcohol (from 29.2% to 22.7%), marijuana (from 21.7% to 15.8%), and binge drinking (from 13.7% to 10.5%). No change was observed in prevalence of current prescription opioid misuse. Lifetime alcohol use, marijuana use, cocaine use, and prescription opioid misuse also decreased from 2019 to 2021; lifetime inhalant use increased from 6.4% to 8.1%.

Compared with males, females had a higher prevalence of current substance use in 2021 for alcohol (26.8% versus 18.8%), marijuana (17.8% versus 13.6%), binge drinking (12.2% versus 9.0%), and prescription opioid misuse (8.0% versus 4.0%) (Table 2). Females also had a higher prevalence of lifetime alcohol use (53.2% versus 42.0%), lifetime marijuana use (30.9% versus 24.8%), lifetime prescription opioid misuse (14.8% versus 9.5%), and lifetime inhalant use (9.4% versus 6.8%) compared with males. However, males had a higher prevalence of lifetime heroin use (1.6% versus 0.8%) and injection drug use (1.7% versus 0.9%).

Changes in substance use from 2019 to 2021 varied by sex (Table 2). Current alcohol use decreased for both females and males. Males also had a 3.7% absolute decrease and a 30% relative decrease in binge drinking and a 2.1% absolute decrease and a 30% relative decrease in current prescription opioid misuse. Among lifetime use measures, alcohol and marijuana use decreased among both females and males. Decreases also were observed in ecstasy use, cocaine use, and prescription opioid misuse for males. However, for females, a 2.5% absolute increase and a 40% relative increase occurred in inhalant use from 2019 to 2021.

Prevalence of substance use measures varied by racial and ethnic group, with different groups reporting higher prevalences of use for different substances. For example, Black students reported a higher prevalence of current marijuana use (20.5%) compared with Hispanic (16.7%) and White (14.8%) students (Table 3). Black students reported a lower prevalence of current alcohol use (13.2%) compared with White (25.9%) and Hispanic (22.9%) students. White students reported a lower prevalence of current prescription opioid misuse (4.6%) compared with Black (8.6%) and Hispanic (8.3%) students.

By race and ethnicity, current and lifetime marijuana use decreased for both White and Hispanic high school students, and lifetime alcohol use decreased for all three racial and ethnic groups from 2019 to 2021. White students reported less binge drinking in 2021 compared with 2019 and more lifetime inhalant use. Hispanic students reported decreases in lifetime ecstasy use, cocaine use, and synthetic marijuana use. Lifetime use measures for cocaine, methamphetamine, and heroin decreased among Black students.

Prevalence of all substance use measures varied by sexual identity in 2021, with students identifying as lesbian, gay, or bisexual reporting a higher prevalence of all current and lifetime substance use measures compared with students identifying as heterosexual (Table 4). Compared with students who identified as heterosexual, students who identified as questioning or other reported a higher prevalence of current marijuana use and prescription opioid misuse, and a higher prevalence of all lifetime use measures except for lifetime alcohol use, marijuana use, and synthetic marijuana use. However, compared with students who identified as lesbian, gay, or bisexual, students who identified as questioning or other reported a lower prevalence of most current use measures (alcohol use, marijuana use, and binge drinking) and multiple lifetime use measures (alcohol, marijuana, ecstasy, and synthetic marijuana). Frequency of current and lifetime use among high school students reporting use of specific substances in 2021 was not substantially different from 2019 (Supplementary Table, https://stacks.cdc.gov/view/cdc/125216) (2).

Students commonly reported current co-occurring substance use (Figure). Among high school students who reported current alcohol use, marijuana use, or prescription opioid misuse, 35.1% reported using two or more substances. Alcohol and marijuana were the most commonly co-used substances among those who reported any current substance use, with 30.2% reporting co-use. Alcohol use and prescription opioid misuse was reported by 7.9%, marijuana use and prescription opioid misuse by 6.7%, and use (misuse) of all three substances by 4.8%.