The War on Drugs has long been cast as a battle against illegal narcotics, but the latest federal data shows that seven of the top 10 drugs being misused by high-school seniors are legal prescription or over-the-counter medications.

Factor in the high rates of use of legal alcohol and tobacco by teens, and the incoming Obama administration will face a very different battle than that waged by the current president and his predecessors since the early 1970s.

The 2008 Monitoring the Future report released this week shows that 15.4 percent of 12th-grade students reported nonmedical use of legal prescription or over-the-counter medications, including 11 percent who misused Vicodin and 4.7 percent who misused Oxycontin. The annual report is based on surveys of about 50,000 8th-, 10th-, and 12th-graders nationally. 

Prescription amphetamines, sedatives, tranquilizers, and the attention-deficit hyperactivity disorder medication Ritalin also were among the most popular drugs of abuse among high-school seniors, along with over-the-counter cough medications.

"Prescription drug use is at or near peak levels," said Lloyd Johnston, Ph.D., principal investigator of the MTF study and a research professor at the University of Michigan's Population Studies Center. "I think this will be difficult to deal with, because the source of these drugs is an informal network of family and friends, not dealers."

Johnston added that 40 percent of teens said they used leftovers from their own prescriptions. "I think the [pharmaceutical] industry is going to have to be involved, and we will need to educate parents and the health professionals who are distributing these drugs," he said.

Marijuana continues to be the most popular illicit drug among adolescents, used at least once in the past year by nearly a third of high-school seniors, 23.9 percent of 10th-graders, and 10.9 percent of 9th-graders.

However, "the MTF survey indicates that marijuana use ... which has shown a consistent decline since the mid-1990s, appears to have leveled off," according to the National Institute on Drug Abuse (NIDA), which funds the MTF study. "Heightening the concern over this stabilization in use is the finding that, compared to last year, the proportion of 8th-graders who perceived smoking marijuana as harmful and the proportion disapproving of its use have decreased."

Youth smoking rates have fallen to the lowest rate ever recorded by MTF researchers, thanks largely to a decline in reported smoking by 10th-graders. Still, more than one in 10 high-school seniors remain daily smokers. Likewise, alcohol remains the most popular drug used by adolescents despite steady year-over-year decreases in reported use.

"While the long-term general decline is encouraging, especially for cigarettes and alcohol, some of the other findings this year amplify our concerns for potential problems in the future -- especially the non-medical use of prescription drugs," said NIDA Director Nora D. Volkow, M.D.

Johnston said that the decline in smoking was a pleasant surprise since the youth smoking rate appeared to have plateaued recently after steadily decreasing for many years. "We're seeing a further significant drop in smoking, which is wonderful news," he said.

Bush: Our Strategy Works

In contrast to the measured statements by NIDA, the White House Office of National Drug Control Policy (ONDCP) used the MTF data -- along with an unrelated new study pointing to increased cocaine prices and decreased purity on U.S. streets -- to claim vindication for the Bush administration's drug-control strategy, which on the demand-reduction side of the ledger has included an emphasis on drug testing in schools, the billion-dollar, marijuana-centric Youth Anti-Drug Media Campaign, vouchers for addiction treatment, and support of drug courts.

"Since 2001, teenage use has declined by 25 percent. That means 900,000 fewer teens on drugs," said President Bush at a White House roundtable discussion held on the day the MTF data was made public.

"President Bush insisted on a balanced effort against demand and supply," added John Walters, director of ONDCP. "The use of drugs has dropped broadly, steeply, and rapidly, while the supply of these poisons has been cut dramatically. Taken together, this impact is historically unprecedented."

Those assertions drew scoffs from critics, who noted that overall drug-use rates remain at higher levels than in the early 1990s. "None of this is true," said former ONDCP budget director John Carnevale of the presumed valedictory by Walters, who like Bush will soon be exiting the White House. "The only good news is the decline in youth drug use, and that started in the mid-1990s ... They're basing their claim for success on something that started before they showed up."

Carnevale also pointed out that the Bush administration has devoted the bulk of its antidrug spending to supply reduction, cut prevention spending, and barely increased funding for treatment. "There's no way they can claim to have a balanced budget," he said.

"The ebb and flow of drug use rates among young people is much more a function of fad and fashion than anything that government does or doesn't do," said Ethan Nadelmann, executive director of the Drug Policy Alliance. "The greatest drug-related threats to young people involve binge drinking and the misuse of pharmaceutical drugs. Hopefully, the next director of ONDCP will focus his or her greatest attention on those types of drug use that pose the greatest threats. The last thing this country needs is yet another drug czar obsessed with marijuana."

MTF researcher Johnston said that it is "difficult to parse what the influences are" on youth drug use, but added that he was "hesitant to try to tie trends to what any administration does."

In fact, trends may vary from drug to drug. A few years ago, for example, many observers were concerned about a coming epidemic of methamphetamine abuse, but Johnson believes the negative publicity about the drug's effects have helped cut use rates by two-thirds.

On the other hand, cultural changes, secondhand-smoking laws, ads that artfully attacked the tobacco industry, and price increases all seem to have played a role in the decline of cigarette use by youth. "More than 75 percent of kids now say they don't want to date someone who smokes," noted Johnston.

Johnston said that the softening of attitudes about marijuana harm among 8th-graders reported in MTF is troubling because such shifts have consistently presaged increases in use by about a year. The veteran researcher also is concerned about a possible resurgence of LSD and Ecstasy use, and warns that the worsening economy could lead to more relapse among people in recovery from addictions.

"Who knows what the future holds?" he said. "There's always a new drug being invented or rediscovered."