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 (i.e., defined as use in the past 30 days) 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.

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