"Marijuana wouldn't be legal if there were any dangers from it, right?"
"Marijuana's not addictive – I can go cold-turkey anytime I want to."
"It's being prescribed for a whole bunch of medical issues, so it's got to be safe, right?"
"My parents used to smoke marijuana when they were in college, and they turned out OK, so why should I worry?"
These are some of the comments and questions I hear on a regular basis from the teens I see in my adolescent clinic. Responding to basic screening questions about their use of alcohol, tobacco, and other substances such as marijuana, what they tell me is that cigarettes are not really that "cool" anymore.
Marijuana, on the other hand, is "safe -- not risky, like cigarettes or alcohol," they tell me.
With recent legislation making marijuana legal for medicinal or recreational use in more than two dozen U.S. states, the drug has become a more common topic of discourse--not just in the media, but among teenagers and their parents. More than ever, it is important that the pediatrician be part of these conversations.
Marijuana is the most commonly used illicit substance among adolescents. (I use the term illicit because it is still illegal for those under the age of 21 years to use it recreationally, and because it is still illegal under federal law.) During the past two-and-a-half decades there have been impressive decreases in the rates of alcohol, tobacco, and other drug use, including marijuana, by our adolescents. But in the past couple of years, rates of marijuana use have plateaued and in some states are now on the rise. Further, national studies show that teens view the use of marijuana as a "less risky" behavior than they used to even a few years ago.
"Any conversation about youth marijuana use should focus on known adverse health effects supported by sound science."
How should we talk to a teen who is using marijuana and who does not consider it to be a problem behavior? What should the conversation be when the pediatrician finds that the parents are using marijuana themselves and see no problem with their child's use? And how can we avoid sounding like the melodramatic lecturer in the 1930s camp film, "Reefer Madness?"
Any conversation about youth marijuana use should focus on known adverse health effects supported by sound science. Teens who use cannabis products seek the desired effect of intoxication, such as a relaxed or an energetic high. But are they aware it also causes increased heart rate, decreased motor coordination and impaired concentration, along with long-term effects that include higher risk for mental health disorders such as psychosis and depression, respiratory problems and deficits in learning and memory? Research suggests marijuana actually alters the course of brain development, which should be a concern for every adolescent since regions of the brain involved in memory, cognition, impulse control and executive functioning continue to mature well into the 20s. It's those areas that may be most affected by regular and heavy marijuana use.
As pediatricians, or parents, we do not need to engage in drawn-out emotional arguments or even extended discussions with teens. Focus on your concern for the adolescent's health. State key facts, and engage in discussion about why they're choosing to use marijuana and what they gain from it. Explain clearly that for an adolescent, marijuana is just not benign--regardless of current policies and laws--and that it is addictive. They may also need to hear that if they are a regular or heavy user and they try to quit by going "cold turkey," they will most likely experience physical symptoms of withdrawal.
"The budding, multibillion dollar marijuana industry would have us all believe that cannabis/marijuana products are safe and effective for many medical conditions and free of danger for recreational use."
Another important issue to discuss is that marijuana today is not the same as it was in the '70s, '80s or even the '90s. The concentration of THC (or delta-tetrahydrocannabinol, the psychoactive component in the cannabis plant) used to be in the 4 to 5 percent range. With newer hybridization techniques of current growers, THC concentrations now range from 12 to 20 percent. With increasingly popular consumption methods such as dabbing or using oil extracts, concentrations can be even higher.
Poison control centers are experiencing a dramatic increase in the number of calls for both unintentional and intentional ingestions, while hospital emergency departments are seeing more toxic reactions and ingestions in young children, adolescents, and young adults.
Many of these "pot poisonings," especially for younger children, are from the many edible cannabis products that are now available. These include a variety of THC-infused treats such as candy, cookies and soft drinks. To younger children, these may be indistinguishable in appearance from the non-cannabis containing products. Especially since they aren't always sold or stored in child-proof packaging, the risk to younger children cannot be underestimated.
Parents also should consider their own use – either for recreational or medicinal purposes -- and what their behaviors are modeling to their children and teens. They need to be reminded that their actions resonate so much more strongly than their words, and that an intoxicated parent is not the best parent in terms of keeping their children cared for and safe.
The budding, multibillion dollar marijuana industry would have us all believe that cannabis/marijuana products are safe and effective for many medical conditions and free of danger for recreational use. This attitude appears to be taking root among young people. Our voices as pediatricians may be the only ones some patients hear countering messages about marijuana they may be getting elsewhere, so it's our responsibility to speak up.
The views expressed in this article are those of the authors, and not necessarily those of the American Academy of Pediatrics.
Sheryl A. Ryan, MD, FAAP, is a pediatrician and adolescent medicine specialist and Professor of Pediatrics at Yale University School of Medicine. She maintains an active clinical practice with adolescents and young adults and her research interest focus on screening and intervention for substance use issues in teens. Dr. Ryan is currently the Chair of the AAP's Committee on Substance Use and Prevention, and is the lead author on the AAP's recent clinical report regarding counseling about marijuana; she has also been a co-author on the AAP's most recent position paper and technical report regarding policies regarding marijuana.