Updated policy statement includes option for
“compassionate use” of marijuana for children with debilitating or
life-limiting diseasesIn an updated policy
statement and technical report, the American Academy of Pediatrics (AAP)
reaffirms its opposition to legalizing marijuana, citing the potential harms to
children and adolescents.
The AAP policy statement, “
The Impact of Marijuana Policies on Youth: Clinical,
Research, and Legal Update” and an
accompanying
technical report will be published in the
March 2015 Pediatrics (published online Jan. 26). In the policy, the Academy
reaffirms its position against the legalization of marijuana, states its
opposition to “medical marijuana” outside the FDA regulatory process, and
presents recommendations to protect children in states that have legalized
marijuana for medical or recreational purposes.
The Academy also recommends
that marijuana be decriminalized, so that penalties for marijuana-related
offenses are reduced to lesser criminal charges or civil penalties. Efforts to
decriminalize marijuana should take place in conjunction with efforts to
prevent marijuana use and promote early treatment of adolescents with marijuana
use problems.
“We know marijuana can be
very harmful to adolescent health and development,” said Seth D. Ammerman, MD,
FAAP, a member of the AAP Committee on Substance Abuse and an author of the
policy statement. “Making it more available to adults – even if restrictions
are in place – will increase the access for teens. Just the campaigns to
legalize marijuana can have the effect of persuading adolescents that marijuana
is not dangerous, which can have a devastating impact on their lifelong health
and development.”
For adolescents, marijuana
can impair memory and concentration, interfering with learning, and is linked
to lower odds of completing high school or obtaining a college degree. It can
alter motor control, coordination and judgment, which may contribute to
unintentional deaths and injuries. Regular use is also linked to psychological
problems, poorer lung health, and a higher likelihood of drug dependence in
adulthood.
The AAP opposes medical
marijuana outside of the usual process by the Food and Drug Administration to
approve pharmaceutical products. Only limited research has been conducted on
medical marijuana for adults, and there have been no published studies of
cannabinoids -- either in the form of marijuana or other preparations --
that involve children. The Academy supports further study of cannabinoids,
which limited research to date shows can help specific conditions in adults.
“While cannabinoids may have
potential as a therapy for a number of medical conditions, dispensing marijuana
raises concerns regarding purity, dosing and formulation, all of which are of
heightened importance in children,” said William P. Adelman, MD, FAAP, a member
of the AAP Committee on Adolescence and an author of the policy statement. “We
need further research to determine the efficacy and correct dosing for
cannabinoids, and we need to formulate cannabinoids safely as we do for any
other medication.
However, given that some
children who may benefit from cannabinoids cannot wait for a meticulous and
lengthy research process, the Academy recognizes some exceptions should be made
for compassionate use in children with debilitating or life-limiting diseases.
The AAP also recommends:
- Research and development should
be conducted of pharmaceutical cannabinoids. The AAP recommends changing
marijuana from a DEA Schedule 1 to a DEA Schedule 2 to facilitate this
research.
- The federal and state
governments should establish robust health surveillance regarding the
impact of marijuana, particularly on children and adolescents.
- In states that have legalized
marijuana for recreational use, the AAP strongly recommends strict
enforcement of rules and regulations that limit access, marketing and advertising
to youth.
- Where marijuana is sold legally,
either for medicinal or recreational purposes, it should be contained in
child-proof packaging to prevent accidental ingestion.
- The AAP discourages adults from
using marijuana in the presence of children because of the influence of
role modeling by adults on child and adolescent behavior.
“It is true we do not yet
have data documenting changes to child health in response to the legalization
of marijuana in Washington and Colorado, though there have been reports of
child ingestion and injuries,” said Sharon Levy, MD, FAAP, chair of the AAP
Committee on Substance Abuse. “It took several generations, millions of lives
and billions of dollars to establish the harms of tobacco use on health, even
though these harms are overwhelming. We should not consider marijuana “innocent
until proven guilty,” given what we already know about the harms to
adolescents.”
# # #
The American Academy of Pediatrics is an organization of
62,000 primary care pediatricians, pediatric medical subspecialists and
pediatric surgical specialists dedicated to the health, safety and well-being
of infants, children, adolescents and young adults