Over recent years, big shifts in the marijuana landscape have made it easier than ever for American teens to be exposed to cannabis and to have the opportunity to use it.
Currently, only six states consider all forms of cannabis use to be illegal. Meanwhile, most states legally allow at least some medical cannabis use and several (including Massachusetts) have already legalized both medical and recreational use for adults.
“Whatever your views are on medical or recreational cannabis use for adults, however, there’s near-universal agreement that adolescents should not use cannabis,” says Lydia Shrier, MD, MPH, who directs clinic-based research in the Boston Children’s Hospital Division of Adolescent/Young Adult Medicine.
But the legal system’s increasing support of cannabis and a rise in public approval of the drug has lowered the perception of risks associated with its use. As a result, in states where medical or recreational use for adults is legal, adolescents between the ages of 12 and 17 are more likely to use cannabis than in states where all uses of the drug are illegal.
“What’s more, cannabis marketers are tailoring products to appeal to young people, creating edibles in the form of candy, soda and other popular snacks,” Shrier says.
As of 2017, nearly half of high school seniors have tried some form of cannabis. Given that the levels of THC in cannabis have steadily risen in recent decades — on average, cannabis grown today contains nearly triple the percentage of THC compared to cannabis grown in 1985 — today’s teenagers are facing heightened health risks associated with cannabis use, including effects on the developing brain’s structure and function, safety behind the wheel, onset of mental health disorders and risk of addiction, just to name a few.
A guide to cannabis intervention
For primary care providers of adolescents, there are several validated tools to screen adolescents for use of cannabis as well as other substances, including the Screening to Brief Intervention (S2BI) assessment developed by Shrier and Sharon Levy, MD, MPH of Boston Children’s with the support of the National Institute on Drug Abuse.
This method outlines a series of responses that a primary care provider (PCP) can give based on a patient’s answers to a survey about their use of alcohol, tobacco, cannabis and other substances.
“For example, if an adolescent patient responds that they have ‘never’ used cannabis within the last year, a PCP can positively reinforce this behavior by praising the patient for making excellent health decisions,” says Dr. Shrier.
But if an adolescent patient responds that he or she has used cannabis in the last twelve months, there are several ways to respond depending on how frequently the patient is using. For responses indicating that the patient has used once or twice, the PCP can advise the patient to discontinue marijuana use for the sake of his or her health.
“On the other hand, if the patient responds that he or she uses marijuana on a monthly or weekly basis, more intervention is needed,” Dr. Shrier says.
For adolescents that are using marijuana monthly, PCPs can use a “motivational interviewing” technique that acknowledges a person’s decision-making autonomy and helps to focus and strengthen an individual’s intrinsic desire to take good care of their health.
“In more extreme cases, if an adolescent responds that he or she is using marijuana daily or several times a week, a referral to a specialist should be made,” Shrier says. “Adolescents using cannabis this frequently often have problems associated with their use and will need additional support and resources to quit.”
PCPs should refer patients using cannabis this frequently to specialized treatment like the Adolescent Substance Abuse Program (ASAP) at Boston Children’s.
To further address this population of adolescent cannabis users, Shrier is currently taking clinical research data and leveraging it toward the creation of digital intervention tools (that can be used with or without the support of a clinician) for young adults that would like to stop using cannabis.
“We are seeing the highest rates of daily marijuana use among young adults in decades,” Shrier says. “From my research and from other people’s research, we know that many young adults try to quit using cannabis and are often not successful — so we’re trying to develop tools that support individuals who want to quit on their own.”
To learn more about young people’s motives to use cannabis and how use impacts positive and negative affect in individuals who are using cannabis frequently, read a recent paper by Shrier and colleagues in the Journal of Addictive Behaviors titled “Positive and negative affect following marijuana use in naturalistic settings: An ecological momentary assessment study.”