Teens and marijuana use: ‘Avoidance is best’

Adolescents-marijuana

As of Dec. 15, adult recreational use of marijuana is legal in Massachusetts. The national conversation — often portraying marijuana as benign or even healthful — along with changes in marijuana policy, means that fewer high-school students believe marijuana use is harmful.

The retail sale of marijuana stands to normalize use, further reducing barriers to youth initiation and potentially decreasing adults’ concerns regarding marijuana use by adolescent children. Pediatricians are in a unique position to provide accurate information on the health effects of marijuana on the developing brain and to advise adolescents and their parents that from a health perspective, no use is best.

Is marijuana safe?

Pediatricians are in a unique position to provide accurate information on the health effects of marijuana on the developing brain and to advise adolescents and their parents that from a health perspective, no use is best. While often considered safe, marijuana is associated with both acute and long-term harm. Increases in mortality from vehicle crashes and suicide associated with acute psychotic reactions, particularly among inexperienced users are concerning but comprise only a small fraction of the consequences of marijuana use. Repeated use during critical windows of brain development is associated with marked anatomic changes, poor functional outcomes, drops in IQ, and serious mental health disorders.

Marijuana is also addictive, although the clinical presentation is distinct from drugs like alcohol or heroin. The long half-life of cannabinoids results in only mild withdrawal symptoms, in most cases, and like nicotine, overdose is not common.

Nonetheless, many marijuana users find they are unable to quit beyond a few weeks. Some adolescents who use marijuana heavily feel as if a short period of abstinence “proves” that they are in control of their use, although in most cases, resumed use of marijuana after a short period more likely indicates just the opposite.

Marijuana use may increase susceptibility to other drug problems

Marijuana use by adolescents is often considered a developmental milestone, rather than a modifiable behavior, and consequently, advice to limit use or to choose one substance as a safer alternative to another is common misnomer. Yet an approach that advises teens to use these substances “carefully” or “in moderation” may inadvertently encourage use, because these messages can easily be misinterpreted. Assuming that substance use is inevitable is wrong.

While teens are “developmentally wired” to seek large rewards, excitement doesn’t have to come in the form of substance use. In fact, teens today are less likely to use substances than their counterparts of a generation ago. Adolescents who use marijuana are much more likely to also drink alcohol, and there is emerging evidence that marijuana’s direct effects on the brain make users more likely to develop problems with other substances.

The simple, clear and empowering prevention message we suggest physicians embrace and routinely deliver to adolescent patients is, “avoidance of marijuana is best.”

Learn more about Boston Children’s Adolescent Substance Abuse Program and the upcoming Adolescent Medicine 2017 CME.

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About the blogger: Sharon Levy, MD, MPH, is the director of the Adolescent Substance Abuse Program at Boston Children’s Hospital, a developmental-behavioral pediatrician and an associate professor of Pediatrics at Harvard Medical School.