Pediatricians need to be able to speak directly and frankly with teens and their parents about the potential harmful effects of marijuana and cannabis products, especially in light of new laws legalizing both recreational and medicinal use of marijuana products, according to a new AAP clinical report.
Counseling Parents and Teens about Marijuana Use in the Era of Legalization of Marijuana, from the AAP Committee on Substance Use and Prevention, addresses the specific content that pediatricians should be including in conversations about cannabis products. The report is available at http://bit.ly/2koWlKb and will be published in the March issue of Pediatrics.
The topic is especially relevant now that more states have passed laws to legalize both recreational use of marijuana for adults and medicinal marijuana for both children and adults. Currently, recreational marijuana use by adults is legal in seven states plus the District of Columbia, and 28 states have legalized some form of medicinal marijuana for a wide variety of conditions.
This means the subject of marijuana is much more likely to be part of the conversation between teens and their parents, and the pediatrician is likely to be seen as a source of accurate information about adverse effects as well as benefits of the many cannabis products now available. Pediatricians also are far more likely to encounter adolescents or parents who are using these products, either recreationally or for their therapeutic effects.
Following are answers to some questions pediatricians might have about cannabis products and counseling teens and their parents.
Q: Are we seeing an increase in marijuana use among teens now that more states have legalized recreational and/or medicinal marijuana?
A: Rates of use have remained static overall among adolescents 12-17 years, even in states with laws permitting recreational or medicinal marijuana use. Among 12th-graders, however, there has been an increase in rates of marijuana use, with 36% reporting use within the previous year. This is in direct contrast with reported use of other illicit substances, alcohol and tobacco, which have been declining significantly since the late 1990s. Teens also are reporting less concern about the “harmful” effects of smoking marijuana.
Q: What adverse effects of cannabis products should be mentioned when counseling teens?
A: Many studies have documented adverse effects, including short-term impairment of memory, attention, concentration and problem-solving skills, as well as motor control, coordination and reaction time. Development of mental health disorders such as depression and psychosis also have been reported. New studies evaluating abnormalities in brain regions involved in memory and executive functioning in teens using marijuana regularly and/or heavily raise concerns about long-term and lasting effects on brain maturation and functioning.
Teens also need to know marijuana smoke is toxic, similar to secondhand tobacco smoke, and use of vaporizers or hookahs does not eliminate the toxic chemicals in marijuana smoke.
Q: Are there special concerns related to marijuana-infused foods?
A: When marijuana is consumed in an edible or drinkable form, there is a slower rate of absorption in the system compared with inhalation. Consequently, it takes longer to appreciate the euphoric effects, and some teens then consume additional “doses.” This can result in significant toxic side effects when the effect of the product finally kicks in.
In addition, rates of calls to poison control centers and visits to emergency departments have increased after young children have ingested products that resemble candy, baked goods or soda.
Q: Are there any data to support the efficacy of medicinal marijuana in children?
A: Studies in adults support its use in chemotherapy-associated nausea and vomiting, spasticity with neuromuscular diseases, and cachexia with certain chronic diseases. The only data on its effectiveness in pediatric populations are limited to its role in decreasing seizures in specific epilepsy conditions, such as Lennox-Gastaut syndrome and Dravet syndrome.
Q: What should physicians tell parents who are reluctant to advise their teen against using marijuana since they themselves used it when they were younger?
A: Tell parents that marijuana products available today can be more than three to five times stronger than what was available even a decade ago. With newer methods, such as vaporization or “dabbing,” potency is even higher, increasing the risks for toxic effects. (Dabbing is a method used to convert marijuana into a concentrate for inhalation; it uses butane to extract tetrahydrocannabinol, or THC, from the cannabis plant.)
Parents also should not feel that they have to share all of their experiences with their children or that they cannot voice disapproval of their teen’s use because they have used marijuana themselves. They need to be encouraged to provide accurate information and express their concerns and values to their children.
Suggestions for pediatricians
- Screen all patients for the use of any cannabis products beginning in early adolescence because the earlier teens begin to use marijuana, the more likely they are to develop dependence.
- If adolescents are not using marijuana, use motivational techniques to support their decision to abstain.
- Adolescents who are using marijuana regularly or heavily are more likely to meet criteria for a substance use disorder. A brief motivational intervention may be used to reduce use and continue the conversation with the pediatrician or a mental health or behavioral counselor.
- Counsel about known side effects, as well as the known euphoric effects or medicinal benefits, so that you can be a source of accurate, scientific information to teens and their parents.
- Speak frankly with parents about the effect that their own use may have on their children or teens, either through modeling or through their own impairment.
Dr. Ryan, a lead author of the clinical report, is chair of the AAP Committee on Substance Use and Prevention.