September-October 2018

While it is illegal in California for anyone under 21 years of age to smoke, consume, buy, or possess non-medicinal cannabis, a significant proportion of adolescents report using cannabis. In Los Angeles County, a 2017/2018 survey of 7th, 9th, and 11th graders found that 6%, 17%, and 31%, respectively, reported ever using marijuana, and daily/near-daily use was reported by 4% of 11th graders.¹

It is essential for healthcare providers to advise parents/caregivers and youth of the detrimental effects of cannabis on the developing brain. Although there is one FDA-approved cannabis product (Epidiolex/oral cannabidiol solution) for two rare and severe forms of epilepsy in individuals aged two years of age and above,² there are currently no other medical indications for cannabis in youth. Clinicians should be aware that some adolescents may acquire and use cannabis for medicinal purposes (e.g., for depression or anxiety) without a physician’s recommendation. In these circumstances, it is important that clinicians provide alternative evidence-based treatments for the conditions, when indicated.

Providers are encouraged to place cannabis fact sheets for parents and youth in exam and waiting rooms. (See “Resources for Patients and Parents/Mentors” below.)

The following information on the risks of cannabis use in youth is adapted from the California Cannabis Health Information Initiative “Cannabis Information for Health Care Providers” fact sheet.

The Developing Brain

Brain development occurs into one’s mid-20’s, and during this period the brain is particularly susceptible to neurodevelopmental dysfunction when it is exposed to psychoactive substances. As a result, youth and young adults who use cannabis before their mid-20’s can suffer short-term and long-term consequences, including negative impacts on educational, professional, and social achievements.³ They are also at risk of injury from motor vehicle crashes. Youth who use cannabis regularly or who use before age 18 may be at higher risk of: skipping classes,⁴ earning lower grades,⁵ dropping out of school,⁶ and unemployment or having less fulfilling jobs later in life.^6,7

Problem Use

Cannabis use can lead to problem use and increase the risk that young people will misuse other substances while their brains are still developing.^5,8 A review conducted by The National Academies of Science, Engineering, and Medicine found substantial evidence that the earlier a young person initiates cannabis use, the greater the likelihood of developing problem use.³

Mental Health Conditions

Regular cannabis use is likely to increase the risk of social anxiety disorder, and among persons with bipolar disorders, regular cannabis use may be linked with greater bipolar-related symptoms.³ Heavy cannabis users are more likely to report thoughts of suicide.³ Cannabis use is also likely to increase the risk of developing schizophrenia and other psychoses in predisposed individuals; the greater the use, the greater the risk, with the highest risk in daily cannabis users.³

Resources for Patients and Parents/Mentors

• California Cannabis Health Information Initiative
  www.cdph.ca.gov/Programs/DO/letstalkcannabis
  • What Parents and Mentors Need to Know about Cannabis Fact Sheet
  • Youth and Cannabis Fact Sheet
• Marijuana Fact Check Interactive Website for Parents
  www.mjfactcheck.org


• Los Angeles County Department of Public Health Youth Cannabis Prevention Campaign - #Bigger Choices www.publichealth.lacounty.gov/sapc/teens/index.htm
  #Bigger Choices is a youth cannabis prevention campaign with the slogan, “There are #BiggerChoices Than Weed.” The campaign was developed by youth for youth, and covers the consequences and health effects of cannabis, as well as resources for bigger choices such as youth employment and internship opportunities.


• California Poison Control Hotline
  800-222-1222
  Advise parents and youth to program the California Poison Control Hotline number into their phones so that it is readily available in the event of unintentional cannabis ingestion and/or overdose.

References

1. California Healthy Kids Survey, 2017/2018. San Francisco, CA: WestEd Health and Human Development Program for the California Department of Education; 2018.
2. FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. [news release]. Silver Spring, MD: U.S. Food and Drug Administration; June 25, 2018. www.fda.gov/newsevents/newsroom/pressannouncements/ucm611046.htm. Accessed September 7, 2018.
3. National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press; 2017. doi:10.17226/24625
4. Arria AM, Garnier-Dykstra LM, Cook ET, et al. Drug use patterns in young adulthood and post-college employment. Drug Alcohol Depend. 2013;127(1-3):23-30. doi:10.1016/j.drugalcdep.2012.06.001
5. Macleod J, Oakes R, Copello A, et al. Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies. Lancet. 2014;363(9421):1579-1588. doi:10.1016/S0140-6736(04)16200-4
6. Fergusson DM, Boden JM. Cannabis use and later life outcomes. Addiction. 2008;103(6):969-76. doi:10.1111/j.1360-0443.2008.02221.x
7. Zhang C, Brook JS, Leukefeld CG, Brook DW. Trajectories of marijuana use from adolescence to adulthood as predictors of unemployment status in the early forties. Am J Addict. 2016;25(3):203-209. doi:10.1111/ajad.12361
8. Chen CY, O’Brien MS, Anthony JC. Who becomes cannabis dependent soon after onset of use? Epidemiological evidence from the United States: 2000-2001. Drug Alcohol Depend. 2005;79(1):11-22. doi:10.1016/j.drugalcdep.2004.11.014