Last month, at home recreational marijuana use became legal in Massachusetts for people 21 years and older. We at Westwood-Mansfield Pediatrics have some significant concerns about the impact this law will have on our patients and their families. We offer some thoughts on marijuana’s dangers, the risks of legalization, and how to parent in this new era.

Before discussing the specific concerns we have about adolescent and young adult marijuana use, it may be helpful to review a little developmental neuroscience. Human brains are still growing and developing until individuals are 25 (or even 30) years old. Until they are fully formed, they are particularly sensitive and vulnerable to the negative effects of marijuana. Immature brains are more likely to become addicted, to have impaired judgement, and to demonstrate long-lasting negative effects on learning and memory. Studies suggest that marijuana use in teenagers and young adults is significantly more harmful than marijuana use in older adults with fully formed brains.

The director of the brain imaging and neuropsychology lab at University of Wisconsin says it best when she say that adolescence “is the absolute worst time [to use marijuana] because the mind-altering drug can disrupt development. Think of the teen years as the last golden opportunity to make the brain as healthy and smart as possible.”

The Role of Parents: You set the tone and the example for your children. Please share this information with your children. We at Westwood-Mansfield Pediatrics strongly encourage you to endorse the belief that marijuana is harmful to your kids and suggest a no-use policy. Whatever your personal opinion about marijuana use in adults, we cannot emphasize enough the American Academy of Pediatric’s statement that adults should be discouraged “from using marijuana in the presence of children because of the influence of role modeling by adults on child and adolescent behavior.”

Legalization Does Not Mean Safe: While the Massachusetts law permits possession of small amounts of marijuana for individuals 21 years and older, public health experts have significant concerns that there will be a trickle-down effect, with the number of adolescent users increasing significantly. We anticipate seeing a large rise in middle and high school use. This has been the experience in Colorado. Parents will have an important role to play in setting the example for their teens, in counseling them, and in helping to ensure their safety.

Harmful Effects of Marijuana: One argument offered by pro-legalization of marijuana advocates is that the risks of its use are no greater than those of alcohol. While that may be true, teenagers and young adults have some particular developmental aspects that make them much more vulnerable to marijuana’s harmful consequences. Specifically, as mentioned above, neuroscience has taught us that the human brain continues to develop up through age 30 and, as a result, the new law’s 21 year of age cutoff is insufficient to protect young adults.

The harmful effects of marijuana can be divided into acute (short-term) effects and chronic (long-term) effects.

Acute Effects:
In the immediate period following marijuana use, multiple brain functions become altered and impaired. These include the following: impaired decision making, increased risk-taking, increased impulsivity, impaired memory, and impaired attention (in recreational users). Psychological side effects may include anxiety, suicidal ideation, and psychosis.

Tetrahydrocannabinol (THC), the psychoactive component of marijuana has dramatically increased in potency over the past few decades. Studies suggestion that it is close to 2-4 times greater than it was in the 1970s. This contributes to increased consequences of use and has led to more emergency room visits for severe anxiety attacks and psychotic episodes in teens.

One feature of marijuana use that comes as a surprise to many people is that the negative neurological effects may last for 3-5 days. This means that learning and memory (school work) is impaired well after the high wears off and individuals feel “normal.” A teenager can use marijuana on Friday night and still have impaired studying and schoolwork the following Wednesday.

A special word about ADHD and marijuana use: The adverse effects on schoolwork are so significant that the American Academy of Pediatrics suggests that adolescents with ADHD who also report marijuana use should be treated for the drug use prior to receiving any medication for ADHD.

Chronic Effects:
Regular marijuana use in adolescence or early adulthood has been associated with poor school performance, higher rates of dropout, and lower life satisfaction. In addition, addiction, mental health issues, and chronic changes in brain anatomy are consequences of frequent use.

Marijuana is an addictive drug. Data suggests that approximately 9% of adults who use marijuana will eventually become addicted. More concerning, of individuals who begin using marijuana in their teens, 17% (more than 1 in 6) will meet criteria for marijuana addiction (this increase is largely due to those vulnerabilities of the developing brain mentioned above). Not surprisingly, marijuana producers in the newly legalized states are well aware of this and are aggressively pursuing younger users. Advertising in youth-centered magazines as well as the sales of edibles with kid-friendly names that evoke candy such as “Sour Gummie Bear” or “Red Fish” has become widespread. As with the cigarette, e-cigarette, and alcohol industries, the promise of a profit has led to increasing efforts to attract younger users as the younger you are when you start, the more likely your are to eventually become addicted.

Chronic marijuana users are at increased risk of developing numerous lifelong mental health issues. Impaired emotional development, depression, anxiety and psychotic conditions (including schizophrenia) have all been demonstrated. Brain MRI studies of regular marijuana users have demonstrated changes in the white matter development that is very similar to that seen in individuals with schizophrenia. Marijuana use in adolescence is also associated with increased future rates of alcohol abuse and other drug use (the gateway drug phenomenon).

A decline in IQ has also been detected in frequent marijuana users. Susan Weiss, PhD, director of the division of extramural research at the National Institute on Drug Abuse says that this decrease is “in the same realm as what you’d see with lead exposure.” This fits with a growing number of studies looking at brain MRIs of regular marijuana users (at least once a week) that demonstrate a decreased hippocampus size (the memory center of the brain) as well as changes in the brain’s white matter development that is similar to that seen in schizophrenia.

Colorado’s Experience of Legalized Marijuana:
Since the legalization of marijuana, Colorado has seen an increase in marijuana use among adolescents and now has the highest percentage of “past-month use” in the country. In addition to this increased use by minors, Colorado has also seen increasing arrests of minors (especially black and Hispanic youth) and increased rates of ER visits and hospitalizations from marijuana poisonings/overdoses (either from accidental exposure of young children through edibles or from ingesting too high a dose, generally through edibles as well). Lastly, Colorado has seen the rate of automobile fatalities related to marijuana use increase 18% as marijuana is now involved in over one in five fatal car crashes in the state.

“Big Marijuana”: Marijuana has become big business. In Colorado, there are now more marijuana businesses than there are McDonalds and Starbucks combined.

For more information, please consider the following web sites:
https://www.drugabuse.gov/publications/drugfacts/marijuana
https://learnaboutsam.org/

Happy Holidays from All of Us at Westwood-Mansfield Pediatrics

12/21/2016