Dear Dr. Kidorf,
Recently, I was talking to my
friend about the recent law making marijuana legal for 21-year-olds. She said, “So what? It’s not worse than alcohol. If
we don’t outlaw alcohol, why should we outlaw marijuana?” To me, this is a
ridiculous statement. As a parent of middle- and high-school-age children, I am
very concerned about what this means for my children and the children of the
community. As if alcohol were not bad enough, what’s to stop teens from using
it? What’s to stop them from driving “drunk”? What about peer pressure,
addiction, and the long-term consequences for their mental and brain health? It
could even happen that small kids will consume marijuana unknowingly in the
form of brownies, candy, or even pizza! The horrific possibilities just blow my
mind. I even worry about my married children and their kids, who are dealing
with marijuana smoke from someone else in their building.
I don’t even know how to start
to process this change. I never thought that I would have to have this
conversation with my kids. In summary, what should we parents be thinking about
regarding this law and how should we talk to our children about it?
Response:
Thank you
for your question, which is quite timely. Starting July 1, 2023, cannabis
(marijuana) possession and use will be legal in Maryland. Adults (21 or older)
can possess up to 1.5 ounces of cannabis and grow up to two cannabis plants in
their backyards.
Maryland
is the 20th state to have legalized recreational cannabis use, just
another in our ever-increasing list of things to worry about. One question that
arises is whether legalization will lead to more people in Maryland using
cannabis. Available research yields good news and bad news. The good news is
that rates of cannabis use among adolescents have remained largely the same in
states that have legalized cannabis. This makes some sense because cannabis is
still illegal for teenagers. The bad news is that adults in these states are
using quite a bit more cannabis. As expected, more adults are developing
cannabis use disorder, which means that they are getting into serious problems
due to cannabis use, making their lives (and the lives of their families)
unpleasant and complicated. Of course, many of these adults are parents, who
are setting poor examples for their kids. So the downstream impact of
legalization on the public health remains to be seen.
You
are asking about how we should address cannabis use with our children. As with
teenage drinking, the short answer is through providing factual education,
setting clear expectations, and modeling good behavior. I want to extend a
special thank you to Eileen Pollock, who noted in her letter to the editor, in
last month’s issue, about the important role that adults have in setting a
proper example for teenagers.
In
regard to education, kids should know basic facts about cannabis and how it affects
the body. If parents do not provide this information, a sneaky older sibling or
friend will be happy to fill the vacuum, and they are sure to emphasize the
acute relaxation effects over the possible dangers. Parents should convey to
their children that they should not smoke cannabis, but if they do, they should
feel free to speak with them about it. Even this goes against the natural
inclination of teenagers to offer details on a need-to-know basis. Of course,
parents should refrain from cannabis use, and if currently engaged in it,
should strongly consider quitting, which often involves seeking treatment. While
medical cannabis is legal in Maryland, the truth is that there are very few medical
conditions that warrant cannabis use.
One
of the obstacles to providing cannabis education to teenagers is that they are
teenagers. Another problem is that adolescents are much less likely than in the
past to view cannabis as a risky drug that can cause problems – perhaps due to all of these
successful legalization efforts. The cannabis lobbies and state governments
have been busy! Nevertheless, I will use the rest of the column to provide some
basic education about cannabis that addresses some of the concerns that you
raise.
What is cannabis? Cannabis is a psychoactive drug
that comes from the cannabis plant. Kids will use the slang terms pot and weed
(probably not grass!) as the term marijuana actually has some racial overtones
(a subject for another column). Cannabis contains THC, its major natural
intoxicating component, and CBD, which does not induce a sensation of being
high. The cannabis grown today is more potent than when I was a kid, and when
acquired illicitly, can be mixed with other drugs, including fentanyl. In fact,
the mixture of cannabis with other drugs might be one of the ways that the
illegal cannabis market will continue to operate to compete with legal cannabis
dispensaries.
How many kids are
using cannabis? We
know that, across the U.S., about 30% of 12th graders report
cannabis use, with about 6% reporting daily use. As usual, we do not have
estimates for our community, though my guess from talking to kids is that our
rates more or less mirror the U.S. population. These data teach us two lessons:
First, there is a good chance that your children will have access to cannabis
and be in a position to use it. And second, despite this access, most kids
report not using cannabis, which means that resisting peer pressure places one
well within the majority of U.S. students. Kids need to know that not using pot is totally normal.
How is cannabis
ingested? Cannabis
is most often smoked through joints, pipes, bongs, or vapes. It is also
frequently consumed in foods like cakes or candies. These edibles take longer
to achieve an effect because the cannabis needs to get through the digestive
system. Because the effect is delayed when eating cannabis, teenagers often use
more cannabis than intended.
What are the acute
effects of cannabis?
In low doses, cannabis causes relaxation and some perceptual effects, like
distorting perceptions of time. It causes kids to laugh at stupid things and
get hungry. These acute effects are by no means universal to all users. Kids
often report more harmful responses, including intense anxiety and paranoia,
depending on the quality or dose of the cannabis, and if it is being used with
other substances, like alcohol. Because cannabis impacts coordination and
judgment, teenagers should not drive after using it.
What about cannabis
smoke? Cannabis
smoke contains a number of harmful chemicals that can cause lung problems,
though no clear link has been made to cancer. One of the problems with this
type of research is that cannabis smokers often smoke traditional cigarettes as
well, which are well-known carcinogens. There is simply less research on
cannabis use than cigarette use. The same is true about second-hand smoke. Current
research suggests that, in closed spaces like a car or a poorly ventilated
room, non-smokers can experience cannabis effects from another’s use, and that
cannabis can be identified in their blood stream and urine samples.
Can cannabis use lead
to addiction? The
answer is yes, absolutely. I have worked with many people who have a cannabis
use disorder, and it is difficult to treat. Cannabis use disorder symptoms
range from physical symptoms, like tolerance and withdrawal, to psychological
symptoms like anxiety and daily obsession over the drug. What unifies people
with a cannabis use disorder is that it has a negative impact on life, harming
school and job performance and negatively impacting relationships.
Is cannabis a gateway
drug? The statistical
research is mixed as to whether cannabis use leads to use of other drugs. Most
kids who use cannabis do not develop a problem with it or other drugs; they
just let it go as they get older and more involved with life responsibilities. However,
some kids continue to use cannabis as an adult, and many progress to other
illicit drugs like cocaine and heroin. The problem with this observation is
that these same people also drank milk before they used dangerous drugs, and
nobody, except perhaps a very radical vegan, would see any connection between
milk and heroin consumption. What seems most likely is that cannabis use puts
kids in touch with others who experiment with different drugs.
What are the
long-term health effects?
Research on the long-term effects of cannabis use is still evolving. It seems
clear that cannabis impacts the developing brain of adolescents, impairing
neural connections and leading to neurocognitive difficulties in memory and
processing. Whether these impairments are sustained through adulthood is not
known.
Is cannabis safer
than alcohol? Alcohol
and cannabis are different drugs with different sets of effects. Alcohol is
clearly a sedative, while cannabis has features of a sedative, stimulant, and
hallucinogen. Because drinking is legal for adults, it is consumed more often
than cannabis by both teenagers and adults, leading to more problems. Cannabis
legalization may start to level the playing field as it is already associated
with increased rates of cannabis-related problems among adults in states that
have legalized it. I think it is fair to say that both substances 1) negatively
impact the developing brain, 2) are associated with neurocognitive problems
that may or may not resolve with time and abstinence, 3) will lead to an
addictive disorder if used frequently, and 4) are associated with psychiatric
problems like anxiety and depression.
This
is really only a brief introduction to cannabis, and I hope to write more about
it as new questions arise. The new laws legalizing
cannabis provide an opportunity for us to be more informed about this drug. For
more information, please consult the NIH website: nida.nih.gov.
Michael Kidorf, Ph.D., is a clinical psychologist,
Associate Professor of Psychiatry at Johns Hopkins University School of
Medicine, and Director of Education at Chayeinu. The Where What When welcomes
readers’ questions to this column.
