With the recent legalization of marijuana in many states, marijuana and its uses are a hot topic in most social circles. As physicians, we see the full spectrum, from its healing properties to its destructive ones. The goal of this article is not to persuade you into changing positions on its legalization, but rather to stress the importance of remaining neutral and educating families on the facts and potential pros and cons as they relate to the health of their children.
On Jan. 26, 2015,* the American Academy of Pediatrics released its policy statement on marijuana and its use (Pediatrics 2014 [doi:10.1542/peds.2014-4146]). The AAP does not support the legalization of marijuana because of the harm that it poses to children and adolescents, nor does it support legalization of medical marijuana outside the regulatory process of the Food and Drug Administration. It does recognize that marijuana may be an option for children with life-threatening or debilitating illnesses. The AAP does support the decriminalization of marijuana use or possession and advocates for less-harsh criminal penalties. Many of the recommendations were made because of the current research on marijuana and its use.
Dr. Francine Pearce
According to 2014’s Monitoring the Future survey of drug use and attitudes among American 8th, 10th, and 12th graders, marijuana is the most common illegal drug used by adolescents. Among 8th graders, 6.5% reported use; among 10th graders, 16.6% reported use; and 21.2 % of 12th graders reported use. A total of 81% of 12th grade students stated it was easy to get. Marijuana use at all three grade levels was higher than cigarette use (National Institute on Drug Abuse. Drug Facts, 2014). Another study found that early initiation of marijuana use was 6.5 times more likely to result in addiction than if it was initiated after the age of 21 years (Adolescent substance use: America’s #1 public health problem. CASA Columbia, 2011).
One thing we can agree upon is that an adolescent using any substance to mask or lessen the pain of a situation is in trouble. Whether adolescents are overeating or denying themselves food, or using drugs to get high, or behaving promiscuously to get attention, overindulgence is never good. So when we evaluate the effects of marijuana use among teens, we have to separate out the underlying emotional issues from the effects related to the drug. Adolescents are at particular risk for overuse because most lack the experience or maturity to stop when things get out of hand. And they are at risk when using anything that will give them a “high.” Substances like glue, gasoline, and cold medicine can bring them that high, and marijuana is no different – except that it is illegal.
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Alcohol, cigarettes, and prescription medications are also vehicles to that desired high. Each has greater addictive properties than marijuana does. According to the Monitoring the Future study, most high school seniors do not think occasional use of marijuana is harmful, with only 36% saying regular use puts you at greater risk, compared with 39.5% in 2013 and 52% in 2009. The perception that marijuana is harmful has definitely declined.
Cannabis smoke contains three times the amount of tar found in tobacco smoke and 50% more carcinogens (N. Engl. J. Med. 1988;318:347). It also can irritate the airways, causing exacerbations of asthma, cystic fibrosis, sputum production, and pharyngitis (Arch. Intern. Med. 2007;167:221). Long-term studies showed that extended use was associated with increased obstructive lung diseases.
There is substantial evidence that indicates that cannabis use can cause psychosis. One review noted evidence that genetic factors may influence the risk of psychosis in adults who used cannabis as adolescents (Biol. Psychiatry 2005;57:1117). Cannabis is believed to release dopamine in the body, which may lead to the psychosis. Another study found that the onset of psychotic illness occurred more than 2 years earlier in patients who were heavy cannabis users (Arch. Gen. Psychiatry 2011;68:555).