December 2014
Yifrah Kaminer, M.D., MBA
Professor, Psychiatry and Pediatrics
University of Connecticut Health Center
Guest contributor Dr. Yifrah Kaminer is a child and adolescent psychiatrist at the University of Connecticut. Dr. Kaminer’s main clinical interests and research lie in the spectrum of adolescent high-risk behaviors. He is also a senior investigator at the Injury Prevention Center of the Connecticut Children’s Medical Center in Hartford, where he has been involved in research on adolescent risky driving behavior and youth suicide prevention. In this month’s feature article, Dr. Kaminer shares his views on marijuana legalization and the consequences for teens.
According to the Monitoring the Future Annual survey (2014)http://www.monitoringthefuture.org/, while the use of tobacco and alcohol is declining among youth, marijuana (MJ) use among US teens has been climbing steadily since 2007. MJ use surpassed tobacco use in 2011 and is expected to surpass alcohol use in 2020. This trend is inversely correlated with the continued decrease in perception of the harmfulness of MJ use to youth wellness (Volkow et al., 2014). Furthermore, this trend is more common in states with medical MJ (MMJ) laws. Liberalization in MJ legal status (i.e., decriminalization, medicalization, and legalization) has also contributed to the misleading perception among youth that MJ is a safe substance, leading to an increase in the number of first-time users as well as a decrease in the age of first time users (Williams & Bretteville-Jensen, 2014). These trends have deleterious public health, medical, mental health, academic and financial consequences (Hopfer, in press, Volkow et al. 2014).
George Bernard Shaw once said “Beware of false knowledge; it is more dangerous than ignorance.” The widespread misinformation created and disseminated by MJ legalization proponents is targeting youth while perpetuating the false notion about the drug’s safety (Project SAM, 2014).
MJ is NOT a harmless drug as some claim, in spite of scientific findings and community concerns to the contrary. The consequences, particularly for youth, present serious risks, as evident by the Colorado medical MJ experience since 2006. This includes, but is not limited to, a doubling of the rate of fatal road accidents for drivers under the influence of MJ, increased availability of MMJ to youth, and increased emergency room admissions, including for children as young as 3 years old due to ingestion of MJ products (Rocky Mountain High Intensity Drug Trafficking Area, 2014).
It is important to consider the statistics: NIDA reports that 9% of MJ users become dependent (NIDA, Drug Facts: Marijuana. 2014). This figure doubles with MJ onset during early teen years, as is the trend now. Equally troubling is emerging research that suggests an association between MJ use and early onset and more severe psychosis (Medscape Medical News, 2014). Increased frequency, dosage, and years of use are directly correlated with the risk of developing psychotic symptoms with poorer outcomes (Bagot et al., in press). Cannabis impairs neurocognitive development and functioning by enhancing changes in both gray and white matter (Crane et al., 2013, Lisdahl et al., 2013 ). MJ also impairs educational attainment in teen users by affecting attention, concentration, and memory. Moreover, long-term users lose an average of 8 IQ points (Meier et al., 2012).
In Colorado, the percent of positive tests for MJ in high-school students, THC levels in samples, and MJ related violations increased steadily on an annual basis between 2006 and 2003 (RMHIDTA, 2014). Interestingly enough, alcohol violations decreased significantly in the same period. MMJ cardholder status is easy to achieve in Colorado, and the “trickle down” effect and availability for youth reported from Colorado is disturbing. MMJ was available to a majority of youth in treatment for cannabis use disorders. Those youth using MMJ had earlier age of regular use, more MJ use-related symptoms and more conduct symptoms compared to youth in treatment who have not had a history of MMJ abuse (Salomonsen-Sautel, 2012).
What does all of this mean? MMJ states would have to allocate more resources for prevention and treatment. It also means an increased loss of life, injuries, and damage to property due to an increase in road accidents (Salomonsen-Sautel et al., 2014). Youth would be mostly affected from driving under the influence of MJ because of their incorrect and fatal perception that MJ does not affect their driving capabilities (Bloomberg News, 2013). The predicted tax revenues from MMJ would be insignificant compared to the public health and medical costs of use, as has been the case with tobacco and alcohol.
We have not done a good job protecting our youth from the harm of alcohol, tobacco, and prescription drugs use. Can we do any better with MJ use? What is the best advice for states still considering legislation regarding MMJ or even legalization?
To address these questions, it is important to pause for a period of 3-5 years to objectively and scientifically study the continued unveiling of the consequences of legalization policies in states such as Colorado and Washington. Encourage research of MMJ policy implementation and consequences in MMJ states. Pay special attention the Office of Medical Cannabis in Minnesota: this state’s medical cannabis laws do not allow a smokeable form of MJ for use by MJ cardholders. Fund an immediate awareness and prevention campaign starting in fourth or fifth grade due to the decrease in age of first use of MJ and corresponding increase in referrals of middle school students for treatment. Prevent any lobbying promoting legalization of MJ and by doing so keep “Big Cannabis” companies away. Promote research of non-smokable low-THC (the ingredient that causes emotional high) and high cannabinoids (the components with alleged medical value). To do that, non-smokeable forms of cannabis should be moved from a Schedule I (i.e., dangerous no medical merit) to Schedule II (i.e., a medication with some medical merit). Finally, impose considerable penalties on those who make MMJ accessible to minors. This includes those who now have MMJ cards allowing them to store cannabis in their medicine cabinet similarly to other harmful prescription medications.
If we consider a gradual and controlled liberalization of MJ use, we have an opportunity to strike a balance between addressing the changing marijuana landscape while making every necessary effort to protect our youth wellness.
This article was supported by NIDA grant RO1 DA 03054-02. The author reports no conflict of interest associated with this publication.