Monday, January 30, 2023

We Need a Public Health Campaign Against Teen Marijuana Use

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There is good news and bad news when it comes to drug and alcohol use among teenagers. The good news is that fewer teenagers are drinking, a trend that has steadily improved over the past two decades. The downside is that the cannabis seems to be taking up the juice of the alcohol.

Research is still developing, but the decline in adolescent alcohol consumption is likely to stem from a mix of policy and public health campaigns. The same level of effort needs to be applied to discouraging adolescent cannabis use – and fast.

A new study that looked at calls to US poison control centers over two decades adds to growing evidence that more teens and tweens are turning to cannabis instead of alcohol. Researchers found a gradual decline in alcohol-related calls since 2010, but a steady increase in cannabis-related calls from 2010 to 2017. Cases since 2017 have increased.

There was a distinct increase in food product misuse, says Adrienne Hughes, an emergency medicine physician at Oregon Health & Science University who led the study. Unlike smoking, which gives an instant high, edibles take longer to kick in and have more unpredictable highs, making it easier to overuse.

The study has several limitations. Calls to the poison center are usually from a parent or a health care provider, meaning the actual number of cases across all substances is likely higher. And the reported cases are all intentional uses — this data doesn’t reflect, for example, a call that comes in because a child accidentally ate an edible they thought was candy.

The work is consistent with other recent studies that suggest teens are shifting their interest from alcohol to cannabis, and especially edibles. A 2018 study that examined drug attitudes and use based on findings from the California Healthy Kids Survey. The researchers were based in a racially and ethnically diverse Northern California high school and found that one-third of the children had used marijuana, and 83% of those children had tried edibles. This study found higher use of snacks among girls, who at the same time were more likely to consider snacks as more dangerous than smoking marijuana.

And a recent study led by Columbia University epidemiologist Katherine Keyes found that between 2000 and 2020, single use of cannabis among high school seniors doubled from 2011 to 2019 — and, like the California research, use increases faster in girls.

This coincided with a significant decline over the past two decades in adolescent and adolescent alcohol consumption. Keyes’ study found that teenagers were also less likely to use alcohol and cannabis together, although the decline was more subtle.

Because the cannabis market is so fragmented and doesn’t receive the same kind of regulatory scrutiny as tobacco or alcohol products, marijuana is being sold in forms that are enticing to children, such as chewing gum, taffy, chocolate and baked goods. The only silver lining is that the market has yet to see a major player come out with a single product that has taken off – in other words, the equivalent of the Juul has yet to enter the scene.

But without regulation of these products, it’s only a matter of time, says Sharon Levy, director of Boston Children’s Hospital’s Adolescent Substance Abuse Program. “If you had one of these really big corporations make something that could be pushed across the country,” there could be a tidal wave of new users.

Cannabis is often (correctly) seen as the least harmful choice on the recreational drug menu. But that doesn’t mean there aren’t many reasons to delay potty training for children. While evidence of its effect on the developing brain is still up for debate, studies have shown that adolescent marijuana use has a negative impact on both academic performance and socioeconomic status in adulthood. Some research suggests that children are much more vulnerable to cannabis addiction than adults, an issue that appears to be exacerbated by the extreme potency of some products.

To curb teen cannabis use, we need to learn some lessons from the decline in teen drinking. And researchers have some strong theories. Keyes suspects that much of it is due to massive public policy and public health efforts to prevent underage drinking, whether that was aligning minimum age limits, educating children and their parents, or trying to reduce drinking on college campuses. “My reading is that when you make it a priority, you can really push the needle in areas where you’re really concerned about public health,” Keyes says.

The same approach seems to have worked for over-the-counter cough medicine abuse. Hughes’ study showed a rapid decline in calls to the poison center related to the cough syrup ingredient dextromethorphan. Over the past decade, products with that ingredient have become much more difficult for children to purchase as individual states over the past decade enacted laws prohibiting its sale to anyone under 18 without a prescription and made a concerted effort to of public health to reduce adolescent use.

A similar effort is now needed for cannabis, where the legal and commercial environment is changing rapidly. The piecemeal approach to legalization has left so many resource gaps – into which children and teenagers are falling.

More from this writer at Bloomberg Opinion:

• Another Crispr First: New treatment wipes out teen cancer: Lisa Jarvis

• Don’t Let the Tripledemic Steal Christmas: Lisa Jarvis

• US needs five times more child psychiatrists: Lisa Jarvis

This column does not necessarily reflect the opinion of the editorial board or of Bloomberg LP and its owners.

Lisa Jarvis is a Bloomberg Opinion columnist covering the biotechnology, healthcare and pharmaceutical industries. Previously, she was executive editor of Chemical & Engineering News.

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