Increased availability of marijuana means more parent questions for pediatricians
Sheryl A.Ryan, M.D., FAAP
AAP Clinical Report
Pediatricians need to be able to speak directly and frankly with teens and their parents
about the potential harmful effects of marijuana and cannabis products, especially
in light of new laws legalizing both recreational and medicinal use of marijuana products,
according to a new AAP clinical report.
Counseling Parents and Teens about Marijuana Use in the Era of Legalization of Marijuana, from the AAP Committee on Substance Use and Prevention, addresses the specific content
that pediatricians should be including in conversations about cannabis products. The
report is available at http://bit.ly/2koWlKb and will be published in the March issue of Pediatrics.
The topic is especially relevant now that more states have passed laws to legalize
both recreational use of marijuana for adults and medicinal marijuana for both children
and adults. Currently, recreational marijuana use by adults is legal in seven states
plus the District of Columbia, and 28 states have legalized some form of medicinal
marijuana for a wide variety of conditions.
This means the subject of marijuana is much more likely to be part of the conversation
between teens and their parents, and the pediatrician is likely to be seen as a source
of accurate information about adverse effects as well as benefits of the many cannabis
products now available. Pediatricians also are far more likely to encounter adolescents
or parents who are using these products, either recreationally or for their therapeutic
Following are answers to some questions pediatricians might have about cannabis products
and counseling teens and their parents.
Q: Are we seeing an increase in marijuana use among teens now that more states have
legalized recreational and/or medicinal marijuana?
A: Rates of use have remained static overall among adolescents 12-17 years, even in
states with laws permitting recreational or medicinal marijuana use. Among 12th-graders,
however, there has been an increase in rates of marijuana use, with 36% reporting
use within the previous year. This is in direct contrast with reported use of other
illicit substances, alcohol and tobacco, which have been declining significantly since
the late 1990s. Teens also are reporting less concern about the “harmful” effects
of smoking marijuana.
Q: What adverse effects of cannabis products should be mentioned when counseling teens?
A: Many studies have documented adverse effects, including short-term impairment of
memory, attention, concentration and problem-solving skills, as well as motor control,
coordination and reaction time. Development of mental health disorders such as depression
and psychosis also have been reported. New studies evaluating abnormalities in brain
regions involved in memory and executive functioning in teens using marijuana regularly
and/or heavily raise concerns about long-term and lasting effects on brain maturation
Teens also need to know marijuana smoke is toxic, similar to secondhand tobacco smoke,
and use of vaporizers or hookahs does not eliminate the toxic chemicals in marijuana
Q: Are there special concerns related to marijuana-infused foods?
A: When marijuana is consumed in an edible or drinkable form, there is a slower rate
of absorption in the system compared with inhalation. Consequently, it takes longer
to appreciate the euphoric effects, and some teens then consume additional “doses.”
This can result in significant toxic side effects when the effect of the product finally
In addition, rates of calls to poison control centers and visits to emergency departments
have increased after young children have ingested products that resemble candy, baked
goods or soda.
Q: Are there any data to support the efficacy of medicinal marijuana in children?
A: Studies in adults support its use in chemotherapy-associated nausea and vomiting,
spasticity with neuromuscular diseases, and cachexia with certain chronic diseases.
The only data on its effectiveness in pediatric populations are limited to its role
in decreasing seizures in specific epilepsy conditions, such as Lennox-Gastaut syndrome
and Dravet syndrome.
Q: What should physicians tell parents who are reluctant to advise their teen against
using marijuana since they themselves used it when they were younger?
A: Tell parents that marijuana products available today can be more than three to
five times stronger than what was available even a decade ago. With newer methods,
such as vaporization or “dabbing,” potency is even higher, increasing the risks for
toxic effects. (Dabbing is a method used to convert marijuana into a concentrate for
inhalation; it uses butane to extract tetrahydrocannabinol, or THC, from the cannabis
Parents also should not feel that they have to share all of their experiences with
their children or that they cannot voice disapproval of their teen’s use because they
have used marijuana themselves. They need to be encouraged to provide accurate information
and express their concerns and values to their children.
Suggestions for pediatricians
Screen all patients for the use of any cannabis products beginning in early adolescence
because the earlier teens begin to use marijuana, the more likely they are to develop
If adolescents are not using marijuana, use motivational techniques to support their
decision to abstain.
Adolescents who are using marijuana regularly or heavily are more likely to meet criteria
for a substance use disorder. A brief motivational intervention may be used to reduce
use and continue the conversation with the pediatrician or a mental health or behavioral
Counsel about known side effects, as well as the known euphoric effects or medicinal
benefits, so that you can be a source of accurate, scientific information to teens
and their parents.
Speak frankly with parents about the effect that their own use may have on their children
or teens, either through modeling or through their own impairment.
Dr. Ryan, a lead author of the clinical report, is chair of the AAP Committee on Substance
Use and Prevention.