What Every Pediatric Gynecologist Should Know About Marijuana Use in Adolescents​

In Summary

Further examination of chronic cannabis use in adolescents correlates with a higher prevalence of anxiety. Research discussing adolescent cannabis use and mental disorders has been inconsistent, mainly debating whether or not some mental disorders are caused by cannabis use. The featured article found no evidence of causation but did notice a positive correlation between chronic (described here as daily) adolescent cannabis use and the development of anxiety. The development of major depressive disorders was not positively correlated with cannabis use, even in regular users. Causation, especially for psychosis, should continue to be looked into in order to determine the full safety profile of cannabis-based medications. ​

Adolescent cannabis use does seem risky when considering that cannabis directly affects the brain while the brain is still developing and very few researchers have published well recognized and accepted data discussing the effect of cannabis on neural development. It seems interesting that chronic cannabis use is positively correlated to the development of anxiety when the most abundant non-psychoactive cannabinoid and multiple terpenes are praised for their anxiolytic effects. Research into the effect of each chemical component of cannabis should be researched to fully elucidate which cannabinoid or combinations of cannabinoids, terpenes, etc., cause alternations in neurodevelopment and other effects. ​

In Summary

A recent meta-analysis and systematic review has shown that the liberalization of cannabis use has not increased the amount of reported cannabis use in adolescents. There appeared to be a slight increase in adult cannabis use post-recreational cannabis legalization but not a significant amount to clearly report that trend. These reports may be skewed due to the social stigma that continues to surround cannabis use and therefore prevents participants from accurately reporting their history, but further research in an area where cannabis legalization is likely to occur but hasn't yet would provide an interesting opportunity to confirm these findings. 

​Medical cannabis use has been legalized in 33 states at the time of this blog and legalized for recreational use in 11 states, highlighting the importance of looking into current demographics and legal activity. Some studies have suggested a decrease in adolescent cannabis use as illicit dealers are replaced by state-regulated dispensaries implying that legalization and regulation may actually provide a safer environment for cannabis use and allow better prevention practices for adolescents. Further research would be needed to confirm these hypotheses and previous findings but prove promising for future legalization.

In Summary

Cannabis use was found to highly correlate with inpatients diagnosed with conduct disorder amongst teenagers. Although some cannabis use was self-reported by patients dealing with other psychiatric disorders, it was seen most significantly in those with conduct disorder (CD), suggesting a higher risk of comorbidity between CD and substance use disorders. Although cannabis use was the most common substance reported by patients it was closely followed by tobacco and alcohol use. The demographics of patients using cannabis varied although those suffering from CD and substance use disorder were primarily male and black. Further research should be conducted to develop efficient prevention strategies. 
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Looking into the substance use frequency and patterns of stigmatized or marginalized groups is not often done leaving many populations without specialized treatment or prevention programs. If members of the male black population are at a higher risk of developing substance use disorders then our prevention efforts should address that population first and foremost. People begin using substances for different reasons although some motivations are common among certain populations. By examining the underlying motivation for substance use frequency members of the healthcare community may be able to develop custom prevention or treatment methods by utilizing psychology or another science to drastically decrease the frequency of substance use disorders in all populations. 

In Summary

 Earlier this July a letter was published providing evidence that adolescent cannabis use may actually decrease post-legalization of medical and recreational cannabis. An analysis of Youth Risk Behavioral Surveys from the past two decades revealed that legalizing medical cannabis had little to no effect on cannabis use among adolescents in 8th and 10th grade but that legalization of recreational cannabis actually led to an overall decrease of adolescent cannabis use across the states. The authors hypothesize that the rate of adolescent use may decrease as illegal drug dealers are replaced by legal, regulated dispensaries. This evidence may prove compelling for the possible rescheduling of cannabis under the federal Controlled Substances Act. 
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Adolescent substance use, like that of alcohol, has been found to be detrimental to brain development. There have been varying results regarding the effects of adolescent cannabis use on brain development yet some caretakers are given special permission to administer cannabis-based products to children experiencing rare forms of epilepsy or other seizure disorders. Cannabis-based medications may be a more ethical and far less dangerous substance to administer to children so that they aren’t set up for a substance use disorder at a young age.  The research focussed on adolescent cannabis use needs to be conducted for better regulations and to better advise the parents and pediatricians of adolescents who have accidentally consumed cannabis or need a cannabis-based medical intervention.  

In Summary

In Summary

​A recent study has revealed that brief interventions given by primary care physicians can reduce alcohol and drug abuse among at-risk adolescents. This study aimed to address only alcohol and cannabis use disorders in teenagers who already reported the misuse of such substances. Participants were randomly assigned to receive an intervention from their physician or assigned as controls and then asked about their substance use habits 12 months later. Those who received an intervention reported a marked decrease in substance use through self-reporting and chemical screening. This research suggests that pediatricians and other general practitioners should speak candidly about the risks of substance use disorders with their patients. 
Pieces like the featured article highlight the importance of responsible cannabis use. Cannabis is becoming more socially acceptable as states continue to put forth policies that legalize medical and recreational use. Like alcohol and other drugs, cannabis should remain a semi-controlled substance whose availability is restricted by age or other factors so that at-risk youth are unable or less likely to abuse its benefits. State laws currently decide who has access to cannabis but as at-home cultivators become more prominent it will be necessary to ensure the security of those plants to prevent adolescents from misusing plants grown by family or friends.