Cannabis, Teens, and Risk: Postponement as Prevention

In a culture where 23 states and the District of Columbia have legalized cannabis, it is not surprising that most teens under the legal age of 21 perceive occasional or weekly use of cannabis as harmless. Of concern is that over the past decade, as the perceived risk of regular cannabis has decreased, use among teens has increased from 11.6 percent to 17.9 percent—an increase which is likely to continue.

The concern of researchers, physicians, even those who are proponents of legalizing cannabis, is that the failure to recognize the impact of Cannabis on a teen’s functioning and their still-developing brain puts them in harm’s way.

A Columbia University Study Offers Some Perspective

The rationale for a recent Columbia University study was the concern that whereas adolescents with cannabis use disorder (CUD) are considered by clinicians to be at risk for adverse outcomes, little is known about those teens using cannabis recreationally, what is considered Non-Disordered Cannabis Use (ND-CU).

The Goal of the Study

The goal of the study was to describe the prevalence and demographics of non-disorderd cannabis use and to compare associations of cannabis use with adverse psychosocial events among adolescents with no cannabis use, and those with cannabis use disorder.

Lead author Ryan Sultan offers a close look at the impact of non-disordered cannabis use across 68,263 teens—drawn from the 2015-2019 National Survey on Drug Use and Health. The participants were adolescents aged 12 to 17 years who were divided into three groups: 59, 617 adolescents (87.3 percent) reported no use of cannabis; 6,971 adolescents (10.2 percent) reported non-disordered cannabis use; and 1,675 adolescents (2.5 percent) had cannabis use disorder. The mean age of the adolescents was 14.5.

Findings

• In the sample, non-disordered cannabis use by teens was four times more common than cannabis use disorder.
• Compared with non-users, individuals with non-disordered cannabis use had approximately two to four times greater odds of all adverse psychosocial events, including: major depression, slower thoughts, difficulty concentrating, cognitive deficits, low grade point average, truancy, arrest, fighting, and aggression.
• Compared with those with cannabis use disorder, teens engaging in non-disordered cannabis use had similar symptoms but to a significantly lesser degree.

Additional Concerns From a Cannabis Proponent

A consistent warning about teen recreational cannabis use comes from Peter Grinspoon, M.D., a primary care physician and proponent of legalized cannabis. Grinspoon grew up in a family that worked toward the legalization of cannabis. His book, Seeing through the Smoke: A Cannabis Specialist Untangles the Truth about Marijuana is open-minded and well-researched.

In his consideration of teens and cannabis use, his position, like other medical researchers, is that the brain does not fully develop until age 21 and we don’t know the impact of cannabis on a 15-year-old brain.

He underscores concerns of dependency mentioned by others in the field and suggests that the last thing a parent wants to see is a young teen having to reach into their pocket for a vaping pen to regulate anxiety. Additionally, he validates findings that cannabis can act in some cases as one of several environmental factors that can trigger schizophrenia in people who already have a predisposition toward psychosis (p.103).

The Message for Teens

Grinspoon suggests that while the experts wrestle with the research questions about relative harms and benefits of using cannabis, one thing most people would agree on is that with our current level of knowledge, cannabis is too risky for young, developing brains. He recommends a "Just Say Wait" approach, where parents can explain to teens the potential harms without exaggeration or dramatics (p.219),

There is merit and potential in the message “Just Say Wait". The rationale for “waiting” in the context of risking healthy brain development may make postponement vs. deprivation more acceptable. For teens, it may be a better, more realistic option than "Just Say No," which did not have success in drug use reduction and may seem inconsistent in light of legalization.

Postponement protects brain development. In their book Strength-Based Prevention: Reducing Violence and other Public Health Problems, Banyard and Hamby (2022) advocate three prevention tools: regulation, interpersonal connections, and meaning-making.

Regulation fosters prevention through sports, music, mindfulness, breathing, meditation, and service projects that enhance mattering and may play a part in the capacity to postpone cannabis use.

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Interpersonal connections foster prevention with parental support (change of or clarification of parents’ own cannabis use). Peers who may all agree to wait or new friends with new activities can become more important than cannabis use.

Meaning-making fosters prevention by enhancing decision-making.