MARIJUANA AND TEENS IN 2016 - DANIELLE RAMO, PHD ASSISTANT PROFESSOR IN RESIDENCE - PARENTS ...
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Marijuana and Teens in 2016
Danielle Ramo, PhD
Assistant Professor In Residence
Department of Psychiatry
University of California, San Francisco
Danielle.ramo@ucsf.edu
Parents’ CoaliAon of Bay Area High Schools
February 1, 2016
Outline • Trends in marijuana use • Consequences of teen marijuana use • Current legal landscape • How parents can help • Scenarios and quesAons
US: Past Month Use
2014 Monitoring the Future Survey
8th grade 10th grade 12th grade
40 37
35
30
% Past month use
25 24 24
21
20 17
17
15 14
11
10 9 9
7 7 8
7 6 6
4 4 3
5 3 3
0
Alcohol Been drunk Marijuana SyntheAc CigareYe E-cigareYes Other
marijuana (Johnston et al,et2014)
Johnston al., 2014
Past Month Marijuana Use by Age:
2002-2014 Na6onal Survey on Drug Use and Health
Age 12 or older Age 12 to 17 Age 18 to 25 Age 26+
20
18
16
% Past Month Use
14
12
10
8
6
4
2
0
SAMHSA, 2015
Daily or Near-Daily Cannabis Use Increasing
2002-2012 NSDUH
9
8
7
Numbers in Millions
6
5
4
Used Marijuana in 20 or
3 More Days in the Past
Month
2
Used Marijuana on 300 or
1 More Days in the Past Year
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Marijuana Use Disorder, Past Year, by Age:
2002-2014 NSDUH
Age 12 or older Age 12 to 17 Age 18 to 25
7
6
Marijuana Use Disorder %
5
4
3
2
4.2 million
1
0
SAMHSA, 2015
Budney et al., 2007. ASCP
Medical Use of Cannabis
• CondiAons for which marijuana can aid in treatment
– Pediatric Developmental and Behavioral Disorders
– Cancer
– Neurological CondiAons
• Epilepsy
• Headache
• MulAple Sclerosis
– DigesAve Disorders
• Chemotherapy induced nausea
• AppeAte sAmulant
• Chronic inflammatory bowel disease
Zhang & Ho; J. Addic; 2015
Marijuana Use in the Past Year among
Individuals Aged 12 or Older:
2002-2014 Na6onal Survey on Drug Use and Health, by State
Bay Area vs. California
Adolescent Marijuana Use
2013-2014 California Healthy Kids Survey
• Used marijuana one or more Ames in the past year:
• 9th grade: 30% Bay Area vs 26% California
• 11th grade: 60% Bay Area vs 45% California
• Heavy use in the past month:
• 9th grade: 11% Bay Area vs 8% California
• 11th grade: 27% Bay Area vs 14% California
• 84% of 11th graders say it is fairly or very easy to get
• 73% of 9th graders say it is fairly or very easy to get.Marijuana Delta-9 THC Levels
14% 12.30%
12%
10%
8% 4.87%
6% 3.35%
4%
0.74%
2%
0%
1975 1990 2000 2012
NaAonal Center for Natural Products Research, 2012How Marijuana is Used: Edibles
SubstanTal discrepancy between labels and actual
THC content at dispensaries
• 75 edible cannabis products tested
(baked goods, beverages, candy/
chocolate)
• San Francisco, Los Angeles, SeaYle
• THC content:
– 17% accurately labeled
– 23% underlabeled
– 60% overlabeled
• Edible cannabis products fail to meet
basic label accuracy standards for
pharmaceuAcals. Vandrey et al.; JAMA; 2015Dabbing: Oil, Shatter, Wax
SACRAMENTO, Calif. (KCRA) —
“A growing number of
teenagers are smoking a highly
potent form of marijuana –
virtually undetected – with no
smell and no way for anyone to
know they’re breaking the
“It’s not for beginners” – Head of Business law.”
Strategy and Development, Medicine Man Feb 13, 2014
Dispensary, CO
Feb 2014Dabbing • THC concentraAons of 20– 25%, up to 80% vs. TradiAonal marijuana: 10%. • Shared and normalized through social media (e.g., YouTube) • Considerable residual solvent and pesAcide contaminaAon (80%) Mehmedic et al. 2010; Krauss et al. 2015; Raber et al. 2015
Vaping marijuana
VapingELECTRONIC NICOTINE DELIVERY DEVICES
hYps://www.yahoo.com/tech/bluetooth-e-cigareYe-lets-you-receive-calls-and-listen-77079339081.html
Vaping
• Good epi data not available.
• TheoreAcal benefits:
– May reduce negaAve health effects associated with
inhalaAon of cannabis smoke
– LimiAng the exposure of others to cannabis smoke.
– Non-health benefits (e.g., discreet, increased delivery
efficiency)
• Downside…
– May lead to earlier iniAaAon of use, increased frequency
or quanAty of use and decreased moAvaAon to quit or
reduce use.
– Promotes high concentrated, potenAally contaminated
(and unregulated) forms of THC.TesTmonial
Smartphone
Apps
• Content analysis of 59 cannabis-related mobile
apps for Apple and Android devices
• Classified apps by feature and 20 content areas
• Most common content areas:
– strain classificaAon (33.9%)
– facts (20.3%)
– games (20.3%)
• Only one app provided informaAon related to
abuse, addicAon, or treatment
Ramo et al.; JMIR mHealth uHealth; 2015Health Consequences:
Concerns for Teens
• Risk of addicAon
• Risk for other drug use
• RelaAon to mental illness
• Effects on school performance:
• Short-term effects: Motor vehicle accidents,
sexual risk behaviors
Volkow et al. NEJM; 2014Impact of Marijuana on Teen Users
Auer 7-30 days of absAnence in healthy
samples without independent mental
health problems…
• CogniAve impairments: Decreased
story memory, poorer processing
speed, execuAve funcAoning and
complex aYenAon
• Structural abnormaliAes: PFC,
cerebellum, amygdala, leu
hippocampus
• AbnormaliAes in white maYer
integrity
Lisdahl et al 2013, 2014Adolescent Onset Marijuana Use is Linked to
Decline in Adult IQ
• 1,037 followed people from birth (1972-73) to age 38.
• MJ use measured at age 18, 21, 26, 32, & 38.
• Neuropsychological tesAng was conducted at age 13, before
iniAaAon of MJ use, and again at age 38.
• Persistent MJ use was associated with neuropsychological
decline FOR ADOLESCENT ONSET USERS (dx at 3 Amepoints ->
8 IQ points lower at age 38).
• IQ decline persisted auer stopping use, but only for
adolescent-onset users.
Meier et al. Proc Natl Acad Sci; 2012Current Legal Landscape
WA ND
MT
MN
ME
ID SD WI VT
OR MI
WY NY NH
IA MA
NE CT
OH PA RI
IL IN NJ
NV UT CO
KS MO WV DE
MD
KY VA
DC
CA
OK TN
AR NC
AZ NM SC
MS AL GA
TX
LA
FL
AK
HI
Marijuana Legal
Medical Marijuana Legal
Marijuana Possession DecriminalizedLegalizaTon and teen MJ use: Colorado
2013-2014 NaTonal Survey on Drug Use and Health
20
A]er legalizaTon in 18
Colorado, past month 16
MJ use: 14
% Age 12-17
• Increased by 20% in 12
Colorado 10 NaAonal
Average
• Declined 4% naAonally 8
6 Colorado
• Colorado youth ranked #1 in Average
the naAon, up from #4 4
2
• In Colorado was 74% higher
0
than the naAonal average
compared to 39%.
SAMHSA, 20152016 IniTaTves
Control, Regulate and Tax Adult Use Marijuana LegalizaTon IniTaTve
of Marijuana Act (AUMA) Statute (ReformCA)
• Backed by Sean Parker, Lt. • CoaliAon for Cannabis Policy
Governor Gavin Newsom, Reform
Drug Policy Alliance, • Grants authority to the
Marijuana Policy Project California Cannabis
• Grants local authority to Commission
local and state governments
BOTH INITIATIVES ALLOW…..
• Industry representaAon in decision-making
• MarkeAng to under age 21Concerns About Retail
Cannabis Use
• NormalizaTon of marijuana use
– In 2013, 19% of HS seniors reported they would
try if legal for general use.
• Unanswered quesTons about effects of
secondhand marijuana smoke exposure
• MarkeTng will reach youth
– Products appealing to youth
– AdverAsements in youth-consumed media (online).
– “CigareYe people maintain peer pressure is the culprit in geyng
kids to start smoking and that adverAsing has liYle effect. That’s
like saying cosmeAc ads have no effect on girls too young to put
on lipsAck.” (Commentator in Adver6sing Age trade journal)
• Limited regulaTons on dosing (esp. edibles)Summary
• Marijuana is used frequently, especially by
youth and young adults, and can cause short
and long term health effects
• Lidle is known about the effects of legalizaTon
on youth use and associated consequences.
• Yet, despite the lack of what is known:
– Legal landscape is changing rapidly, incl. in CA
– MarkeAng (incl. to youth) is going full steam ahead
– In the absence of regulaAon, parents play an
important role in sending messages about MJ use to
teensWhat Parents Can Do • What you model is criAcally important • Establish open communicaAon – Ask open-ended quesAons – Listen, listen and listen! Use the 3 to 1 rule – Control your emoAons • Show you care (1:1 Ame) • Set limits (It’s no too late!) • Show acceptance and respect independence/ privacy
How to Talk to Teens
About Marijuana
• Have conversaAons, not lectures
– Use ballot iniAaAve(s) or this talk as lead-in
– Ask open-ended quesAons
• Share facts/ask quesAons about marijuana
that counteract “harmless” noAon.
– Affects the teen brain
– Involved in accidents/deaths, especially for teens
– New laws will create an industry focused on $$
• Share reasons NOT to smoke/vape
• Discuss how MJ is portrayed in the media
• Discuss how to handle peer pressureMore informaTon
• NIDA for Teens
– hYps://teens.drugabuse.gov
• NIDA info on Marijuana
– hYp://www.drugabuse.gov/drugs-abuse/marijuana
• CA Blue Ribbon Commission on MJ Policy
– hYps://www.safeandsmartpolicy.org
• California Society for AddicAon Medicine: Youth
First IniAaAve
– hYp://www.csam-asam.org/sites/default/files/
csam_youth_first_final_14.pdfCommon Scenarios • “Have you ever smoked marijuana?” • “How old were you when you first tried marijuana?” • You overhear your child and a friend talking about an e-cigareYe device that “you can use with marijuana and no one can smell it.” • Your child says that you should vote to legalize marijuana use in CA because the drug war is racist and unethical. • Your son or daughter comes home from a party clearly high. • Your son or daughter has turned 18 and wants to get a medical marijuana card. • You’ve seen recent changes in mood/friends/school performance and you’re worried your son/daughter is using too much marijuana.
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