The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update
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POLICY STATEMENT Organizational Principles to Guide and Define the Child Health
Care System and/or Improve the Health of all Children
The Impact of Marijuana Policies on
Youth: Clinical, Research, and Legal
Update
COMMITTEE ON SUBSTANCE ABUSE and COMMITTEE ON ADOLESCENCE
This policy statement is an update of the American Academy of Pediatrics abstract
policy statement “Legalization of Marijuana: Potential Impact on Youth,”
published in 2004. Pediatricians have special expertise in the care of children
and adolescents and may be called on to advise legislators about the potential
impact of changes in the legal status of marijuana on adolescents. Parents
also may look to pediatricians for advice as they consider whether to support
state-level initiatives that propose to legalize the use of marijuana for medical
and nonmedical purposes or to decriminalize the possession of small amounts
of marijuana. This policy statement provides the position of the American
Academy of Pediatrics on the issue of marijuana legalization. The
accompanying technical report reviews what is currently known about the
relationships of marijuana use with health and the developing brain and the
legal status of marijuana and adolescents’ use of marijuana to better
understand how change in legal status might influence the degree of
This document is copyrighted and is property of the American
marijuana use by adolescents in the future. Academy of Pediatrics and its Board of Directors. All authors have filed
conflict of interest statements with the American Academy of
Pediatrics. Any conflicts have been resolved through a process
approved by the Board of Directors. The American Academy of
Pediatrics has neither solicited nor accepted any commercial
involvement in the development of the content of this publication.
DEFINITIONS
Policy statements from the American Academy of Pediatrics benefit
For the purpose of clarifying terminology, the following are definitions from expertise and resources of liaisons and internal (AAP) and
used in this policy statement and the accompanying technical report1: external reviewers. However, policy statements from the American
Academy of Pediatrics may not reflect the views of the liaisons or the
organizations or government agencies that they represent.
Legalization
The guidance in this statement does not indicate an exclusive course
Allowing cultivation, sale, and use of cannabis (restricted to adults of treatment or serve as a standard of medical care. Variations, taking
$21 years of age). into account individual circumstances, may be appropriate.
All policy statements from the American Academy of Pediatrics
Legalization of Medical Marijuana automatically expire 5 years after publication unless reaffirmed,
revised, or retired at or before that time.
Allowing the use of marijuana to treat a medical condition or symptom
with a recommendation from a physician. www.pediatrics.org/cgi/doi/10.1542/peds.2014-4146
DOI: 10.1542/peds.2014-4146
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2015 by the American Academy of Pediatrics
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PEDIATRICS Volume 135, number 3, March 2015 FROM THE AMERICAN ACADEMY OF PEDIATRICSDecriminalization marijuana did not start in Colorado decreasing nausea and vomiting in
Reducing penalties for cannabis- until January 1, 2014, the patients with cancer and for chronic
related offenses to lesser criminal postlegalization 2013 rates of youth pain syndromes,5,6 although side
charges or to civil penalties. use increased.4 It is possible that effects of dizziness and dysphoria
public health campaigns that may also be experienced. There are
effectively communicate the harms no published studies on the use of
INTRODUCTION associated with teen marijuana use medicinal marijuana or
Marijuana is the most commonly could reduce youth use despite pharmaceutical cannabinoids in
used illicit substance among legalization. Legalization campaigns pediatric populations.
adolescents.2 Recreational sale and that imply that marijuana is a benign
possession of marijuana by adults substance present a significant
remain illegal in most states and challenge for educating the public EFFECTS OF MARIJUANA
remain illegal under federal law. about its known risks and adverse The adverse effects of marijuana have
However, a number of states and effects. Therefore, it is unclear what been well documented, and studies
local jurisdictions have the impact of legalization of have demonstrated the potential
decriminalized the possession of marijuana for adults will have on the negative consequences of short- and
marijuana for recreational use by prevalence of marijuana use by long-term recreational use of
adults, reducing penalties to adolescents, especially if the marijuana in adolescents. These
misdemeanors or citations. Many implementation of legalization consequences include impaired short-
states also have legalized medical includes messaging that minimizes term memory and decreased
marijuana for adults who receive the health and behavioral risks. concentration, attention span, and
recommendations for use by Substance abuse by adolescents is an problem solving, which clearly
physicians. Almost all states with ongoing health concern. Marijuana interfere with learning. Alterations in
medical marijuana laws allow access remains classified in the Controlled motor control, coordination,
by minors, though often with greater Substances Act (21 USC x801-971 judgment, reaction time, and tracking
regulation. States in which marijuana [2012]) as a schedule I drug. This ability have also been documented7;
is legal prohibit marijuana sales to classification implies that it has these may contribute to unintentional
and use by minors, but changes in a high potential for abuse, has no deaths and injuries among
the legal status of marijuana, even if currently accepted medical use in the adolescents (especially those
limited to adults, may affect the United States, and lacks accepted associated with motor vehicles if
prevalence of use among safety for use under supervision by adolescents drive while intoxicated
adolescents. Although the a physician. Despite this by marijuana).8 Negative health
epidemiologic data are not classification by the federal effects on lung function associated
consistent across states and time government, marijuana has been with smoking marijuana have also
periods, with the exception of legalized for medical purposes in been documented, and studies linking
Michigan and New Mexico, in all a number of states, in direct marijuana use with higher rates of
states where medical marijuana has opposition to federal law. Since the psychosis in patients with
been legalized, marijuana use by first policy statement from the a predisposition to schizophrenia
minors has been stable or has American Academy of Pediatrics have recently been published,9 raising
decreased.3 Youth substance use (AAP) on the legalization of concerns about longer-term
rates depend on a number of factors, marijuana was published in 2004, psychiatric effects. New research has
including legal status, availability limited research has been performed also demonstrated that the
and ease of access of the substance, to examine the potential therapeutic adolescent brain, particularly the
and perception of harm. For example, effects of marijuana for adults, prefrontal cortex areas controlling
although tobacco is easily accessible, specifically the class of chemicals judgment and decision-making, is not
youth tobacco use rates have known as cannabinoids, which are fully developed until the mid-20s,
decreased substantially since the responsible for most of the medicinal raising questions about how any
1990s, in conjunction with effects of marijuana. This research substance use may affect the
aggressive public health campaigns has demonstrated that both the developing brain. Research has
warning of the medical drugs approved by the US Food and shown that the younger an adolescent
consequences of smoking. In Drug Administration and other begins using drugs, including
Colorado, the passage of the pharmaceutical cannabinoids, such marijuana, the more likely it is that
amendment to legalize recreational as cannabidiol, can be helpful for drug dependence or addiction will
marijuana occurred in November adults with specific conditions, such develop in adulthood.10 A recent
2012. Although sales of recreational as increasing appetite and analysis of 4 large epidemiologic
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2 FROM THE AMERICAN ACADEMY OF PEDIATRICStrials found that marijuana use during medical marijuana and the adverse a schedule II drug to facilitate
adolescence is associated with effects of marijuana use, the impact of this research.
reductions in the odds of high school criminal penalties particularly on 6. Although the AAP does not
completion and degree attainment minority teens and communities, and condone state laws that allow the
and increases in the use of other illicit adolescent brain development related sale of marijuana products,
drugs and suicide attempts in a dose- to substance use, is available in the in states where recreational
dependent fashion that suggests that accompanying technical report.1 marijuana is currently legal,
marijuana use is causative.11 pediatricians should advocate
that states regulate the product
DECRIMINALIZATION EFFORTS AND RECOMMENDATIONS as closely as possible to tobacco
EFFECTS 1. Given the data supporting the and alcohol, with a minimum age
The illegality of marijuana has negative health and brain de- of 21 years for purchase. Revenue
resulted in the incarceration of velopment effects of marijuana in from this regulation should be
hundreds of thousands of children and adolescents, ages used to support research on the
adolescents, with overrepresentation 0 through 21 years, the AAP is health risks and benefits of
of minority youth.12 A criminal record opposed to marijuana use in this marijuana. These regulations should
can have lifelong negative effects on population. include strict penalties for those
an adolescent who otherwise has had 2. The AAP opposes “medical who sell marijuana or marijuana
no criminal justice history. These marijuana” outside the regulatory products to those younger than
effects can include ineligibility for process of the US Food and Drug 21 years, education and diversion
college loans, housing, financial aid, Administration. Notwithstanding programs for people younger than
and certain kinds of jobs.13 In states this opposition to use, the AAP 21 years who possess marijuana,
that have passed decriminalization recognizes that marijuana point-of-sale restrictions, and
laws, marijuana use is still illegal, may currently be an option for other marketing restrictions.
although the consequences of cannabinoid administration for 7. In states where marijuana is sold
possession and use are less punitive. children with life-limiting or legally, either for medical or
Although these laws are not severely debilitating conditions recreational purposes, regulations
applicable to adolescents in all states, and for whom current therapies should be enacted to ensure that
the changes in the law are intended to are inadequate. marijuana in all forms is distributed
address and reduce the long-term 3. The AAP opposes legalization in childproof packaging, to
effects that felony charges can have of marijuana because of the prevent accidental ingestion.
on youth and young adults.13 potential harms to children and 8. The AAP strongly supports the de-
Continued efforts to address this adolescents. The AAP supports criminalization of marijuana use
problem are based on issues of social studying the effects of recent for both minors and young adults
justice, given the disparate rate of laws legalizing the use of marijuana and encourages pediatricians to
adjudication for drug offenses for youth to better understand the impact advocate for laws that prevent
of racial minority groups compared and define best policies to reduce harsh criminal penalties for
with white youth. Advocates of adolescent marijuana use. possession or use of marijuana. A
decriminalization have also sought focus on treatment for adolescents
4. In states that have legalized
to increase the availability of drug with marijuana use problems should
marijuana for recreational
treatment services.14 be encouraged, and adolescents
purposes, the AAP strongly
recommends strict enforcement with marijuana use problems
CONCLUSIONS of rules and regulations that should be referred to treatment.
Ultimately, the behavioral and health limit access and marketing and 9. The AAP strongly opposes the use of
risks associated with marijuana use advertising to youth. smoked marijuana because smoking
by youth should be the most salient 5. The AAP strongly supports is known to cause lung damage,15
criteria in determining whether research and development of and the effects of secondhand
policies that are enacted are effective pharmaceutical cannabinoids and marijuana smoke are unknown.
in minimizing harm. More supports a review of policies 10. The AAP discourages the use of
information, including the legal status promoting research on the marijuana by adults in the pres-
of marijuana for both recreational medical use of these compounds. ence of minors because of the im-
and medical use, the effect of legal The AAP recommends changing portant influence of role modeling
status on rates of use by adolescents marijuana from a Drug Enforcement by adults on child and adolescent
and young adults, research on Administration schedule I to behavior.
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PEDIATRICS Volume 135, number 3, March 2015 3LEAD AUTHORS report: the impact of marijuana policies driving performance. Publication no.
Seth D. Ammerman, MD, FAAP on youth: clinical, research, and legal 808–078. Washington, DC: US Department
Sheryl A. Ryan, MD, FAAP update. Pediatrics. 2015; (in press) of Transportation; 1993. Available at:
*William P. Adelman, MD, FAAP 2. Monitoring the Future. Trends in 30-day http://druglibrary.org/schaffer/misc/
prevalence of use of various drugs in driving/driving.htm. Accessed October 3,
COMMITTEE ON SUBSTANCE ABUSE, 2014
grades 8, 10, and 12. Table 3. Ann Arbor,
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MI: University of Michigan; 2013. 9. Moore THM, Zammit S, Lingford-Hughes
Sharon Levy, MD, MPH, FAAP, Chairperson Available at: www.monitoringthefuture. A, et al. Cannabis use and risk of
Seth D. Ammerman, MD, FAAP
org/data/10data/pr10t3.pdf psychotic or affective mental health
Pamela K. Gonzalez, MD, FAAP
3. Lynne-Landsman SD, Livingston MD, outcomes: a systematic review. Lancet.
Sheryl A. Ryan, MD, FAAP
Lorena M. Siqueira, MD, MSPH, FAAP Wagenaar AC. Effects of state medical 2007;370(9584):319–328. Available at:
Vincent C. Smith, MD, MPH, FAAP marijuana laws on adolescent marijuana www.ncbi.nlm.nih.gov/pubmed/
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LIAISONS
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James Baumberger, MPP
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Katie Crumley, MPP
Renee Jarrett, MPH Findings. In: N.S.D.U.H. series H-48, Vol 11. Silins E, Horwood LJ, Patton GC, et al.
HHS Public. Rockville, MD: Substance Young adult sequelae of adolescent
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Paula K. Braverman, MD, FAAP, Chairperson at: www.samhsa.gov/data/NSDUH/ Available at: www.thelancet.com/
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4 FROM THE AMERICAN ACADEMY OF PEDIATRICSThe Impact of Marijuana Policies on Youth: Clinical, Research, and Legal
Update
COMMITTEE ON SUBSTANCE ABUSE and COMMITTEE ON ADOLESCENCE
Pediatrics; originally published online January 26, 2015;
DOI: 10.1542/peds.2014-4146
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/early/2015/01/20
/peds.2014-4146
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned, published,
and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk
Grove Village, Illinois, 60007. Copyright © 2015 by the American Academy of Pediatrics. All
rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Downloaded from pediatrics.aappublications.org by guest on March 4, 2015The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal
Update
COMMITTEE ON SUBSTANCE ABUSE and COMMITTEE ON ADOLESCENCE
Pediatrics; originally published online January 26, 2015;
DOI: 10.1542/peds.2014-4146
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/early/2015/01/20/peds.2014-4146
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2015 by the American Academy
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
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