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Legalization of marijuana and youths’ attitudes toward its use

The legal status of marijuana has changed a great deal during the last 4 decades. In the United States, several states have legalized the use of marijuana to treat several medical conditions. Some states have decriminalized marijuana possession, and several have legalized marijuana for recreational use by adults. These changes have contributed to a growing misperception among young people that marijuana is harmless or not as risky as other illicit substances.

In this article, I explore the effect the legalization of marijuana has had on young peoples’ attitudes toward its use.

Marijuana use among adolescents

Among adolescents, marijuana is the most commonly used illicit substance, after alcohol.1 According to data from the 2019 Monitoring the Future Survey, while past month, past year, and lifetime marijuana use among 8th and 10th graders remained steady from 2018 to 2019, daily marijuana use among these adolescents increased.2 This survey also reported increases in adolescent marijuana vaping from 2018 to 2019.2 Further, the percentage of adolescents who think that the regular use of marijuana is risky has been trending down since the mid-2000s.2

Youth substance use rates depend on numerous factors, including legal status, availability, ease of access to the substance, and perception of harm.3 Although the legalization of marijuana for recreational use has been for adults only, based on rates of tobacco and alcohol use in adolescents (both of which are legal for adults), the legalization of marijuana is likely to have implications for adolescents.4

Adverse effects among adolescents

During adolescence, the brain is still developing, and marijuana use during this time could cause decreased cognitive functioning, especially executive functions.4 Marijuana use by adolescents also has been associated with4,5:

  • an increased risk of mental health disorders, including depression, anxiety, and psychosis, particularly among adolescents at higher risk, such as those with a family history of psychiatric illness
  • a decline in school performance
  • an increased school dropout rate
  • an increased risk of marijuana de­pen­dence
  • an elevated rate of engaging in risky behaviors.

Factors by which the legalization of marijuana might increase its use among adolescents include4:

  • perceived decreased risk of marijuana use
  • increased availability
  • lower cost
  • decreased fear of legal consequences of marijuana use.

Increased parental use is an indirect way in which legalization of marijuana for adult recreational use might increase use in youth.

Continue to: What the evidence says

 

 

What the evidence says

Colorado legalized marijuana for medical use in 2000, and for adult recreational use in 2014. A 2012 study of adolescents receiving substance abuse treatment in Colorado found diversion of medical marijuana to these adolescents was common.6 This study also reported that compared with those who did not use medical marijuana, adolescents who used medical marijuana had an earlier age of regular marijuana use, more marijuana use disorder symptoms, and more symptoms of conduct disorder.6 However, data from the US Substance Abuse and Mental Health Services Administration7 and from the Colorado Department of Public Health & Environment8 suggest that marijuana use among adolescents has not increased since legalization in Colorado.

In 2012, voters in Washington state legalized marijuana for recreational use. In 2013, Moreno et al9 interviewed college students in Washington, where marijuana had just been legalized, and Wisconsin, where it had not. In both states, most participants indicated that legalization would not change their attitude towards use. A small proportion of students felt that legalization would signify an endorsement of marijuana, and they were likely to perceive it as safe to use.

In an analysis of data on more than 250,000 students in 8th, 10th, and 12th grade, Cerdá et al10 found that after legalization in Washington, the perceived harmfulness of marijuana decreased and marijuana use increased among 8th and 10th graders in Washington; however, there were no significant differences noted among adolescents in Colorado.

In 2010, voters in California passed legislation to decriminalize marijuana. In an analysis of data from 8th, 10th, and 12th graders in California, Miech et al11 found a positive correlation between decriminalization and increases in youth future marijuana use. They also found that compared with their peers in other states, 12thgraders in California were more likely to have used marijuana in the last 30 days, less likely to perceive marijuana use as a health risk, and less likely to disapprove of its use.11

Although some studies have suggested that legalization of marijuana might increase use among adolescents, limitations of these studies include that they relied on self-reported use by adolescents, and they did not evaluate adolescent populations outside of school settings.

Continue to: Addressing adolescents' marijuana use

 

 

Addressing adolescents’ marijuana use

Strategies for preventing or reducing marijuana use among adolescents might include imposing restrictions and passing stricter laws on the sale of marijuana to individuals age <21, regulating marijuana advertising, increasing adolescent substance use prevention program initiatives, and educating youth about the negative effects of marijuana. Further research is needed to clearly establish if the legalization of marijuana for adult recreational use will increase its use among adolescents.

References

1. US Department of Health & Human Services. Marijuana use in adolescence. https://www.hhs.gov/ash/oah/adolescent-development/substance-use/marijuana/index.html. Updated April 19, 2019. Accessed January 15, 2020.
2. University of Michigan Institute for Social Research. National adolescent drug trends in 2019: Findings released. http://monitoringthefuture.org//pressreleases/19drugpr.pdf. Updated December 18, 2019. Accessed January 13, 2020.
3. Ammerman S, Ryan S, William P; Committee on Substance Abuse, the Committee on Adolescence. The impact of marijuana policies on youth: clinical, research, and legal update. Pediatrics. 2015;135(3):584-587.
4. Hopfer C. Implications of marijuana legalization for adolescent substance use. Subst Abus. 2014;35(4):331-335.
5. Silins E, Horwood LJ, Patton GC, et al. Young adult sequelae of adolescent cannabis use: an integrative analysis. Lancet Psychiatry. 2014;1(4):286-293.
6. Salomonsen-Sautel S, Sakai JT, Thurstone C, et al. Medical marijuana use among adolescents in substance abuse treatment. J Am Acad Child Adolesc Psychiatry. 2012;51(7):694-702.
7. US Department of Health & Human Services. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health: Comparison of 2014-2015 and 2015-2016 Population Percentages (50 States and the District of Columbia). https://www.samhsa.gov/data/sites/default/files/NSDUHsaeShortTermCHG2016/NSDUHsaeShortTermCHG2016.htm. Accessed January 15, 2020.
8. Colorado Department of Public Health & Environment. Data Brief: Colorado youth marijuana use 2017. https://drive.google.com/file/d/1AX_2RWWgygGXtGpAGoOMTe84Crzsv62T/view. Accessed January 15, 2020.
9. Moreno MA, Whitehill JM, Quach V, et al. Marijuana experiences, voting behaviors, and early perspectives regarding marijuana legalization among college students from 2 states. J Am Coll Health. 2016;64(1):9-18.
10. Cerdá M, Wall M, Feng T, et al. Association of state recreational marijuana laws with adolescent marijuana use. JAMA Pediatrics. 2017;171(2):142-149.
11. Miech RA, Johnston L, O’Malley PM, et al. Trends in use of marijuana and attitudes toward marijuana among youth before and after decriminalization: the case of California 2007-2013. Int J Drug Policy. 2015;26(4):336-344.

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Dr. Dsouza is a PGY-5 Psychiatry Resident, Division of Child & Adolescent Psychiatry, Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Glen Oaks, New York.

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Dr. Dsouza is a PGY-5 Psychiatry Resident, Division of Child & Adolescent Psychiatry, Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Glen Oaks, New York.

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The author reports no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.

Author and Disclosure Information

Dr. Dsouza is a PGY-5 Psychiatry Resident, Division of Child & Adolescent Psychiatry, Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, Glen Oaks, New York.

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The author reports no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.

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The legal status of marijuana has changed a great deal during the last 4 decades. In the United States, several states have legalized the use of marijuana to treat several medical conditions. Some states have decriminalized marijuana possession, and several have legalized marijuana for recreational use by adults. These changes have contributed to a growing misperception among young people that marijuana is harmless or not as risky as other illicit substances.

In this article, I explore the effect the legalization of marijuana has had on young peoples’ attitudes toward its use.

Marijuana use among adolescents

Among adolescents, marijuana is the most commonly used illicit substance, after alcohol.1 According to data from the 2019 Monitoring the Future Survey, while past month, past year, and lifetime marijuana use among 8th and 10th graders remained steady from 2018 to 2019, daily marijuana use among these adolescents increased.2 This survey also reported increases in adolescent marijuana vaping from 2018 to 2019.2 Further, the percentage of adolescents who think that the regular use of marijuana is risky has been trending down since the mid-2000s.2

Youth substance use rates depend on numerous factors, including legal status, availability, ease of access to the substance, and perception of harm.3 Although the legalization of marijuana for recreational use has been for adults only, based on rates of tobacco and alcohol use in adolescents (both of which are legal for adults), the legalization of marijuana is likely to have implications for adolescents.4

Adverse effects among adolescents

During adolescence, the brain is still developing, and marijuana use during this time could cause decreased cognitive functioning, especially executive functions.4 Marijuana use by adolescents also has been associated with4,5:

  • an increased risk of mental health disorders, including depression, anxiety, and psychosis, particularly among adolescents at higher risk, such as those with a family history of psychiatric illness
  • a decline in school performance
  • an increased school dropout rate
  • an increased risk of marijuana de­pen­dence
  • an elevated rate of engaging in risky behaviors.

Factors by which the legalization of marijuana might increase its use among adolescents include4:

  • perceived decreased risk of marijuana use
  • increased availability
  • lower cost
  • decreased fear of legal consequences of marijuana use.

Increased parental use is an indirect way in which legalization of marijuana for adult recreational use might increase use in youth.

Continue to: What the evidence says

 

 

What the evidence says

Colorado legalized marijuana for medical use in 2000, and for adult recreational use in 2014. A 2012 study of adolescents receiving substance abuse treatment in Colorado found diversion of medical marijuana to these adolescents was common.6 This study also reported that compared with those who did not use medical marijuana, adolescents who used medical marijuana had an earlier age of regular marijuana use, more marijuana use disorder symptoms, and more symptoms of conduct disorder.6 However, data from the US Substance Abuse and Mental Health Services Administration7 and from the Colorado Department of Public Health & Environment8 suggest that marijuana use among adolescents has not increased since legalization in Colorado.

In 2012, voters in Washington state legalized marijuana for recreational use. In 2013, Moreno et al9 interviewed college students in Washington, where marijuana had just been legalized, and Wisconsin, where it had not. In both states, most participants indicated that legalization would not change their attitude towards use. A small proportion of students felt that legalization would signify an endorsement of marijuana, and they were likely to perceive it as safe to use.

In an analysis of data on more than 250,000 students in 8th, 10th, and 12th grade, Cerdá et al10 found that after legalization in Washington, the perceived harmfulness of marijuana decreased and marijuana use increased among 8th and 10th graders in Washington; however, there were no significant differences noted among adolescents in Colorado.

In 2010, voters in California passed legislation to decriminalize marijuana. In an analysis of data from 8th, 10th, and 12th graders in California, Miech et al11 found a positive correlation between decriminalization and increases in youth future marijuana use. They also found that compared with their peers in other states, 12thgraders in California were more likely to have used marijuana in the last 30 days, less likely to perceive marijuana use as a health risk, and less likely to disapprove of its use.11

Although some studies have suggested that legalization of marijuana might increase use among adolescents, limitations of these studies include that they relied on self-reported use by adolescents, and they did not evaluate adolescent populations outside of school settings.

Continue to: Addressing adolescents' marijuana use

 

 

Addressing adolescents’ marijuana use

Strategies for preventing or reducing marijuana use among adolescents might include imposing restrictions and passing stricter laws on the sale of marijuana to individuals age <21, regulating marijuana advertising, increasing adolescent substance use prevention program initiatives, and educating youth about the negative effects of marijuana. Further research is needed to clearly establish if the legalization of marijuana for adult recreational use will increase its use among adolescents.

The legal status of marijuana has changed a great deal during the last 4 decades. In the United States, several states have legalized the use of marijuana to treat several medical conditions. Some states have decriminalized marijuana possession, and several have legalized marijuana for recreational use by adults. These changes have contributed to a growing misperception among young people that marijuana is harmless or not as risky as other illicit substances.

In this article, I explore the effect the legalization of marijuana has had on young peoples’ attitudes toward its use.

Marijuana use among adolescents

Among adolescents, marijuana is the most commonly used illicit substance, after alcohol.1 According to data from the 2019 Monitoring the Future Survey, while past month, past year, and lifetime marijuana use among 8th and 10th graders remained steady from 2018 to 2019, daily marijuana use among these adolescents increased.2 This survey also reported increases in adolescent marijuana vaping from 2018 to 2019.2 Further, the percentage of adolescents who think that the regular use of marijuana is risky has been trending down since the mid-2000s.2

Youth substance use rates depend on numerous factors, including legal status, availability, ease of access to the substance, and perception of harm.3 Although the legalization of marijuana for recreational use has been for adults only, based on rates of tobacco and alcohol use in adolescents (both of which are legal for adults), the legalization of marijuana is likely to have implications for adolescents.4

Adverse effects among adolescents

During adolescence, the brain is still developing, and marijuana use during this time could cause decreased cognitive functioning, especially executive functions.4 Marijuana use by adolescents also has been associated with4,5:

  • an increased risk of mental health disorders, including depression, anxiety, and psychosis, particularly among adolescents at higher risk, such as those with a family history of psychiatric illness
  • a decline in school performance
  • an increased school dropout rate
  • an increased risk of marijuana de­pen­dence
  • an elevated rate of engaging in risky behaviors.

Factors by which the legalization of marijuana might increase its use among adolescents include4:

  • perceived decreased risk of marijuana use
  • increased availability
  • lower cost
  • decreased fear of legal consequences of marijuana use.

Increased parental use is an indirect way in which legalization of marijuana for adult recreational use might increase use in youth.

Continue to: What the evidence says

 

 

What the evidence says

Colorado legalized marijuana for medical use in 2000, and for adult recreational use in 2014. A 2012 study of adolescents receiving substance abuse treatment in Colorado found diversion of medical marijuana to these adolescents was common.6 This study also reported that compared with those who did not use medical marijuana, adolescents who used medical marijuana had an earlier age of regular marijuana use, more marijuana use disorder symptoms, and more symptoms of conduct disorder.6 However, data from the US Substance Abuse and Mental Health Services Administration7 and from the Colorado Department of Public Health & Environment8 suggest that marijuana use among adolescents has not increased since legalization in Colorado.

In 2012, voters in Washington state legalized marijuana for recreational use. In 2013, Moreno et al9 interviewed college students in Washington, where marijuana had just been legalized, and Wisconsin, where it had not. In both states, most participants indicated that legalization would not change their attitude towards use. A small proportion of students felt that legalization would signify an endorsement of marijuana, and they were likely to perceive it as safe to use.

In an analysis of data on more than 250,000 students in 8th, 10th, and 12th grade, Cerdá et al10 found that after legalization in Washington, the perceived harmfulness of marijuana decreased and marijuana use increased among 8th and 10th graders in Washington; however, there were no significant differences noted among adolescents in Colorado.

In 2010, voters in California passed legislation to decriminalize marijuana. In an analysis of data from 8th, 10th, and 12th graders in California, Miech et al11 found a positive correlation between decriminalization and increases in youth future marijuana use. They also found that compared with their peers in other states, 12thgraders in California were more likely to have used marijuana in the last 30 days, less likely to perceive marijuana use as a health risk, and less likely to disapprove of its use.11

Although some studies have suggested that legalization of marijuana might increase use among adolescents, limitations of these studies include that they relied on self-reported use by adolescents, and they did not evaluate adolescent populations outside of school settings.

Continue to: Addressing adolescents' marijuana use

 

 

Addressing adolescents’ marijuana use

Strategies for preventing or reducing marijuana use among adolescents might include imposing restrictions and passing stricter laws on the sale of marijuana to individuals age <21, regulating marijuana advertising, increasing adolescent substance use prevention program initiatives, and educating youth about the negative effects of marijuana. Further research is needed to clearly establish if the legalization of marijuana for adult recreational use will increase its use among adolescents.

References

1. US Department of Health & Human Services. Marijuana use in adolescence. https://www.hhs.gov/ash/oah/adolescent-development/substance-use/marijuana/index.html. Updated April 19, 2019. Accessed January 15, 2020.
2. University of Michigan Institute for Social Research. National adolescent drug trends in 2019: Findings released. http://monitoringthefuture.org//pressreleases/19drugpr.pdf. Updated December 18, 2019. Accessed January 13, 2020.
3. Ammerman S, Ryan S, William P; Committee on Substance Abuse, the Committee on Adolescence. The impact of marijuana policies on youth: clinical, research, and legal update. Pediatrics. 2015;135(3):584-587.
4. Hopfer C. Implications of marijuana legalization for adolescent substance use. Subst Abus. 2014;35(4):331-335.
5. Silins E, Horwood LJ, Patton GC, et al. Young adult sequelae of adolescent cannabis use: an integrative analysis. Lancet Psychiatry. 2014;1(4):286-293.
6. Salomonsen-Sautel S, Sakai JT, Thurstone C, et al. Medical marijuana use among adolescents in substance abuse treatment. J Am Acad Child Adolesc Psychiatry. 2012;51(7):694-702.
7. US Department of Health & Human Services. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health: Comparison of 2014-2015 and 2015-2016 Population Percentages (50 States and the District of Columbia). https://www.samhsa.gov/data/sites/default/files/NSDUHsaeShortTermCHG2016/NSDUHsaeShortTermCHG2016.htm. Accessed January 15, 2020.
8. Colorado Department of Public Health & Environment. Data Brief: Colorado youth marijuana use 2017. https://drive.google.com/file/d/1AX_2RWWgygGXtGpAGoOMTe84Crzsv62T/view. Accessed January 15, 2020.
9. Moreno MA, Whitehill JM, Quach V, et al. Marijuana experiences, voting behaviors, and early perspectives regarding marijuana legalization among college students from 2 states. J Am Coll Health. 2016;64(1):9-18.
10. Cerdá M, Wall M, Feng T, et al. Association of state recreational marijuana laws with adolescent marijuana use. JAMA Pediatrics. 2017;171(2):142-149.
11. Miech RA, Johnston L, O’Malley PM, et al. Trends in use of marijuana and attitudes toward marijuana among youth before and after decriminalization: the case of California 2007-2013. Int J Drug Policy. 2015;26(4):336-344.

References

1. US Department of Health & Human Services. Marijuana use in adolescence. https://www.hhs.gov/ash/oah/adolescent-development/substance-use/marijuana/index.html. Updated April 19, 2019. Accessed January 15, 2020.
2. University of Michigan Institute for Social Research. National adolescent drug trends in 2019: Findings released. http://monitoringthefuture.org//pressreleases/19drugpr.pdf. Updated December 18, 2019. Accessed January 13, 2020.
3. Ammerman S, Ryan S, William P; Committee on Substance Abuse, the Committee on Adolescence. The impact of marijuana policies on youth: clinical, research, and legal update. Pediatrics. 2015;135(3):584-587.
4. Hopfer C. Implications of marijuana legalization for adolescent substance use. Subst Abus. 2014;35(4):331-335.
5. Silins E, Horwood LJ, Patton GC, et al. Young adult sequelae of adolescent cannabis use: an integrative analysis. Lancet Psychiatry. 2014;1(4):286-293.
6. Salomonsen-Sautel S, Sakai JT, Thurstone C, et al. Medical marijuana use among adolescents in substance abuse treatment. J Am Acad Child Adolesc Psychiatry. 2012;51(7):694-702.
7. US Department of Health & Human Services. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health: Comparison of 2014-2015 and 2015-2016 Population Percentages (50 States and the District of Columbia). https://www.samhsa.gov/data/sites/default/files/NSDUHsaeShortTermCHG2016/NSDUHsaeShortTermCHG2016.htm. Accessed January 15, 2020.
8. Colorado Department of Public Health & Environment. Data Brief: Colorado youth marijuana use 2017. https://drive.google.com/file/d/1AX_2RWWgygGXtGpAGoOMTe84Crzsv62T/view. Accessed January 15, 2020.
9. Moreno MA, Whitehill JM, Quach V, et al. Marijuana experiences, voting behaviors, and early perspectives regarding marijuana legalization among college students from 2 states. J Am Coll Health. 2016;64(1):9-18.
10. Cerdá M, Wall M, Feng T, et al. Association of state recreational marijuana laws with adolescent marijuana use. JAMA Pediatrics. 2017;171(2):142-149.
11. Miech RA, Johnston L, O’Malley PM, et al. Trends in use of marijuana and attitudes toward marijuana among youth before and after decriminalization: the case of California 2007-2013. Int J Drug Policy. 2015;26(4):336-344.

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