The perception of the dangers of marijuana use has changed dramatically since the first anti-drug movie about the subject - Reefer Madness - was released in 1936. The fact that this movie is now considered a “comedy” rather than its original designation as a “documentary,” speaks volumes about this change. The relaxation of the stigma associated with pot consumption is presenting another challenge for parents and pediatricians: adolescents and younger children are increasing their use of marijuana.The Center for Disease Control and Prevention (CDC) notes that “marijuana (cannabis) is the most commonly used illicit drug in the United States. Data from the National Survey on Drug Use and Health in 2013, indicated that approximately 2.4 million persons, aged 12 years and older, had used marijuana for the first time during the preceding 12 months, an average of approximately 6,600 new users each day.” The agency also advised that increased trends in marijuana use can often coincide with decreased trends in its perceived risk.
According to the American Academy of Pediatrics (AAP), “The legalization of medical marijuana in many states and the District of Columbia (D.C.) and the outright legalization of recreational marijuana for adults aged 21 years and older in a few states and D.C. have resulted in changes in the access to and availability of this drug. Most of these states now allow the use of marijuana for a variety of medical conditions in adults as well as in children (with parental permission). In addition, many states have reduced penalties for the recreational use of marijuana; criminal penalties have been reduced from felonies in some cases to misdemeanors or infractions.”
This AAP report also pointed to the potential for abuse of this controlled substance by children. The National Survey on Drug Use and Health recently documented a decline in the percentage of 12- to 17-year-olds who perceived that there is “great risk” in smoking marijuana once a month or 1 to 2 times per week. This concerns parents and pediatricians because “the same survey has documented that decreases in perceived risk typically precede or occur at the same time as increases in use. Plus, the concentration of tetrahydrocannabinol (THC), the psychoactive substance in the marijuana plant, has increased considerably, from approximately 4% in the early 1980s to upward of 12% in 2012, increasing the risk of adverse effects and the potential for addiction.”
What Marijuana Use Among Children Means to Pediatricians
As is often the case, pediatricians are the first line of defense for dealing with societal challenges that affect children. From the increase in juvenile suicide attempts, to gender stigmatization, to chronic childhood obesity, pediatricians have a unique responsibility to counsel both their patients - the children - and their parents.
There are compelling scientific reasons for a practitioner to urge abstinence, or at the very least, delay in the use of this drug. Research from the University of Montreal pointed to the benefits of delaying marijuana use. “What a difference a year or two can make: If you started smoking marijuana at the start of your teens, your risk of having a drug abuse problem by age 28 is 68 percent, but if you started smoking between 15 and 17 your risk drops to 44 per cent.”
The AAP has been on record as opposing pot consumption for many years. “The consequences (of consuming marijuana) include impaired short-term memory and decreased concentration, attention span, and problem-solving skills, all of which interfere with learning. Alterations in motor control, coordination, judgment, reaction time, and tracking ability have also been documented.
“These effects may contribute to unintentional deaths and injuries among adolescents, especially those who drive after using marijuana. Negative health effects on lung function associated with smoking marijuana also have been documented.
“Longitudinal studies linking marijuana use with higher rates of mental health disorders, such as depression and psychosis, recently have been published, raising concerns about longer-term psychiatric effects.The adolescent brain, particularly the prefrontal cortex areas that control judgment and decision-making, is not fully developed until the early 20s, raising questions about how any substance use may affect the developing brain.”
New Research on the Effects of Marijuana and Breastfeeding
Since mothers have gotten more access to marijuana due to its legalization in some states, researchers and physicians have been examining the implications of the drug’s use while breastfeeding. While there is still more research that needs to be completed, the results are troubling to pediatricians.
According to a study published in the journal Pediatrics,”low levels of chemicals in marijuana, like THC, were measurable in several mothers' breast milk up to six days after they said they smoked pot or ate an edible, among other forms of use.”
Separate research, published in 2017 in the medical journal JAMA, found that the prevalence of marijuana use among a sample of 279,457 pregnant women in California climbed from 4.2% to 7.1% from 2009 through 2016.
Since there are still questions about the effect on the children of the mothers who consume marijuana while breastfeeding, further research is planned on this subject.
EHR: A Tool for Counseling About Marijuana Use
When a child and parent visit the office of their pediatrician, this presents an excellent opportunity for the practitioner to communicate the potential dangers of marijuana use and abuse. If the practice has pediatric-focused electronic health records (EHR) platform, such as that of PCC, this counseling process is much more efficient and effective.
The certified clinical workflow tools of the PCC EHR were designed in collaboration with top pediatricians from across the nation, taking into consideration the flow of a busy clinic and the challenges a pediatrician faces every day in the changing healthcare environment. This software streamlines the operations of the practice and makes patient visits flow more smoothly.
This platform also includes AAP pediatric education and information services such as the Bright Futures guidelines at no additional charge. As an example of the benefits of these guidelines, the Bright Futures Handbook, “Adolescent Alcohol and Substance Use and Abuse” notes the risk factors for substance abuse:
- A family history of substance abuse or mood disorders. One in 5 children grows up in a household where someone abuses alcohol or other drugs. Substance use by a family member is associated with higher rates of substance use in adolescents.
- Poor parental supervision and household disruption are associated with involvement in substance use and other risk behaviors.
- Low academic achievement and/or academic aspirations.
- Untreated attention-deficit disorder (ADD) and attention-deficit/hyperactivity disorder (ADHD).
- Perceived peer acceptance of substance use and substance use in peers.
These Bright Futures guidelines also include “talking points” and open-ended questions that enable the practitioner to broach the subject of marijuana use and facilitate a more comprehensive discussion with the child. AAP research has suggested that many adolescents do not discuss their substance use with their physician. The most common reason given was never being asked. Evidence shows that 65 percent of adolescents report a desire to discuss substance use during clinic visits.
A pediatrician is in the unique position to provide accurate information about any number of problems - both psychological and physiological - that vex children and their parents. This includes the use of marijuana. The pediatric-focused PCC platform can be valuable resource to help begin the dialog that will lead to healthier, happier kids.