Set policies to curb teen pot use
Last year, the California electorate voted to legalize the recreational use of cannabis by adults. Next year, cannabis will be for sale in California stores. Our focus now must be on how to implement legalization in the way that best supports public health — including setting policies and cultural values to support teens.
Teens are more likely than adults to develop problems using cannabis; and earlier use is associated with longer term problems, including problems with brain functioning that don’t seem to exist if use is put off until later adolescence or adulthood. Early heavy cannabis use affects brain systems involved in learning and memory, the speed at which we process new information, and complex decision-making. Car accidents are the leading cause of death for teens and the risk of accidents and injuries is made worse when alcohol is combined with cannabis.
For these reasons, it’s important that cannabis legalization be undertaken in a way that will reduce use among teens, not increase it. That’s likely to be a tall order. Here’s why: Legalization may support normalization
of cannabis use. Nationwide, teens have reported that they’d be more likely to try cannabis if it were legal, and intentions historically predict subsequent use. It is reasonable to expect that cannabis culture will become more pervasive in the wake of legalization. There are already ads for cannabis dispensaries pasted on the sides of San Francisco buses. More liberal policies may result in widely available highly concentrated forms of THC
(e.g., dabs, wax, shatter) as increased knowledge about cannabis cultivation and extraction of THC produces stronger products. These products can lead to intoxication much higher than intended, even by seasoned users, and such products affect teens more strongly than adults. We don’t know if this is also true of products such as vaping devices, touted as “safer” than other forms of cannabis delivery, because of an almost complete lack of research in the area. Teens are more likely than adults to try novel methods without critically evaluating them. Any burgeoning industry is motivated by profits.
Snoop Dogg has morphed from marijuana rights advocate to marijuana industry investor to startup founder. Former NORML Executive Director Allen St. Pierre has joined a venture-capital company focused on the cannabis industry. Although the new law includes some limitations on advertising to minors, the promise of financial gain is only likely to increase the marketing already happening online and through social media, channels deeply integrated into the lives of California teens. Questions remain about the effects of secondhand marijuana smoke
exposure. Some work out of UCSF has shown that one minute of exposure can impair arterial function in a manner similar to that of tobacco, increasing the risk of partially blocked arteries and heart attack. The potential increased use of cannabis could mean more secondhand smoke exposure for teens.
Data from other states offer some hope for California, however.
Colorado and Washington saw no significant change in teen cannabis use in the year after recreational legalization, and use even decreased in the second year after legalization in Colorado. A study in Colorado showed extremely high level (95 percent) compliance with age-restriction policies. California should consider penalizing dispensaries and delivery services for underage sales of cannabis as severely, or more severely, than we do establishments that sell alcohol to kids. Our commitment to age restrictions need also be reflected in regulating websites, apps and delivery services, as well as in consequences for teenagers driving while high.
There are a few other ways in which legalization can be implemented to best support reduction in cannabis use among teens: We can appeal to new cannabis businesses to self-regulate, enforce age restrictions, and fund research that helps keep teens safe. That said, industry representation should be limited in the decision-making process about regulations governing cannabis cultivation and sale, giving voice instead to public health officials and others whose incentives align with the needs of teens.
Marijuana should be included in smoke-free laws, and regulated like tobacco is in California. And public health campaigns supporting the concept that teen cannabis use is different from adult use should be widely disseminated.
This is the chance for California to set in motion the proper protections so that cannabis legalization best serves our young people.
Danielle Ramo is an assistant professor of psychiatry at UC San Francisco and a licensed psychologist working at the intersection of substance use and digital health. Twitter: @danielleramo