A recent report from researchers in Colorado presents concerning data about the impact of cannabis legalization with findings of a significant increase of marijuana use in teens and young adults who have committed suicide. Analyzing data from 2014 when cannabis was legalized in the state through 2017 showed the number of individuals committing suicide who had positive drug screens for marijuana rose by 250 % in teens (ages 10-19) and increased by 22% for adults age 20 and older. Similar findings are reported in other states. While many other factors are involved in youth suicides, this association and other data about cannabis use by youth are of obvious public health concern.
The number of youth age 12 and older using marijuana in the past month in Colorado was reported as having increased by 45% over the three-year period studied. Use by college students also increase by nearly 20%– both data significantly higher than national averages. A factor in the increased use of cannabis is the perception of decreased risk of harm associated with use that has evolved over recent decades.
Clinically, the area of greatest concern is focused on the increased availability and use of highly concentrated forms of cannabis such as wax, dabs, shatter and hash oils which may contain very high levels of psychoactive tetrahydrocannabinol, running as high as 75 – 90% levels. Increased incidence of ED visits for cannabinoid hyperemesis and acute first episode psychosis was also found, with a 50% increase in marijuana related hospitalizations. The incidence of psychotic episodes strongly correlated to the dose of the drug ingested and there are clear indications that continued use of cannabis is associate with both recurrent acute psychotic episodes as well as risks for the development of chronic psychotic conditions.
Edibles are also of significant concern as the delayed absorption of the cannabis can lead to higher levels of drug intake and even untreated marijuana used in smoking can now have upwards of ~15-25% concentration levels – this as compared with levels of 3-6% in the 1960’s – 2000’s.
Even among youth holding part-time jobs, were found to use of cannabis at a significant rate. The 2019 Monitoring the Future national survey reported significant rates of use of cannabis products among high school students:
Grade in School Use in Past Year Use in Past Month
8th 12% 7%
10th 29% 18%
12th 36% 29%
Use of high potency cannabis products is associated with greater risks for tobacco use, use of other illicit drugs and of developing a generalized anxiety disorder. In adult population studies, it has been reported that individuals with per-existing mental health mood disorders (e.g., anxiety disorders depression, bipolar) are at 3X higher risk of using cannabis products compared with non-affected individuals.
Clinically, the age of onset of cannabis use, the duration and frequency of use, and the potency of the form of cannabis used are significant considerations in assessing the potential risks for adolescent and young adult users. Also of note, though often more subtle in their impact, are the findings of withdrawal syndromes associated with marijuana use which include increased irritability, anxiety, sleep disruption, changes in appetite, depression, restlessness and physical discomforts.
Clinical intervention to reduce risks and harm from cannabis use is a challenge for a number of reasons, but clearly screening inquiries with older children and adolescents followed by dispassionate discussion about the health risks associated with cannabis use are warranted interventions that may have impact on some vulnerable youth.
Referrals for either mental health or substance use interventions should be considered when elevated risk is evident.
References:
- Legalized Cannabis: Report show link to suicide among youth; Brunk,D.; Clinical Psychiatry News; Vol 49, No 3, March 2021
- Cannabis, Marienfeld,C.; American Society of Addiction Medicine The ASAM Board Exam Study Course – Virtual 2020