Transcription:
Is Your Teen Smoking Marijuana?

Anne Walters, PhD: When it comes to cannabis, times have certainly changed. What was once smoked almost exclusively can now be consumed in many forms and potencies. Now, cannabis can be disguised as cookies or candy gummies and brownies. It can be vaped, ingested, dabbed. It's no wonder that parents' and caregivers' heads are spinning. And with recent legalization of cannabis, there is perhaps a misconception that it is safe and that couldn't be further from the truth.

Host 1: Today, we welcome Dr. Jeff Hunt, Director of Inpatient and Intensive Services at Bradley Hospital. Dr. Hunt is here to give our listeners support on this issue. He's going to educate us on warning signs that your child may be using cannabis, how to talk to kids about cannabis, and what to do if you suspect substance abuse. More so, Dr. Hunt is going to share in his experience how cannabis affects teens and their mental health.

Greg Fritz, MD: So, that's a tall order, Jeff. But if anybody can do it, we're sure you're the man for the job. It's great to have you here today.

Jeff Hunt, MD: Thanks, Greg and Anne. It's great to see you guys. It's good to be here, to be talking about this important topic. There is a fact that the recent legalization of cannabis across the country has been leading to increased use. And we'll talk a little bit about how that has happened and what we can do about it.

Host 1: So, as you mentioned, with the legalization for both medicinal and recreational use in so many states, even young children at times are exposed to usage in parents, caregivers, siblings as part of everyday life. So, we're eager to hear more about the effects and what to be concerned about.

This is Mindcast: Healthy Mind, Healthy Child, a podcast from the mental health experts at Bradley Hospital, leaders in mental health care for children. I'm Dr. Anne Walters, here with my colleague, Dr. Greg Fritz.

Host 2: Jeff, to start off, can you give us an idea of what the numbers look like with regard to cannabis use in kids? How big of a problem really is this?

Jeff Hunt, MD: Yeah, we have several points of data that is available to us, and it comes out on a yearly basis. In 2019, 37% of US high school students reported a lifetime use of marijuana. Between 2020 and 2021, during the pandemic, there actually was a decrease in use, which was interesting, probably because the kids were not around each other and couldn't get to it. In 2022, the data just came out, and currently about 8% of eighth graders are using in the past year, 20% of 10th graders and 27% of 12th graders. And there's some smaller percentage that are using vape, which is a more intense product of cannabis. And there's also other data relating to how often they're using edibles and other such types of cannabis.

Host 2: Is that typically more or less than smoking?

Jeff Hunt, MD: More than smoking. You know, in terms of what we might talk about later is the prevention efforts to emulate what we've done with cigarette smoking that has been fairly effective in terms of nicotine use has continued to go down and, in cannabis, that's not the case.

Host 1: Jeff, I mentioned earlier in the intro that legalization of cannabis has led to a perception that cannabis is safe. What are some of the ways that you're seeing legalization affect young children?

Jeff Hunt, MD: Yeah. That's probably one of the biggest issues we've seen, that we're at the lowest level of concern for safety in the history of tracking this, including in the '70s when there was really also a low perception of risk. So, that's one part of it. And then, the other issue with legalization and medical marijuana, there's a lot of people close to these kids who are smoking at home on the couch, in the kitchen. And so, they're demonstrating that this is okay. And I think that's one of the big problems. And the other issue is that most of the time, kids are seeing that their colleagues or their peers are not having problems after they smoke, there's a vulnerable group that do. But most of the time, they're seeing people smoke, go back to school next day, so they think it's going to be fine. And also, there's just far greater availability of cannabis than there was before. As you can see, these numbers in high school, when you look at the young adults, it's skyrocketed in terms of how much use there is.

Host 2: So, what can parents do about all of these? What's the first step in talking to kids about cannabis use?

Jeff Hunt, MD: Yeah, I think that's one of those things where starting early makes sense, having discussions not only about cannabis, but about nicotine, alcohol, starting before they're in the risk area, which is probably around sixth grade. So, having discussions early and also having a discussion that they don't want them to smoke. I think that's a problem when they're seeing you smoke. But you also see parents who smoke cigarettes and kids who don't. You know, my father smoked cigarettes and I didn't smoke because there was a fair amount of noxiousness about being around somebody who's smoking. And I think that's part of the discussion. You know, it's probably harder if you are smoking for medical marijuana use or if you're smoking recreationally and your kids see that. But if you're not in that category, then having discussions about the risks of early use. I think one of the things we're trying to promote is trying to get kids further into their life before they first try marijuana, the best outcome would be like mid-20s, but at least until 18. So, we're having a lot of kids who are getting exposed to this in 8th, 9th, 10th grade, and that's way too early. And the earlier you used, the more likely it is that you'll use more. So, I think having discussions with parents about those risks, helping them also be aware, I think is something useful. There are products available, like workbooks that you can work with your teen and go through the early teens and the tween age. Having discussions with them about the risks of using, I think, would be a real good strategy.

Host 1: And maybe especially important, knowing that kids are likely to be exposed and even especially important if you happen to be a parent that is a cannabis user yourself, to open that conversation pretty early. And thinking back on some of the sort of campaigns about drugs in the '80s, remembering the This is Your Brain, This is Your Brain on Drugs campaign, that visual was quite compelling. Can you tell us a little bit about the effects that marijuana use has on teen brains?

Jeff Hunt, MD: Yeah, I think that's one of the areas of research and it's beginning to be a little more clear. One of the things that, you know, we learned early is that THC mimics endogenous cannabinoids, which are part of everyone's body already, and the endogenous cannabinoids are involved early in development. So, helping the brain figure out where it needs to go, what circuits to move to, all of that is part of the cannabinoid system, already a part of your body and your brain, and THC mimics that. So, it derails those processes. And as you all know, the brain develops well into your 20s and, for men, could even be almost into 30. So, the earlier you use cannabis, then you're derailing all those very precise and careful circuits that need to be developed to develop a healthy brain. And I think that's probably the biggest area that we're certain about, is that the earlier you use, there's influence on how your brain is wiring up.

Host 1: Well, and what might that look like? Like what would be behavioral effects of some of the disruption in brain development?

Jeff Hunt, MD: Yeah, it looks like there's several cognitive areas. There's something called working memory that when you're using cannabis, your working memory, which is a lot of what you do in school, it reduces your ability to remember things to then utilize them and implement in your studies. The other thing is it interferes with something called executive functioning as well, and very much a lingering effect once you smoke, if you smoke on a weekend, it's affecting you the whole next week, even if you don't smoke again. And if you smoke all the time, I think that's the area where we are seeing real persistent declines in executive functioning, working memory and other cognitive areas. So, it is interfering with some of those circuits and we're not totally sure that if you stop, that it'll come back to where it was supposed to be. So, that's one of the worries we have.

Host 2: I've mentioned this to people just casually and the idea or the fact that you always have a few kids in the hospital who are having very serious sequelae, lasting problems that you've tracked to only to cannabis use. Not a lot, but they're always there. And a lot of people are blown away by that idea. They think that it's just such a common and well tolerated product. Can you say a little bit more about that?

Jeff Hunt, MD: Yeah, the induction of psychosis happens more regularly the younger you are. And there are beginning to be some markers that we have, genetic markers, for kids who are more vulnerable to have that happen. And if you think about just in terms of family history, if you have a family history of people with psychosis or schizophrenia, you're more likely to be vulnerable when you smoke marijuana at a young age to have the development of psychosis. And as you pointed out, this results in significant impairment in their ability to function and dangerous behavior because their distorted thinking and some of their actions in the context of that, you know, psychotic process is quite pronounced. And they either do something that's dangerous to themself or to others. And again, those are the kind of situations that are not announced. You know, the kids at school just know that the kid is not in school. They don't know typically that a person has had such a reaction. The other issue is the longer, and this is across all age groups, the more you smoke, the more likely it is that you will develop psychosis later on in life. That's been one of those findings that's been replicated several times now.

Host 2: So, getting to the heart of the matter, why is it that kids are turning to cannabis? He says simply as though it's an easy answer.

Jeff Hunt, MD: I mean there's probably two or three things that I would think as some of the primary reasons. One, peers, I think, are influential. You're a 10th grader and you're out with your friends and somebody has it and don't want to be not cool, so you smoke and you try it. And then, sometimes you'll say, "This actually helps. I like feeling this way. It reduces some of the things I was thinking about, and maybe I'll try it again." Kids will try it and immediately it's not a good reaction and they don't take it. But the earlier exposure is often through peers, sometimes it's a cousin or, rarely, a parent, but it's not unheard of. Sometimes the issue is that teens are by nature sensation-seeking, so they're trying to find new experiences. Their ability to control their impulses is low until they get into your early 20s, especially for boys. So, given a new experience, kids will say, "All right, I'll try that." And so, they try it, and then the outcome is, "Well, this isn't so bad. I'll try it again." So, that's one part.

And then, the other issue is, you know, life for adolescence is stressful. The pandemic was stressful. Just the typical high school is stressful. There's all kinds of social alliances that go up and down and performance in school, thinking about college frequently. There's maybe troubles at home, they're worried about that. So, all kinds of things. And then, if you try cannabis and it takes away that for a while, then you start using it as a way of coping. There's also the sentiment that because there's medical marijuana, that people will say, "Well, I'm going to treat my anxiety with cannabis" or "I'm going to treat my PTSD with cannabis." And the reality is that when you look at the studies of the impact of cannabis on those disorders, there's really no evidence for it at all. Probably the only evidence that cannabis has that has any kind of effect size, which is a term for how well it works, is very complex seizures. Otherwise, the data is really poor for any kind of medical marijuana, for treatment of any disorder. I think that what's in the community. People are like Rhode Island, few years ago was the number one state for teen use and kids using cannabis. And I think that's related to the medical marijuana has been in Rhode Island since 2006, and I think that contributes.

Host 1: So in thinking a little bit about talking with children about cannabis use, I mean we know that often adolescents are sort of the mindset, "This may be a problem for other people, but not necessarily for me" or, you know, "Well, that won't happen. I'll never take it that far." So, what's a good way for parents to approach the conversation without kind of turning a child off before they can really get started?

Jeff Hunt, MD: Yeah, that's a tough one, especially if you find out later, and they've been using for a while. Then, you have to try to convince them that there's a problem and they may not always agree with you. Typically, you start to see school decline. You start to see different friendships and you start to see not being as interested in things that you used to be interested in. And so, you try to have the parent bring those things up and talk about what are the ways of getting back to a more healthy life.

But the other thing that I think is the key is parents need to say, "I don't approve of you smoking marijuana." And that there also is something called contingency management, which is, you know, "I don't approve and I want you to stop. And as part of that, I mean, this is always one of the tough ones, but the kids usually have a lot of privileges. But, you know, you have to say, "I'm going to continue to pay for your phone, but only if you stop smoking marijuana," or "I'm going to allow you to use my car, but only if you stop using marijuana." So then, you probably, at that point are in need of some help. So, you might start with your pediatrician and ask for like a drug test, and also have the pediatrician talk to the teen about where they are. Not so much lecturing them about the dangers because they're already discounting that. But you can also begin to point out the parts that they can see, like their school decline, like their change of friends and the fact that their dreams for the future might have been changing because their academic performance is declining, so they're starting to say, "Well, maybe I won't go to college." So, those are the kind of things you'd be looking for.

And one of the things is trying to keep your cool. So, you don't make it something-- I mean, this is a process and it is a conversation. And hopefully, optimally, if you've had earlier conversations with the teen and you have your stance very clear that "I don't approve of your smoking marijuana until you're 18 or older," then that's easier. If they're 16 or 17 and you're now just getting into it, you sometimes need extra help. And there's counseling available, there's programs available to help parents and the kids get off of it.

Host 1: Are there any prevention programs that you have come across that you think are particularly helpful or worth getting behind?

Jeff Hunt, MD: That's one of those areas where, if it's a forward-thinking school, you would bring it in. But you know, in this political climate, sometimes those kinds of things get blocked by discussions that will take care of it at home. But there is good evidence that, you know, especially DARE program that was in all of schools for a long time, that didn't work at all. I think some kids were even saying, "I learned more about what to use than it was to not do it." But there are ways, and particularly thinking about coping skills, kind of the basic stuff. Like how do you deal with anxiety? What is anxiety? What is depression? And we don't do that well enough. And I think if we had more mental health discussions earlier on, which would include cannabis, we wouldn't have to come on the back end of things and start to deal with it when it's not too late, it's just harder.

Host 2: So, we could go on for quite a while with this. I have one question though that I want to hear your thoughts on. Have you seen in your clinical experience these parents making these interventions and them actually having an effect?

Jeff Hunt, MD: Yes. I think often it's when there's been a legal involvement that the kid was picked up for something, either for driving under the influence or getting involved in selling it or something like that. That requires treatment. And during that part of the experience, people do change and you can get parents behind it. But older you are, you really have to get the teen to buy in that this is not something that they should continue to do, that there's real significant impacts. And I think many people have heard of motivational interviewing, and that's a strategy that's commonly used with pediatricians, child psychiatrists, counselors to try to get kids to see the different perspectives of their lives and try to help them make different choices. I think parents can support that and they can use those strategies when they talk to the kids.

Host 2: There's a current with this legalization to make it more difficult for parents. But there is hope and reason to do it because it does have a positive impact. Is that a fair statement?

Jeff Hunt, MD: Yeah. One of the things that has come up as states are deciding about legalizing, there's always a discussion in the beginning about what can be added to the budget, because you're going to be making a lot of tax revenue for this, and so why not put in prevention efforts as part of it? Even in Rhode Island, we had a discussion about that a few years ago, and it's not always clear that the group who's been studying this, the researchers and the scientists, they're not always included in any of these discussions. So, sometimes the politics of it, the revenue part of it is the way the decisions are made. And there's not always a component of prevention that's added to the budget, which is when you think about what we've done with cigarette smoking, we spent a lot of money on trying to keep kids from smoking, and it's generally been pretty successful, not immediately, but it has been effective and even with alcohol starting to work, so we need to do the exact same thing with cannabis and it costs money to do it well. And they're bringing in lots of money as we're seeing from other states that it should be added to part of the legislation and I don't know that it is.

Host 2: We want to thank you so much for being here with us. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library at bradleyhospital.org/podcast. This is Mindcast: Healthy Mind, Healthy Child, a podcast from the experts on Children's Mental Health at Bradley Hospital. I'm Dr. Greg Fritz with Dr. Anne Walters. Thanks for listening.