Pediatricians need to be able to
speak directly and frankly with teens
and their parents about the potential
harmful effects of marijuana and cannabis products, especially in light of new laws legalizing both recreational and medicinal use of marijuana
products, according to a new AAP clinical report.
Counseling Parents and Teens about Marijuana Use
in the Era of Legalization of Marijuana, from the
AAP Committee on Substance Use and Prevention,
addresses the specific content that pediatricians
should be including in conversations about cannabis products. The report is available at http://bit.
ly/2ko WlKb and is published in the March issue
The topic is especially relevant now that more
states have passed laws to legalize both recreational
use of marijuana for adults and medicinal marijuana
for both children and adults. Currently, recreational
marijuana use by adults is legal in seven states plus
the District of Columbia, and 28 states have legalized some form of medicinal marijuana for a wide
variety of conditions.
This means the subject of marijuana is much more
likely to be part of the conversation between teens
and their parents, and the pediatrician is likely to
be seen as a source of accurate information about
adverse effects as well as benefits of the many cannabis products now available. Pediatricians also are
far more likely to encounter adolescents or parents
who are using these products, either recreationally
or for their therapeutic effects.
Following are answers to some questions pedia-
tricians might have about cannabis products and
counseling teens and their parents.
Are we seeing an increase in marijua-
na use among teens now that more
states have legalized recreational and/
or medicinal marijuana?
Rates of use have remained static overall among
adolescents 12-17 years, even in states with laws
permitting recreational or medicinal marijuana use.
Among 12th-graders, however, there has been an in-
crease in rates of marijuana use, with 36% reporting
use within the previous year. This is in direct contrast
with reported use of other illicit substances, alcohol
and tobacco, which have been declining significantly
since the late 1990s. Teens also are reporting less
concern about the “harmful” effects of smoking
What adverse effects of cannabis
products should be mentioned when
Many studies have documented adverse effects, including short-term impairment of
memory, attention, concentration and problem-solv-ing skills, as well as motor control, coordination and
reaction time. Development of mental health disorders such as depression and psychosis also have
been reported. New studies evaluating abnormalities
in brain regions involved in memory and executive
functioning in teens using marijuana regularly and/
or heavily raise concerns about long-term and lasting
effects on brain maturation and functioning.
Teens also need to know marijuana smoke is toxic,
similar to secondhand tobacco smoke, and use of
vaporizers or hookahs does not eliminate the toxic
chemicals in marijuana smoke.
Are there special concerns related to
When marijuana is consumed in an
edible or drinkable form, there is a slow-
er rate of absorption in the system compared with in-
halation. Consequently, it takes longer to appreciate
the euphoric effects, and some teens then consume
additional “doses.” This can result in significant toxic
side effects when the effect of the product finally
In addition, rates of calls to poison control centers
and visits to emergency departments have increased
after young children have ingested products that re-
semble candy, baked goods or soda.
Are there any data to support the ef-
ficacy of medicinal marijuana in chil-
Studies in adults support its use in
chemotherapy-associated nausea and vomiting,
spasticity with neuromuscular diseases, and cachexia
with certain chronic diseases. The only data on its
effectiveness in pediatric populations are limited
to its role in decreasing seizures in specific epilepsy
conditions, such as Lennox-Gastaut syndrome and
What should physicians tell parents
who are reluctant to advise their teen
against using marijuana since they
themselves used it when they were
Tell parents that marijuana products available to-
day can be more than three to five times stronger
than what was available even a decade ago. With
newer methods, such as vaporization or “dabbing,”
potency is even higher, increasing the risks for tox-
ic effects. (Dabbing is a method used to convert
marijuana into a concentrate for inhalation; it uses
butane to extract tetrahydrocannabinol, or THC,
from the cannabis plant.)
Parents also should not feel that they have to
share all of their experiences with their children or
that they cannot voice disapproval of their teen’s
use because they have used marijuana themselves.
They need to be encouraged to provide accurate information and express their concerns and values to
Suggestions for pediatricians
• Screen all patients for the use of any cannabis
products beginning in early adolescence be-
cause the earlier teens begin to use marijuana,
the more likely they are to develop dependence.
• If adolescents are not using marijuana, use mo-
tivational techniques to support their decision
• Adolescents who are using marijuana regularly
or heavily are more likely to meet criteria for
a substance use disorder. A brief motivational
intervention may be used to reduce use and continue the conversation with the pediatrician or
a mental health or behavioral counselor.
• Counsel about known side effects, as well as the
known euphoric effects or medicinal benefits, so
that you can be a source of accurate, scientific
information to teens and their parents.
• Speak frankly with parents about the effect that
their own use may have on their children or
teens, either through modeling or
through their own impairment.
Dr. Ryan, a lead author of the clinical
report, is chair of the AAP Committee
on Substance Use and Prevention.
Increased availability of marijuana
means more parent questions for pediatricians
A new AAP clinical report can help pediatricians
conduct frank conversations about cannabis products and their adverse effects.
• AAP policy statement (2015) The Impact of Marijua-
na Policies on Youth: Clinical, Research, and Legal
Update, http://bit.ly/2k1crLJ, and technical report
• AAP information on marijuana, including speaking
points and a webinar, www.aap.org/marijuana