Background

The legalization of medical marijuana in many states and the District of Columbia and the outright legalization of recreational marijuana for adults aged 21 years and older in a few states and the District of Columbia 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.1 For up-to-date information on the numbers of states allowing these laws related to marijuana use, the reader is referred to www.aap.org/marijuana.

Although there are currently no initiatives to legalize the recreational use of marijuana for minors and marijuana is still a federally controlled substance, changes in the legal status of marijuana, even if limited to adults, may affect use among adolescents by decreasing the perceived risk of harm or through the marketing of legal marijuana, despite restrictions that prohibit marketing and advertising to this age group. 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, which is concerning, because the same survey has documented that decreases in perceived risk typically precede or occur at the same time as increases in use.2 The concentration of tetrahydrocannabinol, or THC, the psychoactive substance in the marijuana plant, has increased considerably, from approximately 4% in the early 1980s to upward of 12% in 2012,3 increasing the risk of adverse effects and the potential for addiction.

Studies have been conducted in adults to research the potential therapeutic effects of the class of chemicals known as cannabinoids (the active compounds in marijuana) administered either as a pharmaceutical preparation or as marijuana leaves, distilled oils, or edibles and drinkables. Cannabinoids have been shown to be helpful for adults in addressing some symptoms, such as increasing appetite and decreasing nausea and vomiting in patients receiving chemotherapy and reducing pain in chronic neuropathic pain syndromes. Cannabinoids may have adverse effects, however, such as dizziness, dysphoria, and clouded sensorium.4,5 The only studies that have been published on the use or efficacy of medicinal marijuana in children and adolescents have been limited to its use in the treatment of refractory seizures.6,7