The adverse effects of marijuana have been well documented. Numerous published studies have shown the potential negative consequences of short- and long-term use of recreational marijuana in adolescents.8 These consequences include impaired short-term memory and decreased concentration, attention span, and problem-solving skills, all of which interfere with learning. Alterations in motor control, coordination, judgment, reaction time, and tracking ability have also been documented. These effects may contribute to unintentional deaths and injuries among adolescents, especially those who drive after using marijuana. Negative health effects on lung function associated with smoking marijuana also have been documented 9; in addition, longitudinal studies linking marijuana use with higher rates of mental health disorders, such as depression and psychosis, recently have been published, raising concerns about longer-term psychiatric effects.8,10 Secondhand marijuana smoke can also be detected in adults who are passively exposed, and new data also suggest that secondhand marijuana smoke may be harmful to children.11 A recent study found that in an inpatient sample of infants admitted for respiratory compromise, 1 in 6 had detectable traces of marijuana in their systems.12
The adolescent brain, particularly the prefrontal cortex areas that control judgment and decision-making, is not fully developed until the early 20s, raising questions about how any substance use may affect the developing brain.8,13–15 Studies examining brain functioning in youth who use cannabis regularly or heavily (defined as using 10 – 19 times/month or 20 or more times/month, respectively) show potential abnormalities that occur across a number of brain regions including those affecting memory (hippocampus) and executive functioning and planning (prefrontal cortex).13–15 Studies assessing the role of marijuana on brain morphology are inconsistent, with 1 study citing increased and decreased volumes of subcortical structures16 and another citing no effect on structures such as the amygdala and hippocampus.17 A major study also has shown that long-term marijuana use initiated in adolescence has negative effects on intellectual function and that the deficits in cognitive areas, such as executive function and processing speed, did not recover by adulthood, even when cannabis use was discontinued.18
As with other psychoactive substances, the younger an adolescent begins using drugs, including marijuana, the more likely it is that drug dependence or addiction will develop in adulthood.15,19 Evidence clearly shows that marijuana is an addictive substance; overall, 9% of those experimenting with marijuana will become addicted; this percentage increases to 17% among those who initiate marijuana use in adolescence and to a range of between 25% and 50% among teenagers who smoke marijuana daily.20 It should be noted that most teenage patients addicted to marijuana do not have lifelong addiction; however, significant effects on cognitive and psychosocial function may occur during the addiction period.21
Marijuana use during pregnancy has adverse effects on the fetus, including growth retardation. Longer-term consequences of prenatal marijuana use that have been reported in infants and children include subtle deficits in learning and memory as well as deficits in executive functions, such as problem-solving skills that require sustained attention, analysis, and integration.22
Role of the Pediatrician
Pediatricians are in an influential position to counteract the perception of teenage marijuana use as benign. Research findings regarding the health effects of marijuana on children and adolescents provide guidance for parents and their children. The office setting provides an excellent opportunity for education and counseling to prevent marijuana use as well as to implement brief interventions and referrals if needed. Parents who use marijuana may not fully realize the problems that their own use may present for their children's health; the effect that their modeling of recreational use may have on their child, adolescent, or young adult 23,24; or the risks of ingestion 25,26 and/or secondhand smoke.9
The American Academy of Pediatrics (AAP) recognizes that parents may choose to administer marijuana to children with severely debilitating or severe chronic conditions when other standard therapies have proven inadequate or in compassionate care/end-of-life care situations and that they may seek support for this practice from their child's pediatrician. However, because marijuana use is still considered a federal offense, there may be legal ramifications for a pediatrician formally recommending the use of medical marijuana in these extenuating circumstances. Awareness of one's state laws and protections for medical providers is essential, and direct discussion of this issue with one's state medical board may be appropriate.
The following sections include key facts and suggested talking points for the pediatrician to use in speaking with youth and their parents about marijuana and the effects of its use. For detailed references to the data listed in this statement, the reader is referred to the full technical report published by the AAP.1
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