Beyond Current TV Programs on Marijuana Farms, the Academy of Pediatrics Issue a Impact On Youth Statement
By Seth Ammerman, M.D., FAAP*
The parents of a 17-year-old ask you to recommend medical marijuana for their daughter, who was injured in an auto accident six months ago and still has back pain. Hydrocodone and acetaminophen initially helped, but the patient stopped taking the medication because of unpleasant side effects. She told her parents she smokes marijuana "for fun" on weekends and believes it improves the pain. Her parents say they also think medical marijuana would be helpful for their daughter’s back pain. They smoke legal marijuana recreationally and feel like it's a benign drug.
A sign supporting marijuana legalization at the Wayne Morse Free Speech Plaza in Eugene, Oregon, May 2014. Wikimedia Commons by Visitor7
This scenario is becoming more common. To date, 23 states and the District of Columbia have legalized medical marijuana, and four states (Colorado, Washington, Oregon and Alaska) and the District of Columbia have legalized recreational marijuana for adults 21 years of age and older.
The Academy's position on the legalization of marijuana is outlined in an updated policy statement (www.pediatrics.org/cgi/doi/10.1542/peds.2014-4146) and technical report (www.pediatrics.org/cgi/doi/10.1542/peds.2014-4147), both titled The Impact of Marijuana Policies on Youth: Clinical, Research and Legal Update. The statements, which update 2004 documents, will be published in the March issue of Pediatrics.
The Academy:
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opposes marijuana use by children and adolescents;
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opposes the use of medical marijuana outside the regulatory process of the Food and Drug Administration but recognizes that marijuana may be an option for cannabinoid administration for children with life-limiting or severely debilitating conditions and for whom current therapies are inadequate;
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opposes legalization of marijuana because of the potential harms to children and adolescents;
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discourages the use of marijuana by adults in the presence of minors, even where legal, because of the influence of adult role modeling on child and adolescent behavior;
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supports studying the effects of recent laws legalizing the use of marijuana to better understand the impact and define best policies to reduce adolescent marijuana use;
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recommends changing marijuana from a Schedule I to a Schedule II drug to facilitate research and development of pharmaceutical cannabinoids; and
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strongly supports the decriminalization of marijuana use and encourages pediatricians to advocate for laws that prevent harsh criminal penalties for possession or use of marijuana. Additionally, a focus on treatment help for adolescents with marijuana use problems should be encouraged.
Additional recommendations focus on issues such as the need for effective bans on marijuana product advertising (the No.1 resolution at the 2014 AAP Annual Leadership Forum) and marketing to youths; strict regulations that prohibit the sale of marijuana products to those under the age of 21; the need for childproof packaging of marijuana products to prevent accidental ingestion; and opposition to smoking of marijuana due to associated lung damage and unknown effects of secondhand smoke.
The technical report provides the evidence base for the policy recommendations, addressing the epidemiology of marijuana use among youths; definitions of cannabinoids, marijuana and related terms; marijuana biology; side effects of marijuana use; impact on adolescent brain development; cannabinoid therapeutics; US and international experiences with legalization and decriminalization of marijuana; comparisons among alcohol, tobacco and marijuana; and social justice issues.
Although there are some good data on the efficacy of medical marijuana (e.g., specific cannabinoids) in adults with identified conditions, such as nausea and vomiting secondary to chemotherapy, spasticity in multiple sclerosis and some chronic neuropathic pain problems, no studies have been done on the use of medical marijuana in children and adolescents. Therefore, the effects of medical marijuana use on the developing brain is unknown. It is known that the younger one starts using the drug, the more likely it is to become addictive.
Another concern is that medical marijuana bought at a dispensary usually is not analyzed for various cannabinoids. Therefore, dosing is based on trial and error.
How to approach the above case? It would be important to counsel the family on the following points:
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Other medical therapies, such as nonsteroidal anti-inflammatory drugs, and treatments, such as physical therapy and/or a formal stretching and exercise regimen, often are highly effective.
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One in 10 adolescent marijuana users becomes addicted. Marijuana is not a benign substance, and even when used medically, can have adverse side effects.
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There are no research studies on the use of medical marijuana in children and adolescents.
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Since both the purity of medical marijuana and the cannabinoid content may be unknown, proper dosing is a hit-or-miss proposition.
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The parents should not use marijuana around their daughter because their actions directly influence her behavior.
Resources
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State marijuana laws and information for parents,www.aap.org/marijuana
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Substance Abuse and Mental Health Services Administration,www.samhsa.gov
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Office of Adolescent Health, US Department of Health and Human Services, http://1.usa.gov/1Ix8WlH
Footnote
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*Dr. Ammerman is co-author of the policy statement and technical report, and a member of the AAP Committee on Substance Abuse.