AAP eBooks

Medical Risks of Marijuana

By American Academy of Pediatrics

In recent years, exposure to marijuana and other cannabinoids has become an increasing challenge. Legalization of marijuana for both medical and recreational use has already happened in some states, and more states are considering this. What is the risk of use or secondary exposure, including accidental ingestion, to marijuana or synthetic cannabinoids?

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    Abstract
    Address correspondence to Heather B. Clayton, PhD, MPH, Health Scientist, Survey Operations and Dissemination Team, Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE Mailstop E-75, Atlanta, GA 30329. E-mail: hhc9@cdc.gov

    BACKGROUND AND OBJECTIVES Data are limited on the behavioral risk correlates of synthetic cannabinoid use. The purpose of this study was to compare the behavioral risk correlates of synthetic cannabinoid use with those among marijuana users.

    METHODS Data from the 2015 Youth Risk Behavior Survey, a cross-sectional survey conducted in a nationally representative sample of students in grades 9 through 12 (N = 15 624), were used to examine the association between self-reported type of marijuana use (ie, never use of marijuana and synthetic cannabinoids, ever use of marijuana only, and ever use of synthetic cannabinoids) and self-report of 36 risk behaviors across 4 domains: substance use, injury/violence, mental health, and sexual health. Multivariable models were used to calculate adjusted prevalence ratios.

    RESULTS Students who ever used synthetic cannabinoids had a significantly greater likelihood of engaging in each of the behaviors in the substance use and sexual risk domains compared with students who ever used marijuana only. Students who ever used synthetic cannabinoids were more likely than students who ever used marijuana only to have used marijuana before age 13 years, to have used marijuana ≥1 times during the past 30 days, and to have used marijuana ≥20 times during the past 30 days. Several injury/violence behaviors were more prevalent among students who ever used synthetic cannabinoids compared with students who ever used marijuana only.

    CONCLUSIONS Health professionals and school-based substance use prevention programs should include strategies focused on the prevention of both synthetic cannabinoids and marijuana.

  3. Page 15
    Abstract
    Address correspondence to Andrew Ninnemann, BA, University of Maryland–College Park, Department of Psychology, 2103 Cole Student Activities Building, College Park, MD 20742-4411. E-mail: aninn@umd.edu

    BACKGROUND Synthetic cannabinoids (SCs) are a large, heterogeneous group of chemicals that are structurally similar to δ-9-tetrahydrocannabinol. Many SCs are high-efficacy full agonists of the CB1 and/or CB2 cannabinoid receptors, resulting in a potent group of chemicals with a variety of negative health effects, including death. SCs are available to adolescents at convenience stores and smoke shops and on the Internet. However, little is known about the risk factors that contribute to eventual use of SCs in adolescents, and no research has examined the psychiatric, personality, and substance-use risk factors that prospectively predict SC use. On the basis of extant cross-sectional research, we hypothesized that anxiety, depression, impulsivity, and marijuana use would prospectively predict eventual SC use.

    METHODS Data were collected across 2 time points 12 months apart on adolescents attending multiple public high schools in southeast Texas (n = 964).

    RESULTS Path analysis indicated that depressive symptoms, marijuana use, alcohol use, and SC use at baseline were predictive of SC use at 1-year follow-up, whereas anxiety symptoms and impulsivity were not. In addition, SC use at baseline was not predictive of marijuana use at the 1-year follow-up. Females and African Americans were less likely to use SCs than males or those of other ethnicities.

    CONCLUSIONS SC-use prevention programming should consider depressive symptoms, marijuana use, and alcohol use as risk factors for SC use. Of particular significance, traditional marijuana use was predictive of subsequent SC use, but SC use was not predictive of later marijuana use.

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    Abstract
    Address correspondence to Joseph J. Palamar, PhD, MPH, Department of Population Health, New York University Langone Medical Center, 227 E. 30th St, 7th Floor, New York, NY 10016. E-mail: joseph.palamar@nyumc.org

    OBJECTIVES In this study, we examined the prevalence and correlates of current synthetic cannabinoid (SC) use among high school seniors in the United States.

    METHODS Monitoring the Future, an annual nationally representative survey of high school seniors, began querying current (30-day) SC use in 2014. Data were examined from the 2 most recent cohorts (2014–2015; N = 7805). Prevalence of self-reported use was examined and differences in demographics and recency and frequency of other drug use was compared between current marijuana-only users and current SC (plus marijuana) users using χ2 and generalized linear model using Poisson.

    RESULTS We found that 2.9% of students reported current SC use; 1.4% of students (49.7% of users) reported using SCs on ≥3 days in the past month. SC users were more likely to report more recent (and often more frequent) use of lysergic acid diethylamide, cocaine, heroin, and/or nonmedical use of opioids compared with marijuana-only users. Compared with current marijuana-only users, SC users were more likely to report lower parent education (P < .05) and current use of a higher number of illegal drugs other than marijuana (Ps < .001). Students using SCs ≥10 times in the past month were more likely to be boys, frequent marijuana users (Ps < .01), African American, and users of multiple other illegal drugs (Ps < .001).

    CONCLUSIONS SC use is typically part of a repertoire of polydrug use, and polydrug use is less prevalent among marijuana-only users. Current SC users are at risk for poisoning from use of the newest generation of SCs and from concurrent drug use.

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    Abstract

    This policy statement is an update of the American Academy of Pediatrics policy statement “Legalization of Marijuana: Potential Impact on Youth,” published in 2004. Pediatricians have special expertise in the care of children and adolescents and may be called on to advise legislators about the potential impact of changes in the legal status of marijuana on adolescents. Parents also may look to pediatricians for advice as they consider whether to support state-level initiatives that propose to legalize the use of marijuana for medical and nonmedical purposes or to decriminalize the possession of small amounts of marijuana. This policy statement provides the position of the American Academy of Pediatrics on the issue of marijuana legalization. The accompanying technical report reviews what is currently known about the relationships of marijuana use with health and the developing brain and the legal status of marijuana and adolescents’ use of marijuana to better understand how change in legal status might influence the degree of marijuana use by adolescents in the future.

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    Abstract

    This technical report updates the 2004 American Academy of Pediatrics technical report on the legalization of marijuana. Current epidemiology of marijuana use is presented, as are definitions and biology of marijuana compounds, side effects of marijuana use, and effects of use on adolescent brain development. Issues concerning medical marijuana specifically are also addressed. Concerning legalization of marijuana, 4 different approaches in the United States are discussed: legalization of marijuana solely for medical purposes, decriminalization of recreational use of marijuana, legalization of recreational use of marijuana, and criminal prosecution of recreational (and medical) use of marijuana. These approaches are compared, and the latest available data are presented to aid in forming public policy. The effects on youth of criminal penalties for marijuana use and possession are also addressed, as are the effects or potential effects of the other 3 policy approaches on adolescent marijuana use. Recommendations are included in the accompanying policy statement.

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    Abstract

    Many states have recently made significant changes to their legislation making recreational and/or medical marijuana use by adults legal. Although these laws, for the most part, have not targeted the adolescent population, they have created an environment in which marijuana increasingly is seen as acceptable, safe, and therapeutic. This clinical report offers guidance to the practicing pediatrician based on existing evidence and expert opinion/consensus of the American Academy of Pediatrics regarding anticipatory guidance and counseling to teenagers and their parents about marijuana and its use. The recently published technical report provides the detailed evidence and references regarding the research on which the information in this clinical report is based.

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    Abstract
    Address correspondence to Joanna Cohen, MD, Division of Emergency Medicine, Children’s National Medical Center, 111 Michigan Ave NW, Washington, DC 20010. E-mail: jcohen@cnmc.org

    Synthetic cannabinoids are relatively novel substances of abuse. The use of these compounds among adolescents and young adults has been increasing, making it important for pediatric providers to be familiar with the presenting signs and symptoms of intoxication. We describe three case presentations of reported synthetic cannabinoid intoxication and provide a brief discussion of these compounds.

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    Abstract
    Address correspondence to Elissa R. Weitzman, ScD, MSc, Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, 300 Longwood Ave, BCH3187, Boston, MA 02115. E-mail: elissa.weitzman@childrens.harvard.edu

    BACKGROUND AND OBJECTIVE Adolescents face peak risks for onset and intensification of alcohol and marijuana use. However, we know little about these behaviors and their associations with knowledge or treatment adherence among chronically ill youth, a medically vulnerable group.

    METHODS Cross-sectional assessment of consented youth ages 9 to 18 years receiving care for asthma/cystic fibrosis, type 1 diabetes, arthritis, or inflammatory bowel disease (IBD) by using a self-administered online tool. Prevalence and correlates of risk behaviors and associations with knowledge and treatment adherence were estimated using descriptive statistics and logistic regression, controlling for demographics, mental health, and the multiclinic sampling frame.

    RESULTS Of 403 consented youth (75.8% response), 51.6% were girls, 75.1% were white, and average age was 15.6 years. Of high school youth, 36.5% and 12.7% reported past-year alcohol use and binge drinking, respectively; 20% reported past-year marijuana use. Among high school youth, 53.1% and 37.2% answered correctly that alcohol can interfere with their medications and laboratory tests; youth answering incorrectly were 8.53 and 4.46 times more likely to drink and binge drink, respectively (P values < .001). Thirty-two percent and 8.3% of high school youth reported regularly forgetting or skipping their medications in the past 30 days; compared with past-year nondrinking youth, drinkers were 1.79 and 1.61 times as likely to report regularly missing or skipping medications (P values < .05).

    CONCLUSIONS Alcohol and marijuana use are common among youth with chronic medical conditions. Alcohol use is associated with treatment nonadherence. Education and preventive interventions are warranted to ameliorate risk.

  10. Page 82
    Abstract
    Address correspondence to Dinesh Singh, MBBS, MD, DCH, Division of Pediatric Critical Care, Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112. E-mail: dsingh@tulane.edu

    We report a case of prolonged atrial fibrillation (AF) precipitated by new-onset generalized tonic–clonic convulsions and marijuana abuse in a developmentally normal 18-year-old adolescent with a structurally normal heart. Our case highlights an interesting association and a unique pathophysiology between generalized tonic–clonic convulsions, marijuana abuse, and AF. We suggest that seizures and marijuana abuse should be considered in the differential diagnosis of the etiology of AF in children.

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