Geoffrey Golia:  What does the evidence say about the safety of cannabis, specifically related to teens?

Dr. Casperson:  We don’t have data stating that there is a “safe” amount of cannabis that can be used by a teenager.  Brain development continues till the age of 25, and cannabis has a pretty profound effect on how that development happens. “Synaptic pruning” is a process that happens during adolescence when many of the connections made during childhood are refined or “pruned” – cannabis interferes with this important process.

GG:  So, the safest option for teens is to avoid use.  What are some of the risks associated with cannabis use, especially with the new high potency THC products on the market?

Dr. C:  People (adults, not just teens) are taking cannabis more casually than is indicated by the scientific evidence for things like sleep and pain, for which there are much better treatments.  In terms of risk, cannabis increases the risk of depression, anxiety, and psychosis.  It can also decrease motivation by sapping energy and drive.  It also has significant cognitive effects – things like memory, recall, and can drop an IQ by 6 points.  

The challenge is that adolescents sometimes feel like they get some kind of relief from “being high.”  In the moment, they can feel relaxed, but over time, they get rebound anxiety and worsening of symptoms.

GG:  Can you speak more about CHS (cannabis hyperemesis syndrome)?

Dr. C:  This is uncontrolled vomiting due to higher potency cannabis.  There are also respiratory effects like damage to the lungs – we have evidence that smoking marijuana is worse for the lungs than cigarettes.  

An important thing for parents to understand is that when some people tried marijuana when they were teens, the highest potency out there was 2-3%.  Now, with some of the vape oils in cartridges for example, they can be as high as 98% THC!  Those are not comparable.  

GG:  Some parents argue that purchasing a small amount of regulated, controlled cannabis products for their teens makes it safer, similar to what parents say about alcohol.  What are your thoughts on this?

Dr. C:   This is not born out in the data at all.  Yes, you can teach your kids that a small amount of alcohol is not as problematic as a large amount, but that is not going to prevent them from drinking more when they have the opportunity.  Dispensaries are slightly more regulated/safe than buying off the street, but New York, for example, does not have a potency cap.  Bottom line:  it’s not advisable to buy these products for your teen.

GG:  What advice and guidance do you have for parents on how they can begin to have these conversations with their kids?

Dr. C:  It’s important to tailor that conversation to the age and development of your child.  At a young age, kids love rules and following directions, so keep it brief and rule oriented.  By middle school, you are going to talk to them about the specific risks.  Later in middle school and high school, coach them on refusal skills.  Coaching them on how to deal with friends who are using or how to handle if they are in a social setting.  You can even teach them how to “fake” smoke or drink – just pretend to take a small sip or “not inhale.”  Sometimes, these in the moment coping skills can be really useful to teens.  

GG:  Some people want to understand how and why cannabis is legal for anyone in the first place.  How does it compare to alcohol?

Dr. C:  This has been partially a social justice effort because different types of people were getting penalized for possession.  There is also a very strong marijuana lobby.  Basically, alcohol and marijuana are both bad but maybe in different ways – alcohol is worse for your liver, for example, which marijuana is worse for your lungs.  Two wrongs don’t make a right.

GG:  How can parents make these lessons “stick” a little more?

Dr. C:  I would recommend a collaborative parenting style that combines strongly recommending against using, but explaining why with reasoning and data.  Make your expectations clear, but emphasis that they can always come to you even if they make a mistake or find themselves in a challenging situation.  Monitoring their phone or looking in their backpack or room is totally ok – you really need to know what’s happening.

GG:  Can you speak about alternative coping skills that teens can use so they don’t feel tempted to smoke?

Dr. C:  Listening to music, watching a comforting a TV show, going for a run, or even having a good cry can all be cathartic or stress relief.  

GG:  Mindfulness, and finding moments of stillness can be important.  This includes acknowledging and accepting our feelings.  Parents also need to model good coping skills to their kids.

Dr. C:  Cognitive behavioral therapy can also be useful.  “What’s the worst thing that could happen?”  Walk them through the possibilities to reduce anticipatory anxiety.  Ask questions like, “What are safer ways we can deal with stress?”

GG:  Can cannabis be laced with fentanyl?  Is that something you see that causes overdose?

Dr. C:  Anecdotally, yes, it does happen.  Fentanyl can be in anything.  We use Narcan to reverse fentanyl overdoses.  It is free from any pharmacy and comes as a nasal dispenser.  

GG:  Is there any relationship between ADHD and cannabis use, and along those lines, with any other medications (either for ADHD or other diagnoses) and cannabis use?

Dr. C:  Having ADHD increases the risk of having a substance abuse disorder because it increases the likelihood of seeking risk-taking, high dopamine behavior.  Cannabis use exacerbates all of the symptoms of ADHD.  Stimulant medications, which are usually used to treat ADHD, usually work in opposition to cannabis.

GG:  Can you speak about some of the warning signs of substance abuse?

Dr. C:  Finding any paraphernalia like cartridges, vape pens, charges on their debit card from smoke shops (which often register as bodegas or grocery stores), changes in behavior, and social or academic changes are all common things to watch out for.

In terms of acute use, any sort of disorientation, red eyes, any smell – those are symptoms.

GG:  What is your take on the idea that cannabis can act as a gateway drug?

Dr. C:  There is some truth to the notion that kids are more likely to try more common drugs before they try less common ones.  So, they might try cannabis before they try cocaine.  There’s no clear connection that trying cannabis will lead to trying a harder drug, however.  Most people will either like a drug that mellows them out or one that amps them up – usually people do not like both categories.  Alcohol, nicotine, cannabis, and mushrooms tend to be the most common drugs.  

GG:  When should parents seek treatment for their teen?

Dr. C:  If you are unable to curb the behavior on your own, it is time to consult a clinician.  Functional impairment can be insidious and take a long time to emerge, so it’s important to address early on even before real impairment is visible.

Geoffrey thanked Dr. Casperson and NYC-PIA and ended the webinar.

*This is a brief synopsis of the questions that were asked by Geoffrey, and Dr. Casperson’sanswers.