This project explores the neurobiological impact of teenage marijuana use, and the ways that public health interventions can help educate adolescents and delay the onset of use.https://scholarworks.uvm.edu/fmclerk/1401/thumbnail.jp

Warther, Katie C

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University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects Larner College of Medicine2018Marijuana and the Teenage Brain: Public HealthImpactKatie C. WartherFollow this and additional works at: https://scholarworks.uvm.edu/fmclerkPart of the Biochemical Phenomena, Metabolism, and Nutrition Commons, Chemical andPharmacologic Phenomena Commons, Community Health Commons, Community Health andPreventive Medicine Commons, Medical Education Commons, Medical Neurobiology Commons,Neurosciences Commons, Pediatrics Commons, Primary Care Commons, and the Substance Abuseand Addiction CommonsThis Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion inFamily Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contactdonna.omalley@uvm.edu.Recommended CitationWarther, Katie C., "Marijuana and the Teenage Brain: Public Health Impact" (2018). Family Medicine Clerkship Student Projects. 333.https://scholarworks.uvm.edu/fmclerk/333TEENAGERS	AND	MARIJUANA:	PUBLIC	HEALTH	IMPACT	Katie	Warther	Family	Medicine	March,	2018	Mentors:	Elizabeth	Cote,	Whitney	Calkins,	M.D.	(preceptor)	Problem	identiﬁcation	(2a)			New	marijuana	legislation	in	Vermont¹:	•  Will	take	eﬀect	on	July	1,	2018	•  Allows	possession	of	1oz	of	marijuana/person,	personal	cultivation	of	2	mature	pants	or	4	immature	plants		•  Protections	included	with	legislation:		•  Anyone	who	gives	marijuana	to	person	under	21yo	(or	enables	consumption)	can	be	imprisoned	up	to	2	years	and	ﬁned	$2,000.	Penalties	raise	to	5	years	and	$10,000	if	underage	person	causes	death/	serious	injury	while	driving	after	receiving	marijuana		•  Will	be	misdemeanor	to	use	marijuana	in	a	car	with	a	child	(penalties	starting	at	$500	and		2	points	on	license).	Despite	protections,	this	legislation	will	allow	much	wider	/easier	access	to	marijuana	for	teens	in	VT.	What	are	the	implications	of	this?				Problem	identiﬁcation	(2b)	Legalization	leads	to	increased	use	among	adolescents:		•  Studies	show	that	in	several	states	where	marijuana	has	been	legalized,	marijuana	use	among	teens	has	increased	and	risk	perception	has	decreased³.	•  A	survey	of	9,945	high	school	seniors	showed	that	10%	of	non-cannabis-using	students	reported	intent	to	initiate	use	if	legal,	and	18%	of	cannabis	users	reported	intent	to	use	more	often	if	legalized².		•  Data	from	18	states	that	had	legalized	marijuana	as	of	2014	showed	that	living	a	short	distance	from	a	marijuana	dispensary	was	associated	with	increased	use	among	middle	schoolers⁴.	•  In	the	face	of	this	new	legislation,	teens	need	more	information	about	the	speciﬁc	risks	of	marijuana	use	for	the	developing	adolescent	brain.	Public	health	cost	:	teenage	marijuana	use	From	the	American	Academy	of	Pediatrics⁵:	•  Negative	eﬀects	on	short-term	memory	•  Decreased	concentration,	attention	span,	motivation	•  Decreased	coordination,	judgement,	reaction	time	(contribute	to	deaths	and	injuries)	•  Deleterious	health	eﬀects	similar	to	those	of	tobacco			From	Substance	Abuse	(journal)³:		•  Higher	school	dropout	rates	•  Elevated	risk	of	developing	psychotic	illnesses	•  Weekly	marijuana	use	under	age	18yo	à	8	point	drop	in	intelligence	among	those	who	develop	persistent	dependence	(not	true	for	those	that	start	after	age	18)		•  Cognitive	capacity	may	not	recover	after	stopping	marijuana	use			Community	perspective	(4a)	Dr.	Jill	Rinehart,	M.D.	(pediatrics)	•  “The	impact	[of	marijuana]	on	the	developing	adolescent	brain	is	concerning	for	impairment,	as	executive	function	is	still	forming	at	this	time	of	life.”	•  “A	teen	starts	using	pot	early	in	high	school	and	has	goals	for	herself	to	become	a	neuroscientist,	and	by	senior	year	they’ve	given	up	on	applying	to	college	altogether…The	use	of	marijuana	is	associated	with	a	decline	in	achieving	goals,	and	that	is	sad	to	watch.”		•  Helpful	safety	measures:	child-resistant	packaging,	storing	marijuana	in	locked	boxes,	prohibition	of	“edible”	sales,	more	robust	after-school	programming,	regulation	of	THC	concentration,	raising	legal	age	to	25.		Dr.	Jon	Porter,	M.D.	(family	medicine)	•  “The	primary	concerns	are	related	to	the	negative	impacts	on	neurocognitive	development…The	literature	raises	concerns	about	blunted	IQ,	but	beyond	this,	early	and	regular	use	is	associated	with	impairments	in	executive	functioning.”		•  Advice	to	teens:	“The	notion	in	the	collective	societal	consciousness	is	that	cannabis	is	safe,	‘organic’,	and	that	doctors	prescribe	it	so	it	must	be	ok.	It’s	true	that	many	people	use	it	without	diﬃculty,	but	many	people	struggle	for	years.”		Community	perspective	(4b)	Chris	Pearson:	VT	state	representative		•  Ideal	situation	for	VT	when	it	comes	to	marijuana:	taxed	and	regulated	system	where	marijuana	is	treated	similarly	to	alcohol		•  Major	issue:	federally-funded	research	on	marijuana	has	been	blocked,	prohibiting	acquisition	of	helpful	data	concerning	driving	impairment,		risks/	beneﬁts	of	use	and	THC	dosing		•  Potential	beneﬁts	of	legalization/taxation:	more	$	available	for	substance	use	education	(particularly	essential	in	the	context	of	the	opiate	crisis	in	VT)	Dr.	David	Rettew,	M.D.	(psychiatry)	•  Main	risk	of	legalization:	increased	adolescent	use	à	teens	are	at	much	higher	risk	when	they	use	cannabis	than	adults:	psychosis,	decreased	memory	and	attention,	suicide	&	traﬃc	crashes	•  “From	working	in	outpatient,	inpatient	and	emergency	room	settings,	I’ve	seen	countless	numbers	of	adolescents	completely	derail	their	life	because	of	marijuana.	I’ve	seen	productive	and	bright	teens	lose	the	motivation	to	engage	in	life.	I’ve	also	witnessed	profound	personality	changes	that	lead	adolescents	to	become	paranoid	and	violent.”		Intervention/methodology	•  Interviews	were	conducted	with	four	community	members:	a	pediatrician,	psychiatrist,	family	physician	and	local	VT	state	representative.	The	purpose	of	these	interviews	was	to	gain	a	wider	perspective	on	the	impact	of	both	marijuana	use	and	potential	legalization	in	VT.	•  Educational	handout	was	created	to	help	educate	teenage	patients	about	marijuana	use,	particularly	use	that	starts	before	age	18.	Information	included	in	materials	was	taken	from	evidence-based		research	(see	references).	•  Included	in	this	material:	mechanism	by	which	marijuana	works	in	the	brain,	the	course	of	teenage	brain	development,	how	brain	development	is	permanently	aﬀected	by	drug	use,	particularly	marijuana	use	before	age	18.	•  This	pamphlet	also	includes	helpful	online	resources	for	learning	about	marijuana	use	(some	meant	for	teens,	others	for	parents/families).		Results	• Educational	materials	were	made	available	for	physicians	to	include	in	after-visit	summaries	(printed	material	that	patients	take	home).	This	will	allow	teens	to	review	the	information	on	their	own	time,	and	will	hopefully	spur	conversations	between	teens	and	families	about	marijuana	use.		• Materials	were	distributed	to	two	health	teachers	at	Essex	High	School,	so	that	the	information	could	be	provided	to	students	and	incorporated	into	classroom	discussions	about	substance	use.		Evaluation	of	eﬀectiveness,	limitations		Evaluating	eﬀectiveness:		•  Tracking	(over	time)	how	many	times	the	handout	is	incorporated	by	physicians	into	patient	after-visit	summaries,	to	assess	for	physician	perceptions	of	utility.	•  Could	provide	surveys	to	students	at	Essex	High	school	(before	and	after	distribution	of	materials)	to	see	how	opinions	on	early	marijuana	use	changes	with	education.			Limitations:		•  Teens	may	not	be	forthcoming	to	their	doctors	about	their	marijuana	use,	especially	if	they	are	accompanied	by	a	parent	during	the	visit.	•  The	success	of	the	intervention	will	depend	on	the	physicians’	perception	of	usefulness	(as	they	can	choose	to	include	the	handout	in	after-visit	summaries).	•  Written	information	may	not	be	the	best	way	to	deliver	facts	to	teenagers;	it	is	possible	that	an	interactive	module	or	video	would	garner	more	attention/interest.			Recommendations	for	future	•  Development	of	guidelines	for	physicians	to	help	identify	teen	marijuana	users	considered	to	be	“at-risk.”	This	could	be	similar	to	the	USPSTF-recommended	screening	for	at-risk	alcohol	users	(AUDIT-C	screening	tool).		•  Formal	marijuana-speciﬁc	education	for	high	school	students	(evidence-based).	This	could	be	paid	for	by	eventual	marijuana	taxation	(as	has	been	done	with	cigarette	tax).					•  Vermont	should	preemptively	ban	advertisements	for	commercial	marijuana	products,	with	the	hope	that	less	media	exposure	would	lead	to	fewer	teenage	users.	•  If	eventually	fully	legalized	and	taxed,	marijuana	products	should	include	child-proof	packaging,	and	adult	users	should	be	urged	to	keep	marijuana	in	locked	containers,	as	is	the	current	recommended	practice	for	opiates	and	ﬁrearms.	References		1)	McCullum	A.	“Vermont’s	legal	marijuana	law:	what	you	should	know.”	Burlington	Free	Press.	22	January	2018.	Web.	3	March	2018.	https://www.burlingtonfreepress.com/story/news/politics/government/2018/01/22/vermonts-legal-marijuana-law-what-you-should-know/1045478001/	2)	Palmer	JJ,	Ompad	DC,	Petkova	E.	Correlates	of	intentions	to	use	cannabis	among	US	high	school	seniors	in	the	case	of	cannabis	legalization.	International	Journal	of	Drug	Policy.	2014	May	25;	25(3):	424-35.		3)	Hopfer	C.	Implications	of	marijuana	legalization	for	adolescent	substance	abuse.	Substance	Abuse.	2014;	35(4):	331-335.		4)	Shi	Y.	The	availability	of	medical	marijuana	dispensary	and	adolescent	marijuana	use.	Preventative	Medicine.	2016	Oct;	91:	1-7.		5)	Lisdahl	K,	Gilbart	E,	Wright	N,	Shollenbarger	S.	Dare	to	delay?	The	impacts	of	adolescent	alcohol	and	marijuana	use	onset	on	cognition,	brain	structure,	and	function.	Frontiers	in	Psychiatry.	2013	July;	4:	1-19.	6)	Neighmond,	P.	“Marijuana	may	hurt	the	developing	teen	brain.”	NPR.	3	March	2014.	Web.	3	March	2018.	www.npr.org/sections/health-shots/2014/02/25/282631913/marijuana-may-hurt-the-developing-teen-brain.	7)	Khazan	O.	“The	surprising	eﬀect	of	marijuana	legalization	on	college	students.”	The	Atlantic.	16	June	2017.Web.	3	March	2018.	<	www.theatlantic.com/health/archive/2017/06/marijuana-legalization-college-students/530607.		8)	Joﬀe	A,	Yancy	W.	Legalization	of	marijuana:	potential	impact	on	youth.	Pediatrics.	2004	June;	113(6):	632-638.		9)	Chen	H,	Searles	J.	Health	considerations	in	regulating	marijuana	in	Vermont.	Preventative	Medicine.	2017	November;	104:	7-9.					Interview	consent		“Thank	you	for	agreeing	to	be	interviewed.	This	project	is	a	requirement	for	the	Family	Medicine	clerkship.	It	will	be	stored	on	the	Dana	Library	ScholarWorks	website.	Your	name	will	be	attached	to	your	interview	and	you	may	be	cited	directly	or	indirectly	in	subsequent	unpublished	or	published	work.	The	interviewer	aﬃrms	that	he/she	has	explained	the	nature	and	purpose	of	this	project.	The	interviewee	aﬃrms	that	he/she	has	consented	to	this	interview.	Yes	__X__		/	No	_____”	Interviewer:	Katie	Warther	Interviewee:	Chris	Pearson:	VT	State	Representative		Interviewee:	David	Rettew,	M.D.		Interviewee:	Jill	Rinehart,	M.D.		Interviewee:	Jon	Porter,	M.	D.			

Marijuana and the Teenage Brain: Public Health Impact

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Marijuana and the Teenage Brain: Public Health Impact

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