The recent report from the Rocky Mountain High Intensity Drug Trafficking Area (Rocky Mountain High) shows Colorado ranked #1 in the nation for past-month marijuana use by youth between 12 and 17 in 2014/2015, up from #4 in 2011/2012 and #14 in 2005/2006. Youth use of marijuana in Colorado is 55 percent higher than the national average and more than double the rate of the last-place state, Utah.
It’s not surprising that the increased access that comes from legalizing marijuana leads to higher usage among youth. Of the top 10 states in youth marijuana use, every single one has either legalized marijuana entirely or made it available for medicinal use. In the bottom 10 states, marijuana is still considered illegal.
Even the most ardent supporter of legalizing marijuana would probably agree that underage use of marijuana is a bad thing, just like underage drinking of alcohol. Research shows that marijuana has a profoundly negative impact on brain development, a process that continues well into a person’s mid-20s. Regular marijuana use as a teenager is especially damaging, causing a permanent 6-point drop in IQ and increasing the likelihood of later difficulties with substance use. For this reason, Caron holds the legal age for usage should be 25 years old, if marijuana is to be legalized at all.
What troubles me is that Colorado doesn’t seem to have taken any concrete steps towards addressing this problem.
Certainly, Colorado has practices in place that promote prevention, similar to what most other states are doing. I applaud this. Any dollar that is spent on prevention is important, so I don’t want to downplay that. But neither I do I see the state doing anything different to address youth use of marijuana, despite being in vanguard of states legalizing marijuana and having the highest rate of youth use in the country.
If we are on a path to legalization of marijuana, I would want to see states like Colorado step up their efforts in two areas: prevention of youth use, and early intervention.
Educating Teens on the Risks of Marijuana. In my conversations with teens, they perceive marijuana as a lower risk alternative to alcohol. They don’t think they’re going to get caught as easily – there’s no breathalyzer for marijuana, after all. Parents are also perceiving marijuana as a lower risk. There are few parents telling their kids we don’t want you to smoke marijuana and drive. “Don’t get stoned and drive” is not part of our vocabulary, but it needs to be.
The prevention messaging around alcohol is working with teens. There’s a big emphasis on “Don’t drink and drive” – the teens know people are being caught at higher rates, the consequences of being caught are severe, and breathalyzers can prove that they’ve been drinking. Schools have also taken measures to prevent alcohol use at events such as proms or football games. Parents are also reinforcing the messages, concerned about the legal and safety issues involved in teens drinking and driving.
We need to step up our efforts in educating teens on the risks and consequences, similar to the efforts undertaken for smoking and drinking. The messages also need to be specific to teens and their interests, reinforced by the expectations of parents, educators, law enforcement, and peers.
Parents Need to Understand the Risks. Many parents will say, “Well, I use [or used] marijuana. What’s the big deal?” The reality is that a percentage of young people are going to develop a substance use disorder as a result of their marijuana use. Those who use marijuana before age 18 are four to seven times more likely than an adult to progress to problem use. We know if we can delay use beyond until after age 18, we can reduce their chances of having a long-term substance use disorder dramatically.
Parents who understand the risks should adopt consistent messaging for their children about marijuana just as they would for alcohol or any other substances, and that they should continue those conversations on into early adulthood. For me it’s about delay, delay, delay.
It’s clear that legalizing marijuana increases the opportunities that teens have for encountering it in their daily lives. In legal states, the risk of availability for teens comes not from the dispensaries themselves, which seem to be doing their job in making sure that customers are of legal age, but from the marijuana found in the teens’ homes and the homes of their friends. Teens quickly discover it is remarkably easy to filch just a little bit of marijuana, which will never be missed by the adults that bought it legally. Parents should keep a watchful eye on the accessibility and availability of marijuana, in and out of the home.
SBIRT Should Be Mandatory in All Schools. I would love to see SBIRT, a universal approach to prevention, adopted in all Colorado schools. The goal of SBIRT (Screening, Brief Intervention, and Referral to Treatment) is to identify problematic substance use at an early age in order to intervene with appropriate services early enough to head off more serious problems. Undergoing an SBIRT review would be like getting your eyes and ears checked, your BMI checked in school, but every student would receive the same screening to catch any issues early.
Massachusetts, which is on the path of legalizing marijuana, mandated in 2016 that all public schools in the state implement SBIRT. Numerous other localities are adopting SBIRT, including here in my local county. Shouldn’t the state that leads the nation in legalizing marijuana also be in the lead in SBIRT?
Pediatricians Are on the First Line of Defense. This really should be looked at as a health issue, and pediatricians can play a key role in early intervention for youth use of marijuana. If pediatricians are urging patients to eat right, exercise, and maintain a healthy weight, marijuana and substance use should also be part of the conversation. Use of marijuana by someone under age should not be seen as a rite of passage. It is something that should be dealt with from a health perspective, with the goal of delaying use until legal age, which would be a more appropriate age from a health perspective.
Of course, there is a question as to whether pediatricians are receiving the training that they need on substance use disorders and incorporating that into their practices with families and teens. For example, Caron recently completed training for pediatric residents in New York. The residents admitted that, while they were asking about sexual health and activity into their traditional well exams, few of them were asking about substance use.
If pediatricians do have a teenaged patient who admits to somewhat regular use, they should recommend a comprehensive behavioral health assessment done by a licensed drug and alcohol professional. If a child was diagnosed with diabetes, the pediatrician would potentially be referring the patient to an endocrinologist for further evaluation and treatment; they should do the same for a drug and alcohol related issue. They should also engage the family in the solution, as they would any other health issue.
Enforcement Must Be Part of Intervention. The fact is, marijuana use by teens is still illegal in Colorado and other states. The approach to enforcement should be similar to that with underage drinking laws, where, for many states, first offenders are given the option of undergoing an extensive educational and intervention program that results in a reduced criminal charge once completed. The goal shouldn’t be to punish but rather to prevent the progression to more serious substance use disorder. Such approaches save lives, and they put at-risk teens back on track for a promising future.
Why isn’t Colorado, that leads the nation in legalizing marijuana and now leads the nation in youth use as a result, also now leading the nation in addressing underage use? It may well be that programs for prevention and early intervention are being put in place, but Colorado should take a highly visible role in being a laboratory for dealing with these issues, developing best practices that other states considering legalization can use to get ahead of the problem of youth use.