As regulations around cannabis continue to loosen after the election in November, it is increasingly important for clinicians to work with patients who use it and help them minimize the potential risks. In thinking about cannabis use realistically, it is going to be hard to deter those patients who are presently using it from using it at all, and thus it seems reasonable for providers to take an approach of trying to help those patients who are using “do no harm” with their cannabis use.
There has been a clear and steady increase in the number of adults reporting use of cannabis since 2000. Interestingly and fortunately, there is not an increase in the number of teens using cannabis, nor are there findings of teens starting to use at younger ages, but teens who are using are using more frequently than in the past and the potency of current supplies are greater than in the past, raising significant risk concerns.
Following are suggested harm reduction recommendations that seem appropriate to use with patients of any age to minimize potential negative consequences of cannabis use.
- Using it less frequently and avoiding daily use
- Delaying starting it until adulthood
- Using safer sources and routes
- Avoiding driving or being driven by someone under the influence
Although research findings are still somewhat limited, several studies have looked into the negative effects of cannabis use in adolescence which include: increased risk of psychosis, increased risk of substance dependence, and reduction of cognitive skills. Regular cannabis use can increase the risk of subclinical psychotic symptoms, and these symptoms can persist even after a long period of abstinence. Additionally, for patients with schizophrenia, using cannabis can move up the onset of schizophrenia up to 3 years earlier than for patients who do not use cannabis. Regular and heavy cannabis use in adolescence can lead to a permanent loss of IQ points, something that is not seen with cannabis use that starts in adulthood. Regular cannabis use in teens has been shown to impair learning, problem-solving skills and short-term and long-term memory. Studies also suggest downward socioeconomic mobility in people who started to use cannabis at a young age. The take home message is that if a teenager is using or at risk of using cannabis, they should be encouraged ideally to wait until adulthood or, absent abstinence, to avoid using it routinely because of these risks.
It is important for all patients, regardless of their age, to be aware of the sources of cannabis they are using and the route they are ingesting it by. It is particularly important for them to avoid products that are very high in THC (trans-Δ9-tetrahydrocannabino) and to avoid concentrates, which can be made in unsafe environments, and especially synthetic cannabinoids, which can be very potent and can have significant negative psychological impacts. Edibles and vaporized cannabis can be safer routes, because they do not irritate the respiratory system, but again, psychological impacts remain an obvious concern as dosing may be higher than anticipated, especially for new users.
It is recommended that providers discuss these issues in a fact oriented and non-judgmental manner just as one might inquire about alcohol or other substance use/abuse. In the face of the changes in social attitudes and the change toward the legality of using cannabis for those over the age of 21, establishing and maintaining an active dialogue with all patients about substance use issues is recommended as part of routine care.
Patients acknowledging problems with dependence or misuse of cannabis should be referred for treatment to a mental health provider or a cannabis specific treatment program.
The San Diego Access and Crisis Line can offer options for your patients seeking treatment. 1-888-724-7240