Adolescents who use cannabis recreationally are two to three times more likely to have depression and suicidal thoughts than teenagers who don't use cannabis products, according to a cross-sectional study of more than 68,000 U.S. teens ages 12 to 17.

Figure. Prevalence of adverse adolescent psychosocial events among nonuse, nondisordered cannabis use, and cannabis use disorder groups. Data are from the 2015 to 2019 National Surveys on Drug Use and Health. Image from Sultan RS, et al.

The study, published in the May JAMA Network Open, also found that teenagers with cannabis use disorder-continued cannabis use despite health and social problems-are four times more likely than nonusers to experience depression and suicidal ideation. For several adverse events, the risk was similar among teens who use cannabis recreationally but not to the extent of those with cannabis use disorder.

Teen cannabis users were also found to be about two to four times more likely than nonusers to be truant from school and about two to three times more likely to report a low grade point average. Cannabis use was associated with "worse executive control, decreased attention, and deficits in episodic memory," the researchers wrote.

However, it is unclear if cannabis use causes mental distress, difficulties in thinking, and poor academic outcomes, or if teenagers who use cannabis are more likely than their nonuser peers to experience mental health challenges and difficulty in school.

"Having depression or suicidality may drive teens to use cannabis as a way to relieve their suffering," said senior study author Frances R. Levin, MD, in an article for the Columbia University Department of Psychiatry. "Concurrently, using cannabis likely worsens depressive and suicidal symptoms."

Whether cannabis causes or worsens adolescents' mental health and cognition, it's important for teens and health care providers to understand that today's marijuana typically contains two to three times more tetrahydrocannabinol, the ingredient that makes people feel high, than the cannabis of years past. According to the University of Southern California Schaeffer Center for Health Policy and Economics, both dried cannabis flowers and, especially, edible products, oils, waxes, and crystals are far more potent than the products available a generation ago.

Yet many teens believe that marijuana is safer than alcohol and other drugs, which may be why cannabis is now the most widely used illicit substance among U.S. teenagers. Nurses should ask teens about cannabis use (including via vaping and edibles) and mental health during clinical encounters and offer support as needed.-Jennifer Fink, BSN, RN