Despite fewer restrictive laws, cannabis products still carry risk.


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The trend among states to legalize recreational use of marijuana suggests a public perception that the drug is safe to use-and older teens seem to agree. Fewer than a quarter of 12th-grade respondents to a 2021 federal survey saw "great risk" in regularly using the drug.

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Public perception aside, evidence is emerging of harm to young marijuana users because of the high concentrations of tetrahydrocannabinol (THC), the cannabis plant's psychoactive component, in today's commercial products. Experts say current formulations lack sufficient amounts of the cannabidiol (CBD) compound that balanced and mitigated the effects of THC in earlier marijuana strains.


Teens who regularly inhale or consume cannabis products containing large amounts of THC are becoming addicted, and some have become sick enough to land in EDs, according to a June 23 report in the New York Times. The average concentration of THC in marijuana samples seized by the Drug Enforcement Administration rose from about 4% in 1995 to more than 17% in 2017. In addition to the dried cannabis sold as marijuana, cannabinoids (chemical substances distilled from the plant) are now available in edibles, vaping oils, and other products, some of which have THC concentrations exceeding 95%. Their potency is largely unregulated.


Recreational marijuana use is legal in 19 states and the District of Columbia for adults ages 21 and older, though surveys suggest these products are easily obtained by teens. "Since 2014, I have seen a huge increase in access to marijuana as well as acceptance, with a lack of understanding of the risks of smoking versus dabbing-inhaling highly concentrated THC or high concentration oils," said Tessa McIlraith, a school nurse in Washington State, which became one of the first states to legalize recreational marijuana in 2012. McIlraith became certified in drug impairment assessment in 2018, and initially used those skills five or six times a year. "It's a weekly occurrence now," she said. "I understand decriminalizing marijuana, but I think the impact it has on brain development isn't talked about enough."


According to the Centers for Disease Control and Prevention, children and teens are especially vulnerable to addiction and other drug-related harms because their brains are still developing. They may experience difficulties with thinking, problem-solving, memory, learning, and concentration as well as reduced physical coordination. An estimated three in 10 regular users of marijuana in all age groups develop cannabis use disorder, defined by the National Council of State Boards of Nursing (NCSBN) as "a problematic pattern of cannabis use leading to clinically significant impairment or distress." The NCSBN's marijuana guidelines, published in a July 2018 supplement to the Journal of Nursing Regulation, also note cases of cannabinoid hyperemesis syndrome, which presents as "severe, cyclic nausea; vomiting; and compulsively taking extremely hot showers or baths," and of cannabis withdrawal syndrome, which is marked by irritability, anxiety, sleeping difficulties, and depressed mood. Daily use by adolescents of cannabis products with 10% or more THC has also been linked to hallucinations and earlier onset of psychotic disorders.


Teen users may overdose after unwittingly consuming cannabis products mixed with opioids. "Our problems have been with students vaping marijuana and finding out it was laced with an unknown substance," reports Lisa E. Patch, executive director of health services for Alamogordo, New Mexico, public schools. "We now have Narcan [an opioid antidote] in all secondary schools and had to use it this year for that reason."


According to McIlraith, some students use marijuana to quell anxiety. "It's not recreational for many of them," she told AJN. "It's really being used medicinally but without guidance, and I think that's where we've let youth down." She recommended that nurses who work with children and adolescents learn about marijuana products and their potential harms so they can inform patients, just as they would about common over-the-counter drugs. The National Institute on Drug Abuse has information for educating young teens in its Mind Matters Series (https://nida.nih.gov/publications/mind-matters-series).-Nicole Fauteux