Marijuana Use Among Children and Adolescents

American Family Physician,  May 1, 2000  by Monica Preboth

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The Committee on Substance Abuse of the American Academy of Pediatrics (AAP) has issued a statement about the growing number of children and adolescents who use marijuana. Marijuana is the most common illicit drug used by children and adolescents in the United States. Survey data show that use is on the rise among this group as they become less concerned about the dangers of the drug. Physicians must develop a reasoned approach to dealing with marijuana use among young persons so that they can provide appropriate care and counsel. The AAP statement appears in the October 1999 issue of Pediatrics.

According to the AAP committee, regular use of marijuana is associated with cardiovascular, pulmonary, reproductive and immunologic problems. Marijuana use may cause an accelerated heart rate and a minimal rise in blood pressure. Heavy use of marijuana may be dangerous for adolescents during puberty and is associated with diminished sperm motility, decreased sperm counts, decreased circulating testosterone levels, irregular ovulation and decreased gonadotrophin levels. Marijuana also influences the immune system and affects antitumor activities in the body.

In the past two decades, the average potency of marijuana has increased fivefold, states the AAP. "Casual use" of low-potency marijuana several decades ago has given way to compulsive use of high-potency marijuana today. Persons under the influence of marijuana show impaired problem-solving skills and difficulty in organizing thoughts and conversing. They have trouble with coordination; the ability to judge elapsed time, speed and distance; the ability to track a moving object; and reaction time. Marijuana contributes significantly to accidental death and injury among adolescents, especially those associated with motor vehicle crashes. Regular use affects short-term memory, learning and attention span. Finally, marijuana use often leads to the use of other more dangerous illicit drugs.

The AAP committee urges physicians to counsel young patients against the use of marijuana. Counsel should focus on health concerns, including the relationship of marijuana use to trauma associated with intoxication and the effect of the drug on memory and learning during this important period of development. Physicians can also discuss the potential harm that marijuana use may cause to adolescents during a period of rapid change in hormonal secretion, possible teratogenicity and the known consequences of long-term use.

Routine discussion of drug use should be part of health care for all young persons. Assessing potential drug use will allow the physician to offer anticipatory guidance before the onset of use, to intervene and minimize consequences if drug use has begun, and to detect and address issues of long-term or heavy use. The AAP committee states that teenagers who are dependent on marijuana should be offered treatment options, rather than simply punishment, for their illness.

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