HomeMy WebLinkAbout2019/09/10 Public Comments - Rapp Written Communi 'onU,S. Surgeon General's Advisory:
Item # Name livana Use and the Developing Brain
1, Surgeon General VADM Jerome Adams, am emphasizing the importance of protecting our Nation
from the health risks of marijuana use in adolescence and during pregnancy. Recent increases in
access to marijuana and in its potency, along with misperceptions of safety of marijuana endanger our
most precious resource, our nation's youth.
KNOW THE RISKS. TAKE ACTION. PROTECT OUR FUTURE.
Background
Marijuana, or cannabis, is the most commonly used illicit drug in the United States. It acts by binding
to cannabinoid receptors in the brain to produce a variety of effects, including euphoria, intoxication,
and memory and motor impairments. These same cannabinoid receptors are also critical for brain
development. They are part of the endocannabinoid system, which impacts the formation of brain
circuits important for decision making, mood and responding to stress'.
Marijuana and its related products are widely available in multiple forms. These products can be
eaten, drunk, smoked, and vaped2. Marijuana contains varying levels of delta-9-tetrahydrocannabinol
(THC), the component responsible for euphoria and intoxication, and cannabidiol (CBD). While CBD
is not intoxicating and does not lead to addiction, its long-term effects are largely unknown, and most
CBD products are untested and of uncertain purity- .
Marijuana has changed over time. The marijuana available today is much stronger than previous
versions. The THC concentration in commonly cultivated marijuana plants has increased three-fold
between 1995 and 2014 (4% and 12% respectively) -. Marijuana available in dispensaries in some
states has average concentrations of THC between 17.7% and 23.2% Concentrated products,
commonly known as dabs or waxes, are far more widely available to recreational users today and
may contain between 23.7% and 75.9% THC6.
The risks of physical dependence, addiction, and other negative consequences increase with
exposure to high concentrations of THC7 and the younger the age of initiation. Higher doses of THC
are more likely to produce anxiety, agitation, paranoia, and psychosis. Edible marijuana takes time
to absorb and to produce its effects, increasing the risk of unintentional overdose, as well as
accidental ingestion by children: and adolescents10. In addition, chronic users of marijuana with a
high THC content are at risk for developing a condition known as cannabinoid hyperemesis
syndrome, which is marked by severe cycles of nausea and vomiting
This advisory is intended to raise awareness of the known and potential harms to developing brains,
posed by the increasing availability of highly potent marijuana in multiple, concentrated forms. These
harms are costly to individuals and to our society, impacting mental health and educational
achievement and raising the risks of addiction and misuse of other substances. Additionally,
marijuana use remains illegal for youth under state law in all states; normalization of its use raises the
potential for criminal consequences in this population. In addition to the health risks posed by
marijuana use, sale or possession of marijuana remains illegal under federal law notwithstanding
some state laws to the contrary.
Marijuana Use during Adolescence
Marijuana is also commonly used by adolescents, second only to alcohol. In 2017, approximately 9.2
million youth aged 12 to 25 reported marijuana use in the past month and 29% more young adults
aged 18-25 started using marijuana23. In addition, high school students' perception of the harm from
regular marijuana use has been steadily declining over the last decade24. During this same period, a
number of states have legalized adult use of marijuana for medicinal or recreational purposes, while it
remains illegal under federal law. The legalization movement may be impacting youth perception of
harm from marijuana.
The human brain continues to develop from before birth into the mid-20s and is vulnerable to the
effects of addictive substances25, 26. Frequent marijuana use during adolescence is associated with
changes in the areas of the brain involved in attention, memory, decision-making, and motivation.
Deficits in attention and memory have been detected in marijuana-using teens even after a month of
abstinence27. Marijuana can also impair learning in adolescents. Chronic use is linked to declines in
IQ, school performance that jeopardizes professional and social achievements, and life
satisfaction28. Regular use of marijuana in adolescence is linked to increased rates of school
absence and drop-out, as well as suicide attempts:
Marijuana use is also linked to risk for and early onset of psychotic disorders, such as schizophrenia.
The risk for psychotic disorders increases with frequency of use, potency of the marijuana product,
and as the age at first use decreases30. Adolescent marijuana use is often also associated with
other substance use31, 32. In 2017, teens 12-17 reporting frequent use of marijuana showed a 130%
greater likelihood of misusing opioids23. Marijuana's increasingly widespread availability in multiple
and highly potent forms, coupled with a false and dangerous perception of safety among youth,
merits a nationwide call to action.
You Can Take Action
No amount of marijuana use during pregnancy or adolescence is known to be safe. Until and unless
more is known about the long-term impact, the safest choice for pregnant women and adolescents is
not to use marijuana. Pregnant women and youth--and those who love them--need the facts and
resources to support healthy decisions. It is critical to educate women and youth, as well as family
members, school officials, state and local leaders, and health professionals, about the risks of
marijuana, particularly as more states contemplate legalization.
Science-based messaging campaigns and targeted prevention programming are urgently needed to
ensure that risks are clearly communicated and amplified by local, state, and national organizations.
Clinicians can help by asking about marijuana use, informing mothers-to-be, new mothers, young
people, and those vulnerable to psychotic disorders, of the risks. Clinicians can also prescribe safe,
effective, and FDA-approved treatments for nausea, depression, and pain during pregnancy. Further
research is needed to understand all the impacts of THC on the developing brain, but we know
enough now to warrant concern and action. Everyone has a role in protecting our young people from
the risks of marijuana.
• Get around-the-clock free advice and referrals: Substance Abuse and Mental Health
Administration (SAMHSA) National Helpline(1-800-662-HELP(4357).
Information for Parents:
You have an important role to play for a healthy next generation..
• Start a conversation with your kids: Marijuana: Facts Parents Need to Know.
• Keep your adolescent from using marijuana and other drugs: Keeping Youth Drug Free - PDF.
• Watch the Message to Parents from NIH/NIDA :Y
Information for Youth:
You have an important role to play for a healthy next generation.
• Want to know how marijuana affects brain development? Get the facts.
• Learn key techniques on how to resist peer pressure: Above the Influence V.
• Learn how to help friends stop using marijuana with Letter to Teen
• Get around-the-clock free advice and referrals: Substance Abuse and Mental Health Administration(SAMHSA)_
National Helpline (1-800-662-HELP (4357). _