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Why legal marijuana will hurt kids

An editorial in @CMAJ says the proposed federal law to legalize marijuana could harm kids. @NightshiftMD explains why.

The federal government's tabled Bill C-45 would allow adults to legally possess and use small amounts of recreational marijuana. The bill would make it a criminal offence to sell pot to minors but it would not be a crime for youth to possess small amounts of it. An editorial published today in the Canadian Medical Association Journal calls on Parliament to reject the bill.  

The overall message of the editorial is that marijuana use in youth is potentially dangerous, so any law the legalizes its use should go the extra distance to protect young people from having harmful access to it. In particular, Bill C-45 would allow Canadians age 18 and older the right to purchase recreational marijuana, putting young people in their late teens and early 20s at risk.  The bill allows for personal cultivation of up to four marijuana plants each no more than one metre in height.

Then, there's the issue of home-grown cannabis. The editorial states that unsupervised personal cultivation increases the risk of access to young people.  Home grown marijuana would not be subject to controls on potency putting youth at greater risk. The fact that possession of small quantities (under five grams) by youth would not be a crime takes an important deterrent off the table.  

Doctors have a number of concerns about marijuana use in young people.  The Canadian Pediatric Society says cannabis use in adolescence is toxic to brain cells and can cause functional and structural changes to the developing brain. The Centre for Addiction and Mental Health (CMAH) in Toronto says, "cannabis is not a benign substance and its health harms increase with intensity of use." CAMH says that while adults are susceptible to the same kinds of effects, the developing brain is at greater risk.  

The Canadian Pediatric Society says that marijuana use is strongly linked to dependence to cannabis and other substances including tobacco.  The lifetime risk of marijuana addiction across all ages is nine per cent, but is 17 per cent for those who begin as teenagers. Marijuana use in young people is linked to depression, anxiety, poor grades and academic achievement, and psychosis.  

In the ER, I've seen patients in their teens and early 20s who are brought to the ER during their first psychotic break, and they have marijuana in their system. Psychosis is a severe mental disorder that causes agitation and impaired thinking such that the person has lost their grasp on reality.  People with psychosis may believe they are omnipotent and that God talks to them.  They may have paranoid thoughts, and may believe that their conversations and even their thoughts are being broadcast to others. They may hear voices that tell them they are bad or unworthy or that they should harm themselves. We don't know whether marijuana use causes psychosis or unmasks it in people who are susceptible. For a good discussion of the issues, read this.

What changes to the bill might address the issue of marijuana use in young people?  The Canadian Medical Association has recommended that the law set the minimum age to buy and use marijuana at 21 instead of 18 years.  The CMA has also joined others in calling for restrictions on the quantity and potency of marijuana that young people can purchase and use until the age of 25.  These restrictions are in line with scientific evidence that the brain continues to develop until the mid-twenties.  A federal law could also set national standards for retail distribution.  As is, the provinces would be mandated to set their own regulations, meaning that access to marijuana will vary with the province, increasing the risk of unlawful access.

I agree that high potency marijuana use in young people is risky.  But I don't think that legislation is the solution. Canada has one of the highest rates in the world of young people using marijuana.  As many as 60 per cent of 18 year olds have tried it at least once.  The absence of legislation hasn't made it that difficult for youth to obtain it. Researchers doubt that bill C-45 or any law for that matter will curb the use of cannabis by young people.  Colorado has had legal marijuana for some time now, and that state has seen no increase or decrease in young people using the drug.  

Elsewhere, it has been suggested that messaging around marijuana is more important than the law.  The federal government should stop suggesting that the law is intended to prevent kids from using marijuana, since that kind of message is likely to make the drug more attractive to teens.  

One doctor said recently that the best way to discourage teens from using is to make marijuana seem boring.

That might be the best approach of all.

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