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Published: 07 November 2024

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The cannabis landscape has undergone a dramatic transformation over the past four decades, one that fundamentally changes the nature of the discussion around legalisation and youth access. This isn’t merely about policy changes – it’s about the substance itself. Cannabis potency has increased exponentially, from approximately 1% THC content in the 1980s to modern strains exceeding 20% THC, with some concentrates surpassing 90% THC. This remarkable increase in potency, driven by selective breeding and advanced cultivation techniques, raises profound questions about the applicability of historical cannabis research to current policy decisions.

Before delving into the policy implications, it’s crucial to understand what we’re dealing with. Cannabis contains numerous chemical compounds called cannabinoids, with tetrahydrocannabinol (THC) being the primary psychoactive component. THC interacts with the brain’s endocannabinoid system, influencing mood, perception, and various cognitive functions. Another major cannabinoid, cannabidiol (CBD), is non-psychoactive and has attracted attention for its potential therapeutic benefits.

Evidence from Recent Research

The recent study published in Psychological Medicine provides some of the most compelling evidence to date regarding youth cannabis use and mental health outcomes. The methodology was robust:

• Population-based survey data from over 11,000 Ontario youths
• Linked health service records including hospitalisations, emergency department visits, and outpatient visits
• Data from Canadian Community Health Survey cycles (2009-2012)
• Careful exclusion of respondents with pre-existing psychotic disorders

The findings are stark: adolescent cannabis users showed an elevenfold higher risk of developing psychotic disorders compared to non-users. Perhaps most telling is that approximately 5 in 6 teens who required hospitalisation or emergency department visits for psychotic disorders had previously reported cannabis use.

Recreational Cannabis Legalisation (RCL):

• Significantly increased odds of past-month cannabis use
• Overall odds ratio: 1.134 (95% CI = 1.116-1.153)
• More pronounced effects in recent studies:
  • Adolescents: OR = 1.089 (95% CI = 1.015,1.169)
  • Young adults: OR = 1.221 (95% CI = 1.188,1.255)

The Gateway Effect: Beyond Rhetoric to Evidence

The gateway hypothesis has often been dismissed as oversimplified or politically motivated. However, the Christchurch Longitudinal Study provides compelling evidence that demands serious consideration. The study found that in 86% of cases where individuals had progressed to multiple illicit drug use, cannabis was their initial substance. This isn’t mere correlation – it emerged as the strongest risk factor for later involvement in other illicit drug use.

Supporting this finding, the University of Bristol’s research through the Population Health Science Institute found that regular and occasional cannabis use during adolescence is associated with significantly higher risks of other illicit drug use in early adulthood. This pattern suggests a developmental trajectory that policy makers cannot afford to ignore.

The Canadian Experience: A Natural Experiment

Canada’s experience with legalisation provides valuable insights into the challenges and consequences of cannabis policy reform. As noted by researcher André McDonald, the country’s move toward legalisation occurred “largely in the absence of solid evidence on the risks of cannabis use.” The subsequent finding that Canadian youth rank among the world’s heaviest cannabis users should serve as a cautionary tale for other jurisdictions considering similar policy changes.

Policy Implications and Public Health Considerations

The mounting evidence regarding cannabis use among youth presents policy makers with an urgent set of challenges that demand immediate attention. At the forefront of these considerations is the pressing need for potency regulation. Given the dramatic increase in THC content over recent decades, implementing strict controls on cannabis concentration has become critical. This extends beyond simple THC limits to encompass comprehensive product labelling requirements and the possibility of graduated concentration restrictions based on age groups – an approach that acknowledges the particular vulnerability of younger users while maintaining access for adults.

Access control mechanisms represent another crucial policy frontier. Current systems for age verification have proven insufficient in many jurisdictions, necessitating more robust approaches. The strategic placement of dispensaries, particularly their distance from schools and youth-centred facilities, requires careful consideration. Furthermore, the proliferation of online sales has created new challenges for ensuring youth cannot circumvent age restrictions, demanding innovative solutions that balance accessibility for legal users with protection for minors.

A critical yet often overlooked aspect of youth protection involves the systematic removal of what might be termed “passive permission models” from public spaces. These are environmental factors that inadvertently signal social acceptance or accessibility of cannabis to youth. This includes:

• Visible storefront advertising near areas frequented by youth
• Cannabis-themed merchandise or promotional materials in general retail settings
• Public consumption areas visible from schools, parks, or youth centres
• Social media content and advertising that may reach underage audiences
• Cannabis industry sponsorship of public events or spaces accessible to youth

The Canadian experience, where youth cannabis use ranks among the world’s highest despite regulated legalisation, suggests that mere age restrictions are insufficient when broader environmental signals continue to normalise access.

Implementation requires a coordinated approach:

• Strict zoning regulations that create cannabis-free zones around youth-centred spaces
• Comprehensive advertising restrictions that go beyond direct product marketing
• Digital safeguards against cannabis-related content reaching youth audiences
• Community engagement programs to identify and address inadvertent permission signals
• Regular audits of public spaces to ensure compliance and identify emerging concerns

This approach recognises that youth protection requires more than just legal barriers to access – it demands the creation of an environment that consistently reinforces non-use messages while eliminating subtle signals that might suggest otherwise.

The mental health implications of youth cannabis use, particularly the elevenfold increase in psychosis risk identified in recent research, necessitate a substantial expansion of mental health resources. Early intervention programs must be scaled up significantly, with specialised youth mental health services receiving particular attention and funding. Crisis response capabilities need enhancement to handle acute cases, while family support systems require strengthening to help parents and caregivers navigate the challenges of adolescent substance use.

Long-term Considerations

Looking beyond immediate policy needs, several long-term considerations emerge that require sustained attention and resource allocation. The educational infrastructure surrounding cannabis requires a complete overhaul to reflect current realities. Drug education programs, largely based on outdated information and approaches, must be updated to address the specific challenges posed by high-potency modern cannabis products. This education cannot stop with youth – parents, many of whom base their understanding of cannabis on their experiences with much lower-potency products from previous decades, need updated information about contemporary risks.

Healthcare system preparedness represents another critical long-term consideration. The increased prevalence of cannabis-related mental health issues among youth requires expanding mental health service capacity and addiction treatment resources. Prevention programs must evolve based on emerging evidence, while research funding needs to be allocated strategically to address critical knowledge gaps. The healthcare system must develop the capability to identify and intervene early in cases of problematic use, particularly among adolescents.

The regulatory framework governing cannabis must be designed with built-in flexibility to evolve as new evidence emerges. This includes developing sophisticated monitoring systems to track usage patterns and health outcomes, creating mechanisms for policy adjustment based on emerging data, and establishing effective enforcement strategies. Inter-jurisdictional coordination becomes particularly important as different regions experiment with varying approaches to legalisation and regulation.

Building a Safer Tomorrow

The evidence regarding cannabis legalisation and youth impact presents policy makers with a complex challenge that resists simple solutions. The demonstrated connection between recreational legalisation and increased youth use, combined with the significantly elevated risk of psychosis among teen users, demands a more nuanced and careful approach to cannabis policy than many jurisdictions have thus far implemented.

The data suggests a clear distinction between medical and recreational legalisation outcomes, with medical programs showing minimal impact on youth use while recreational legalisation correlates with significant increases. This disparity, combined with the unprecedented potency of modern cannabis products, creates a policy environment requiring sophisticated, evidence-based approaches that go beyond traditional regulatory frameworks.

As McDonald’s research emphasises, the precautionary principle must guide policy development, particularly given the stakes involved for youth mental health. The challenge lies not in choosing between prohibition and legalisation, but in developing regulatory systems sophisticated enough to protect vulnerable populations while acknowledging the reality of cannabis use in contemporary society.

Moving forward, success will require regulatory frameworks that effectively balance adult access with youth protection, supported by robust research programs and flexible policy mechanisms. The evidence demands nothing less than a comprehensive approach that prioritises public health over commercial interests, particularly when it comes to protecting our most vulnerable populations. The costs of failing to do so, measured in rising youth use rates and mental health impacts, are simply too high to ignore. (Source WRD News)

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Published: 07 November 2024

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As cannabis is legalized and is more accessible in various forms across the country, there is increasing concern among health care providers about potential impact on children. Researchers at Nationwide Children’s Hospital have new findings to add to the existing evidence that cannabis exposure before birth can negatively impact children.

In a study published today in JAMA Pediatrics, researchers found prenatal cannabis exposure was associated in early childhood with poorer thinking skills and behaviors such as impulse control, paying attention, planning ability, and more aggressive behavior, all of which play a vital role in how children perform in school and interact with others.

“Although cannabis is a natural [only ‘maybe natural’ in its un-engineered state]  product, there are still many risks to using it during pregnancy,” said Sarah Keim, PhD, principal investigator in the Center for Biobehavioral Health at Nationwide Children’s, and lead author of the study. “Some women may turn to cannabis to help deal with some common issues of pregnancy including nausea, sleep problems and stress. This is not recommended. Consulting with a health care provider to find safer options to help with these issues during pregnancy is important.”

Researchers used multiple assessments, including asking parents about their child’s typical behaviors and measurement of skills related to impulse control, paying attention, solving problems, and managing emotions in preschool-aged children. Results showed children exposed to cannabis had more difficultly controlling their impulses, paying attention and planning, and showed more aggressive behavior when researchers observed their behavior in a play laboratory environment.

“Our findings were not surprising – they actually confirm and expand on longstanding evidence from previous research,” said Dr. Keim. “With our more contemporary and diverse sample of women and children, and with much higher potency of cannabis now than in past decades, this study validates previous research and supports existing clinical recommendations for patients.”

The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists both caution against cannabis use during pregnancy because of possible health risks to mothers and children.

More information is available at Nationwide Childrens.org/Research. Cannabis Use During Pregnancy Can Impact Thinking | Newswise

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Published: 29 October 2024

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As cannabis legalisation spreads across the United States, a disturbing pattern has emerged that threatens to undermine the safety of both medical and recreational marijuana: the widespread presence of dangerous pesticides. What began as a concerning discovery in California, the first state to legalise medical marijuana, has evolved into a nationwide issue that mirrors historical challenges with tobacco regulation.

The Scale of Contamination: When Los Angeles city officials conducted covert testing of dispensary products, their findings were alarming. Two out of three samples contained pesticide levels up to a thousand times the legal limit. This isn’t an isolated incident. Similar investigations in Washington state revealed that five out of six samples were contaminated with potentially neurotoxic and carcinogenic agents. Even more concerning, many samples contained multiple contaminants, with researchers identifying 24 distinct pesticide agents, including various insecticides and fungicides—none of which have been approved for use on cannabis.

The problem becomes particularly acute with concentrated cannabis products. Studies have shown that pesticide levels in concentrated forms, such as oils and waxes used in edibles or dabbing, can be approximately ten times higher than in the original plant material. This intensified toxicity in concentrated products poses a significant public health threat, especially considering the growing popularity of these consumption methods.

Exposure and Health Risks: The method of consumption significantly affects pesticide exposure levels. While filtered cigarettes only transmit about 10% of pesticides to the user—a rate comparable to using cannabis in a water pipe with attached filters—the story changes dramatically with common consumption methods. Regular bong use allows approximately half of the pesticides to reach the lungs, and glass pipes present even greater exposure risks.

The health implications are particularly concerning for medical marijuana patients. These individuals, often already dealing with serious health conditions, may inadvertently exacerbate their problems through exposure to these contaminated products. Without proper regulatory frameworks, the toxicological threat to cannabis users remains substantial.

The Regulatory Challenge: The heart of the problem lies in a complex regulatory landscape. The Environmental Protection Agency (EPA) hasn’t approved any pesticides for cannabis cultivation because marijuana remains federally illegal. This legal limbo has created a situation where growers, overwhelmed by pest issues, sometimes resort to “nuclear tactics,” using whatever means necessary to protect their crops—regardless of safety considerations.

Some states have attempted to address this issue through regulation, but they’ve encountered a formidable obstacle: the multi-billion-dollar cannabis industry itself. In Colorado, for instance, the Department of Agriculture’s initial proposal to limit permissible pesticides to the most non-toxic options was defeated by industry pushback. This resistance to regulation bears a striking resemblance to the historical actions of the tobacco industry.

The Big Tobacco Parallel: Internal documents revealed through tobacco industry lawsuits show that major multinational tobacco companies have been preparing to enter the legalised marijuana market since at least 1970. This potential entry of “Big Tobacco” into cannabis raises serious concerns, given the industry’s historical playbook: denying addiction potential, downplaying adverse health effects, rapidly creating and protecting market share through lobbying and campaign contributions, and successfully avoiding consumer protection legislation.

The situation has become so concerning that some testing labs in California have become reluctant to publicise their services or list the agents they can test for, fearing this information might be used as a guide by unscrupulous growers to seek even more toxic alternatives.

The emergence of “King Cannabis” following Big Tobacco’s blueprint presents a significant challenge to public health advocates, who have considerably fewer financial resources to fight for consumer protection. The industry’s demonstrated ability to modify products to increase addictiveness, obscure information, deceive the public, and target vulnerable groups gives it enormous power to reshape the cannabis landscape.

Source (WRD News)

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Published: 23 October 2024

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Cannabis use among adolescents and young adults has become a significant area of concern, especially regarding its potential impact on academic performance. A systematic review and meta-analysis published in JAMA Pediatrics explores the association between cannabis use during adolescence and young adulthood and academic achievement, shedding light on the implications of early cannabis exposure.

Overview of the Meta-Analysis

This comprehensive meta-analysis evaluated data from 63 studies, encompassing 438,329 individuals, to determine the impact of cannabis use on academic outcomes. The studies analysed were selected through a meticulous search of several databases, including CINAHL, EMBASE, MEDLINE, PsycInfo, PubMed, Scopus, and Web of Science, up to November 10, 2023. The review provides moderate-certainty evidence linking cannabis use with lower academic achievement.

Key Findings on Academic Performance

The findings indicate that cannabis use during adolescence and young adulthood is associated with several adverse academic outcomes. Moderate-certainty evidence suggests that cannabis users are less likely to achieve high school completion, university enrollment, and postsecondary degree attainment. Specifically, the odds ratio (OR) for achieving grades B and above is 0.61 (95% CI, 0.52-0.71), indicating a probable decrease in academic performance.

School Dropout and Absenteeism

Cannabis use is also associated with increased school dropout rates and absenteeism. The meta-analysis reveals an OR of 2.19 (95% CI, 1.73-2.78) for school dropout and 2.31 (95% CI, 1.76-3.03) for absenteeism. These statistics highlight the potential educational disruptions caused by cannabis use during critical developmental periods.

University Enrollment and Postsecondary Attainment

The likelihood of university enrollment and postsecondary degree attainment is negatively impacted by cannabis use, with ORs of 0.72 (95% CI, 0.60-0.87) and 0.69 (95% CI, 0.62-0.77), respectively. These figures suggest that cannabis users are less likely to pursue higher education, which can have long-term implications for career prospects and socioeconomic status.

Employment and Cannabis Use

Low-certainty evidence from the analysis suggests that cannabis use may be linked to increased unemployment, with an OR of 1.50 (95% CI, 1.15-1.96). This association underscores the potential economic consequences of cannabis use, as it may hinder individuals’ ability to secure and maintain employment.

Subgroup Analyses

The review also includes subgroup analyses that indicate worse academic outcomes for students who frequently use cannabis or begin using it at an earlier age. These findings emphasise the importance of understanding different patterns of cannabis use and their distinct impacts on educational attainment.

While the review highlights significant associations between cannabis use and academic performance, it also points to the need for further research to explore interventions and policies that can mitigate the negative effects of cannabis exposure during adolescence. Understanding upstream and downstream factors is crucial for developing effective strategies to support youth education and wellbeing.

Source: JAMA Pediatrics