Advancing prevention efforts for marijuana use in a changing legal climate

It can be hard to keep up with where various states stand on cannabis or marijuana access, ranging from adhering to federal guidelines that prohibit use and possession, to allowing medical access, to providing outright legalization for personal use for those over 21 years of age.

Many people hear things like marijuana is “safer” than alcohol, believe it’s “not addictive,” or had personal experience when younger and feel that it’s “not a big deal.”

Some talk about the money that presumably could be made if marijuana were to be legalized; yet, from a public health standpoint, at what cost?

What follows are a few considerations in this changing legal climate.

Marijuana potency has changed – dramatically
The psychoactive ingredient associated with the “high” from marijuana, THC, has been increasing in potency. It has been estimated that THC content in the 1980s was 3 percent, reached 4 percent by the mid-90s, and was close to 12 percent by 2012.

In Washington, the most recent Marijuana Impact Report showed that the average THC content in one store in Seattle (as an example) was 21.62 percent.

This reflects a potency that has simply not been tested in a controlled way for impact on the body.
In some ways, states that put their foot on the gas for legalization passed right by any scientifically assessed limits in a way that what is being made available to people surpasses any controlled research – science desperately needs to catch up.

There is a diagnosable cannabis use disorder, as well as documented cannabis withdrawal
Can people get addicted to marijuana? Absolutely. There are clear criteria for a cannabis use disorder. The symptoms of withdrawal, ironically, often mirror the very reasons people cite for their cannabis use.
For example, many people report using marijuana to help with sleep, reduce anxiety, cope with depression, boost appetite, or relieve headaches.

Among the criteria for cannabis withdrawal are sleep problems, anxiety, depressed mood, appetite problems, and headaches.

If people report frequent use for medical conditions, and assume they are getting a medical benefit because every time they stop they see symptoms emerge, it could be more a matter of feeling better because they are relieving withdrawal symptoms, not that an underlying issue is being treated.

There are misperceptions that “everyone” uses marijuana
Data from the Substance Abuse and Mental Health Services Administration’s National Survey of Drug Use and Health shows that any past year marijuana use is 12.6 percent for those between the ages of 12-17, 32.2 percent for those 18-25, and 10.4 percent for those 26 and older.

So, what do “most” people do? Abstain from marijuana use.

However, a number of studies have shown that there are gross misperceptions in the prevalence of marijuana use; among those with marijuana use, this misperception is even more pronounced.

This misperception could prompt initiation of use if a person wanting to fit in genuinely believes that “everyone” is using, could result in an increase in use for those already using, and might even be a barrier to making a change (i.e. if people want to stop using but believe they’ll be the only abstainer if they do, their use might persist).

Marijuana is not without risks and harms, particularly in an academic setting
A full review of the effects of marijuana is outside the scope of this article. But, as someone who works in a college setting, it is so important that people understand this is not a harmless substance and it can absolutely impact cognitive functioning.

Research consistently shows that the more people use marijuana, the more they experience decreases in attention, concentration, and memory.

Among those who use daily, it takes 28 days for these abilities to return. For students struggling with memory and/or attention who are also using marijuana, it is clear that a move toward abstinence would result in improvement in these domains.

Additional research shows that the more college students use marijuana, the more they are dropping out of classes and taking longer to graduate (if they make it to graduation).

As conversations take place about how to make college more affordable for everyone (a worthwhile conversation for sure), part of affecting cost involves seeing students get out on time.

Marijuana gets in the way of that.

Parents matter
The Washington State Healthy Youth Survey shows that although 13 percent of 10th graders who believe their parents think it’s wrong for them to use marijuana nevertheless used marijuana in the past 30 days, rates of past 30 day use are almost 5 times higher (59 percent) among those who believed their parents think it’s not wrong for them to use.

Communicate your values and expectations to your children, and understand that this matters in the decision that they will make.

There’s the old saying that “an ounce of prevention is worth more than a pound.”

When we consider the issues discussed above, as well as those not addressed here (e.g., driving under the influence of marijuana use, potential harms to heart and lung health, etc.), it seems to be the case that an ounce of prevention has never weighed more.

While more research is needed on the effects of marijuana (particularly at the potencies we see today), it is important to keep prevention and intervention efforts moving forward to address emerging needs.