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American Academy of Pediatrics Marijuana Policy Statement

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American Academy of Pediatrics Marijuana Policy Statement POLICY STATEMENT Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update COMMITTEE ON SUBSTANCE ABUSE, COMMITTEE ON ADOLESCENCE abstract This policy statement is an update of the American Academy of Pediatrics policy statement “Legalization of Marijuana: Potential Impact on Youth,” published in 2004. Pediatricians have special expertise in the care of children and adolescents and may be called on to advise legislators about the potential impact of changes in the legal status of marijuana on adolescents. Parents also may look to pediatricians for advice as they consider whether to support state-level initiatives that propose to legalize the use of marijuana for medical and nonmedical purposes or to decriminalize the possession of small amounts of marijuana. This policy statement provides the position of the American Academy of Pediatrics on the issue of marijuana legalization. The accompanying technical report reviews what is currently known about the relationships of marijuana use with health and the developing brain and the legal status of marijuana and adolescents’ use of marijuana to better understand how change in legal status might influence the degree of This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed marijuana use by adolescents in the future. conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication. DEFINITIONS Policy statements from the American Academy of Pediatrics benefit fi from expertise and resources of liaisons and internal (AAP) and For the purpose of clarifying terminology, the following are de nitions external reviewers. However, policy statements from the American used in this policy statement and the accompanying technical report1: Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent. Legalization The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking Allowing cultivation, sale, and use of cannabis (restricted to adults into account individual circumstances, may be appropriate. $21 years of age). All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, Legalization of Medical Marijuana revised, or retired at or before that time. Allowing the use of marijuana to treat a medical condition or symptom www.pediatrics.org/cgi/doi/10.1542/peds.2014-4146 with a recommendation from a physician. DOI: 10.1542/peds.2014-4146 PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2015 by the American Academy of Pediatrics FROM THE AMERICAN ACADEMY OF PEDIATRICS PEDIATRICS Volume 135, number 3, March 2015 Decriminalization marijuana did not start in Colorado decreasing nausea and vomiting in Reducing penalties for cannabis- until January 1, 2014, the patients with cancer and for chronic related offenses to lesser criminal postlegalization 2013 rates of youth pain syndromes,5,6 although side charges or to civil penalties. use increased.4 It is possible that effects of dizziness and dysphoria public health campaigns that may also be experienced. There are effectively communicate the harms no published studies on the use of INTRODUCTION associated with teen marijuana use medicinal marijuana or Marijuana is the most commonly could reduce youth use despite pharmaceutical cannabinoids in used illicit substance among legalization. Legalization campaigns pediatric populations. adolescents.2 Recreational sale and that imply that marijuana is a benign fi possession of marijuana by adults substance present a signi cant remain illegal in most states and challenge for educating the public EFFECTS OF MARIJUANA remain illegal under federal law. about its known risks and adverse The adverse effects of marijuana have However, a number of states and effects. Therefore, it is unclear what been well documented, and studies local jurisdictions have the impact of legalization of have demonstrated the potential decriminalized the possession of marijuana for adults will have on the negative consequences of short- and marijuana for recreational use by prevalence of marijuana use by long-term recreational use of adults, reducing penalties to adolescents, especially if the marijuana in adolescents. These misdemeanors or citations. Many implementation of legalization consequences include impaired short- states also have legalized medical includes messaging that minimizes term memory and decreased marijuana for adults who receive the health and behavioral risks. concentration, attention span, and recommendations for use by Substance abuse by adolescents is an problem solving, which clearly physicians. Almost all states with ongoing health concern. Marijuana interfere with learning. Alterations in medical marijuana laws allow access remains classified in the Controlled motor control, coordination, by minors, though often with greater Substances Act (21 USC x801-971 judgment, reaction time, and tracking regulation. States in which marijuana [2012]) as a schedule I drug. This ability have also been documented7; is legal prohibit marijuana sales to classification implies that it has these may contribute to unintentional and use by minors, but changes in a high potential for abuse, has no deaths and injuries among the legal status of marijuana, even if currently accepted medical use in the adolescents (especially those limited to adults, may affect the United States, and lacks accepted associated with motor vehicles if prevalence of use among safety for use under supervision by adolescents drive while intoxicated adolescents. Although the a physician. Despite this by marijuana).8 Negative health epidemiologic data are not classification by the federal effects on lung function associated consistent across states and time government, marijuana has been with smoking marijuana have also periods, with the exception of legalized for medical purposes in been documented, and studies linking Michigan and New Mexico, in all a number of states, in direct marijuana use with higher rates of states where medical marijuana has opposition to federal law. Since the psychosis in patients with been legalized, marijuana use by first policy statement from the a predisposition to schizophrenia minors has been stable or has American Academy of Pediatrics have recently been published,9 raising decreased.3 Youth substance use (AAP) on the legalization of concerns about longer-term ratesdependonanumberoffactors, marijuana was published in 2004, psychiatric effects. New research has including legal status, availability limited research has been performed also demonstrated that the and ease of access of the substance, to examine the potential therapeutic adolescent brain, particularly the andperceptionofharm.Forexample, effects of marijuana for adults, prefrontal cortex areas controlling although tobacco is easily accessible, specifically the class of chemicals judgment and decision-making, is not youth tobacco use rates have known as cannabinoids, which are fully developed until the mid-20s, decreased substantially since the responsible for most of the medicinal raising questions about how any 1990s, in conjunction with effects of marijuana. This research substance use may affect the aggressive public health campaigns has demonstrated that both the developing brain. Research has warning of the medical drugs approved by the US Food and shown that the younger an adolescent consequences of smoking. In Drug Administration and other begins using drugs, including Colorado, the passage of the pharmaceutical cannabinoids, such marijuana, the more likely it is that amendment to legalize recreational as cannabidiol, can be helpful for drug dependence or addiction will marijuana occurred in November adults with specific conditions, such develop in adulthood.10 A recent 2012. Although sales of recreational as increasing appetite and analysis of 4 large epidemiologic PEDIATRICS Volume 135, number 3, March 2015 585 trials found that marijuana use during medical marijuana and the adverse a schedule II drug to facilitate adolescence is associated with effects of marijuana use, the impact of this research. reductions in the odds of high school criminal penalties particularly on 6. Although the AAP does not completion and degree attainment minority teens and communities, and condone state laws that allow the and increases in the use of other illicit adolescent brain development related sale of marijuana products, drugs and suicide attempts in a dose- to substance use, is available in the in states where recreational 1 dependent fashion that suggests that accompanying technical report. marijuana is currently legal, 11 marijuana use is causative. pediatricians should advocate that states regulate the product DECRIMINALIZATION EFFORTS AND RECOMMENDATIONS as closely as possible to tobacco EFFECTS 1. Given the data supporting the and alcohol, with a minimum age The illegality of marijuana has negative health and brain de- of 21 years for purchase. Revenue resulted in the incarceration of
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