Marijuana Legalization

Revised May 2017

The American Academy of Child and Adolescent Psychiatry (AACAP) advocates for careful consideration of potential immediate and downstream effects of marijuana policy changes on children and adolescents. Marijuana legalization, even if restricted to adults, may be associated with (a) decreased adolescent perception of marijuana’s harmful effects, (b) increased marijuana use among parents and caretakers, and (c) increased adolescent access to marijuana, all of which reliably predict increased rates of adolescent marijuana use and associated problems.1-3 Marijuana use during pregnancy, occurring at increasing rates, raises additional concerns regarding future infant, child, and adolescent development.4-6

AACAP is aware that, among hundreds of chemical constituents, marijuana contains select individual compounds that, if safely administered in reliable doses, may potentially convey therapeutic effects for specific conditions in specific populations.7 Advocacy regarding potential cannabinoid therapeutics, alongside social justice, public policy, and economic concerns, have contributed to marijuana policy changes. Amid these factors, AACAP remains focused on concerns regarding adolescent marijuana use.

Adolescents are especially vulnerable to marijuana’s many known adverse effects.8,9 One in six adolescent marijuana users develops cannabis use disorder, a well characterized syndrome involving tolerance, withdrawal, and continued use despite significant associated impairments.10,11 Selective breeding has increased marijuana’s addictive potency and potential harm to adolescents.12 Heavy use during adolescence is associated with increased incidence and worsened course of psychotic, mood, anxiety, and substance use disorders.13,14 Furthermore, marijuana’s deleterious effects on adolescent cognition, behavior, and brain development may have immediate and long-term implications, including increased risk of motor vehicle accidents, sexual victimization, academic failure, lasting decline in intelligence measures, psychopathology, addiction, and psychosocial and occupational impairment.8,13-16

Marijuana-related policy changes, including legalization, may have significant unintended consequences for children and adolescents. AACAP supports (a) initiatives to increase awareness of marijuana’s harmful effects on adolescents, (b) improved access to evidence-based treatment for adolescents with marijuana-related problems, and (c) careful monitoring of the effects of marijuana-related policy changes on child and adolescent mental health. Finally, AACAP strongly advocates for the involvement of the medical and research community in these critical and highly impactful policy-related discussions.

  1. Committee on Substance Abuse, Committee on Adolescence (2015). The impact of marijuana policies on youth: clinical, research, and legal update. Pediatrics, 135(3), 584-587.
  2. Cerdá, M., Wall, M., Feng, T., Keyes, K. M., Sarvet, A., Schulenberg, J., O’Malley, P. M., Pacula, R. L., Galea, S., & Hasin, D. S. (2017). Association of state recreational marijuana laws with adolescent marijuana use. JAMA Pediatrics, 171(2), 142-149.
  3. Kosterman, R., Bailey, J. A., Guttmannova, K., Jones, T. M., Eisenberg, N., Hill, K. G., & Hawkins, J. D. (2016). Marijuana legalization and parents’ attitudes, use, and parenting in Washington State. Journal of Adolescent Health, 59(4), 450-456.
  4. Alp´r, A., Di Marzo, V., & Harkany, T. (2016). At the tip of an iceberg: prenatal marijuana and its possible relation to neuropsychiatric outcome in the offspring. Biological Psychiatry, 79(7), e33-e45.
  5. Brown, Q. L., Sarvet, A. L., Shmulewitz, D., Martins, S. S., Wall, M. M., & Hasin, D. S. (2017). Research letter: trends in marijuana use among pregnant and nonpregnant reproductive-aged women, 2002-2014. Journal of the American Medical Association, 317(2), 207-208
  6. Calvigioni, D., Hurd, Y. L., Harkany, T., & Keimpema, E. (2014). Neuronal substrates and functional consequences of prenatal cannabis exposure. European Child and Adolescent Psychiatry, 23(10), 931-941.
  7. Whiting, P. F., Wolff, R. F., Deshpande, S., Di Nisio, M., Duffy, S., Hernandez, A. V., Keurentjes, J. C., Lang, S., Misso, K., Ryder, S., Schmidkofer, S., & Westwood, M. (2015). Cannabinoids for medical use: a systematic review and meta-analysis. Journal of the American Medical Association, 313(24), 2456-2473.
  8. Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss S. R. B. (2014). Adverse health effects of marijuana use. New England Journal of Medicine, 370(23), 2219-2227.
  9. Rubino, T., & Parolaro, D. (2016). The impact of exposure to cannabinoids in adolescence: insights from animal models. Biological Psychiatry, 79(7), 578-585.
  10. Hall, W., & Degenhardt, L. (2009). Adverse health effects of non-medical cannabis use. Lancet, 374(9698), 1383-1391.
  11. Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 criteria for substance use disorders: recommendations and rationale. American Journal of Psychiatry, 170(8), 834-851.
  12. ElSohly, M. A., Mehmedic, Z., Foster, S., Gon, C., Chandra, S., & Church, J. C. (2016). Changes in cannabis potency over the last 2 decades (1995-2014): analysis of current data in the United States. Biological Psychiatry, 79(7), 613-619.
  13. Levine, A., Clemenza, K., Rynn, M., & Lieberman, J. (2017). Evidence for the risks and consequences of adolescent cannabis exposure. Journal of the American Academy of Child and Adolescent Psychiatry, 56(3), 214-225.
  14. Renard, J., Krebs, M. O., Le Pen, G., & Jay, T. M. (2014). Long-term consequences of adolescent cannabinoid exposure in adult psychopathology. Frontiers in Neuroscience, 8, 361.
  15. Silins, E., Horwood, L. J., Patton, G. C., Fergusson, D. M., Olsson, C. A., Hutchinson, D. M., Spry, E., Toumbourou, J. W., Degenhardt, L, Swift, W., Coffey, C., Tait, R. J., Letcher, P., Copeland, J., Mattick, R. P., for the Cannabis Cohorts Research Consortium (2014). Young adult sequelae of adolescent cannabis use: an integrative analysis. Lancet Psychiatry, 1(4), 286-293.
  16. Volkow, N. D., Swanson, J. M., Evins, A. E., DeLisi, L. E., Meier, M. H., Gonzales, R., Bloomfield, M. A. P., Curran, H. V., & Baler, R. (2016). Effects of cannabis use on human behavior, including cognition, motivation, and psychosis: a review. JAMA Psychiatry, 73(3), 292-297.