With the recent legalization of cannabis in Canada, the question of its impact on youth is very much uncertain. According to the 2015 Canadian Tobacco, Alcohol and Drugs Survey, the rate of cannabis use is two times higher among Canadian youth aged 15-24 than for adults. In Ontario, cannabis use increases with high school grade level to a high of 34.2% among 12th grade students, as reported in the Ontario Student Drug Use and Health Survey (2015) and as many as one in five teens in grades 9-12 had used cannabis within the past year (2017).
The reasons that youth may begin to use cannabis are myriad, complex and may also change and evolve over time. Medical literature often cites the motivational model - which views an individual’s choice to use a particular substance as influenced by the perception of that substance being able to fulfill particular needs – when attempting to understand the underlying factors influencing substance use among youth. Some of the most common factors for cannabis use by youth explored in literature include: pleasure, experimentation, conformity, coping and medical use. (Canadian Students for Sensible Drug Policy - Sensible cannabis education: a toolkit for educating youth*)
Much of the caution around cannabis use among youth surrounds the physiological and cognitive development of the young brain. Youth are particularly at risk for cannabis related harms since their brains are undergoing rapid and extensive development. Research shows that chronic cannabis use is linked to memory, thinking and attention difficulties, especially among those who began cannabis use in early adolescence. Chronic use may also increase risk of psychosis, depression and anxiety, in addition to respiratory conditions and lung cancer.
There is also evidence to support that among Canadian youth, much confusion and a lack of evidence-based education exists about cannabis use, misuse and its potential harms. Youth report that “scare tactics” are an ineffective approach to education and instead endorse providing more fact-based information at an earlier age, providing more content specifically related to cannabis, and using approaches that are aimed at reducing harm, rather than focusing on abstinence. (What Canadian Youth Think About Cannabis - Canadian Centre on Substance Abuse)
Currently, low-risk cannabis use guidelines in Canada endorse abstaining from or reducing cannabis use until the age of 25. However, a significant cohort of Canadian youth are already exposed to cannabis (either directly or indirectly) and in an atmosphere of potentially problematic misinformation and little evidence-based education.
If working with youth, practitioners will likely encounter situations where “myth-busting” around cannabis may have to be discussed. Misinformation may have to be countered with burgeoning evidence of potential risks and harms. Counselling youth from a harm reduction lens seems to be the preferred approach, with an acknowledgement that cannabis use among adolescents and youth is a complex issue and often connected to other factors such as peer pressure or wanting to fit in, coping, trauma, and feelings of anxiety. A harm reduction approach would include ensuring the patient has an informed understanding of the potential adverse effects on their physiological and cognitive development, including difficulties associated with memory, thinking and attention, as well as, an increased risk of psychosis, depression, anxiety, respiratory conditions and lung cancer. Additionally, emphasizing effective wraparound care – in the form of referrals to youth oriented psychosocial supports or trauma-informed counseling and engaging family members, if able – will likely be required prior and during any treatment cycle.
Youth reporting cannabis use to manage mood, anxiety, sleep or depression, may require a more thorough assessment and education or counselling about their cannabis use and its potential role in exacerbating these conditions. Assessment for cannabis use disorder and subsequent intervention may also be necessary in these cases. Again, referral to relevant youth services or psychiatric resources may also be required.
Continued research into the effects of cannabis on adolescent brain development is necessary and remains ongoing. The longitudinal Adolescent Brain Cognitive Development Study at the National Institutes of Health, a systematic review of approaches to treating cannabis misuse among university students (out of McMaster University in Hamilton ON), the ongoing Ontario Student Drug Use and Health Survey (out of the Centre for Addiction and Mental Health), and countless others, will hopefully provide more evidence-based insight into the impact of cannabis among youth.
*supported by a Canopy Growth Corporation grant