Parents are not ready for the new reality of teen cannabis use →

The voice mail was waiting on Amy’s phone one morning in February 2019, a missed call from her 18-year-old son the night before. When Amy, a mom from Connecticut who is being identified by first name only to protect her family’s privacy, played the message, she heard the panicked voice of her child.

Mom, he said, my face won’t stop twitching. I feel like I’m going to die. I’m trapped in another dimension and I can’t get out.

Terrified, Amy called the campus police at the University of Delaware. They found him asleep in his dorm room. Just a panic attack, they told her.

But she knew better. When she spoke to her son William, who is being identified by his middle name to protect his privacy, he told her: “I’m sorry. I think I just smoked way too much pot.”

Her son — an incredibly bright boy, a rule-abiding kid, a doting big brother — had started experimenting with marijuana as a junior in high school, Amy says. He told her it helped with his social anxiety, which intensified when he went to college, where he started smoking marijuana nearly every day. But the voice mail was the first time William had ever exhibited psychotic symptoms. About two months later, he called again with the same plea for help: He was trapped in another dimension, afraid he was about to die.

“My husband was like, ‘This isn’t from pot, no way, pot wouldn’t do this,’” Amy says. “But I’d started researching cannabis-induced psychosis, and I was like, ‘This is what’s happening.’”

That sense of disbelief — pot wouldn’t do this — is prevalent among parents who have watched their teenagers become gripped by addiction. But the landscape of teen marijuana use has radically transformed in the decades since today’s parents were teens themselves, and many Gen X’ers and millennials might not be attuned to what that means. A typical joint smoked decades ago contained less than 4 percent THC, the psychoactive compound in marijuana that causes the sensation of a high. Dried cannabis flower now averages closer to 15 to 20 percent THC, while the high-potency products most popular with teens — including THC-concentrated oils, edibles, waxes and crystals — often contain anywhere from about 40 percent to upward of 95 percent THC, an astronomical increase in potency that can have a significant impact on a developing adolescent brain.

Meanwhile, the number of American teens using these products has soared in recent years. Research published in 2022 by Oregon Health & Science University found that adolescent cannabis abuse in the United States has increased by about 245 percent since 2000; a 2022 study by the Columbia University Mailman School of Public Health found that, in 2020, 35 percent of high school seniors and 44 percent of college students reported using marijuana within the past year. That study also found that vaping was increasing as the most popular method of cannabis use.

Even as more families find themselves navigating the complex new reality of teen cannabis use, an antiquated cultural perception of the drug persists: Marijuana is medicinal, it’s natural, it’s not dangerous.

That’s what Laura Stack thought when her then-14-year-old son, Johnny, told her that he’d tried marijuana at a friend’s party near their home in Colorado in 2014, the same year that marijuana dispensaries first opened in their state. “I said to myself, ‘It’s just weed,’” she says.

She remembers what she told her child at the time: “‘Thank you for telling the truth, but please don’t ever do that again; you’ll ruin your brilliant mind.’” Privately, though, she wasn’t very concerned. “I’d used it when I was in high school, so I said to myself, ‘I used it, I’m fine, it clearly didn’t hurt me,’” she says. “I didn’t have any urgency around it. I was just so ignorant.”

[Potent pot, vulnerable teens trigger concerns in first states to legalize marijuana]

Johnny was a gifted, well-adjusted kid, Stack says, an excellent student with a perfect SAT score in math and a scholarship to Colorado State University. But by the time he was a senior in high school, he’d started vaping and “dabbing” — inhaling high-concentrate THC oil — multiple times per day, and his life unraveled. He developed paranoia, which progressed to psychosis, and he cycled through different treatment programs and hospitalizations as his family frantically tried to help him find a way back to himself. He was ultimately diagnosed with cannabis use disorder and cannabis-induced psychosis; he never tested positive for any other drug. He was put on antipsychotic medication, which helped, until he stopped taking it. In November 2019, Johnny leaped to his death from the top of a parking garage.

Stack has shared her son’s story with high school students and their parents countless times as the founder of Johnny’s Ambassadors, a nonprofit organization that seeks to educate parents and teens about the danger of youth marijuana use. “When we do a parent night or a community event, and I ask a crowd: How many of you know what ‘dabbing’ is? You’ll get just a few hands. And then the ones who raise their hands will say ‘Oh, I thought you meant the dance move,’” she says. “These parents just don’t know. They are just as unaware as I was.”

As an addiction develops, parents often describe a common pattern of decline and disengagement, the distortion of a teenager’s sense of self and personality as they grow removed from things they once cared about. M., a parent in California who is being identified by his middle initial to protect his family’s privacy, watched this happen to his youngest child, S., who is also being identified by his middle initial. S. was a good-natured and affectionate son, his father says, a diligent student and a star athlete who was on track to get a scholarship to a top-tier school; he dreamed of someday going pro.

S. started experimenting with marijuana as a high school sophomore. “He knew his big brother smoked, he knew his big sister did,” M. says. “He was curious. And it’s everywhere. It’s legal, right? It’s natural, right? It’s not meth or heroin.” M. felt he had a handle on what his children were using: “I grew up in the marijuana scene and I smoked weed, I smoked a lot of weed.”

But his son’s product of choice wasn’t the same plant buds that M. once knew; S. gravitated toward cannabis vape cartridges, flavored oils that left no scent in the air, so his parents wouldn’t detect when he was smoking. As his use progressed, fueled in part by his distress over athletic injuries, his behavior began to deteriorate. He grew increasingly hostile when his parents expressed concern. Then, one night in February 2022, S. didn’t show up to a school event, and the police later called to say they’d found him wandering a nearby neighborhood, shirtless in near-freezing weather, consumed by paranoid delusions.

Over the months that followed, M. says, the family endured a succession of traumatic episodes that have left lasting scars: There was the day S. was first hospitalized, when he FaceTimed his older sister in tears and told her that their parents wanted to call the police to take him to the emergency room; M.’s daughter cried as she tried to calm her little brother down, telling him, you need help. There was the second time S. experienced psychotic symptoms, when M. says his son appeared “demonic,” explaining with calm, chilling certainty that his mother had been partially possessed by an evil spirit, and he needed to “kill off” that part of her. There was the time M. was driving his son home, and S. kept begging his father to change lanes repeatedly, because he was convinced that driving behind certain cars would stop his body from itching.

This kind of account represents an extreme outcome — many teens, including S.’s two older siblings, might use marijuana without experiencing anything so severe — but psychotic symptoms themselves are hardly a rarity among adolescents and teens who use marijuana, says Sharon Levy, director of the Adolescent Substance Use and Addiction Program at Boston Children’s Hospital and associate professor of pediatrics at Harvard Medical School.

“I see kids with psychotic symptoms all the time,” she says. “It doesn’t mean they all have psychotic disorders, but it is scary.” In 2018, her team published a letter in the medical journal JAMA Pediatrics after surveying more than 500 children during their annual physical exams. Seventy teens who indicated that they had used marijuana “monthly or more” within the past year were asked a follow-up question: Had they experienced a hallucination or paranoia? “These symptoms are really psychotic symptoms,” Levy says, “and 60 percent of these kids said yes, they had experienced one or both of those.”

The impact occurs on a spectrum, Levy says: There are children who might experience hallucinations, delusions or paranoia as an acute symptom that resolves as soon as they’re no longer under the influence. There are teens who experience lingering psychotic symptoms, but can identify them as such — like one of Levy’s recent patients, a teen girl who thought that household objects were talking to her but recognized that this could not be real. And then there are the children like S., who develop psychosis that persists, and who no longer recognize that they are dissociated from reality.

“That’s the most severe form, and that’s the form that happens least commonly,” Levy says, “but I think as you move to lesser degrees of this, it’s actually fairly common.”

Teens are more vulnerable than adults to the impact of THC, Levy says, because the compound affects parts of the brain — the hippocampus, the prefrontal cortex — that are still undergoing structural development during adolescence. THC mimics a class of chemicals that the body naturally produces, Levy says, chemicals that guide the development of neurons in an adolescent brain. “Brain development is a very, very complicated process that we don’t fully understand, but we do know which areas of the brain are really rich in these receptors,” she says. When THC binds to those sites, “it interferes, it messes with the system.”

The lasting impact of this interference has been well documented, Levy says. “We’ve known for a very, very long time that the children who use cannabis products during their adolescence have worse outcomes across the board: They’re less likely to finish school, they’re less likely to get married and start a family of their own, they don’t do as well in the workplace.”

Any psychoactive compound has the potential to be addictive, Levy says, and while it’s true that some people can drink alcohol or use marijuana without developing a substance use disorder, the age of the user and the potency of the product matters: “When it comes to addictive substances, dose matters, and how quickly a dose gets to a brain really matters,” she says. “These highly potent products are much more addictive.”

Recreational cannabis use is illegal for those under age 21 in the U.S., but some studies indicate that children can more easily access the drug in states where it has been legalized. Some parents note that their children first accessed the drug through older friends or siblings who had obtained a medical cannabis card when they turned 18.

“The dramatic rise in adolescent cannabis use in 2017 really does coincide with the wave of decriminalization in the country,” says Adrienne Hughes, lead author of the OHSU study and assistant professor of emergency medicine in the OHSU School of Medicine. Beyond rendering the drug more accessible, she says, legalization has also “contributed to the perception that it’s safe.”

Levy believes the problem isn’t legalization itself, but rather a lack of sufficient regulation (Vermont and Connecticut are the only states to limit the potency of cannabis concentrate products). In certain states, she says, “the industry is very involved in regulating itself … which means that more and more products are available, and there is more confusing messaging to the population.” The result, she says, is that “marijuana is becoming more accepted by parents and kids, and it’s also more dangerous.”

But even for children who have been diagnosed with cannabis-induced psychosis, Levy says, there is hope of recovery; if they stay sober, their brains have the potential to heal.

That is what M. and his family are fiercely hoping for. M. estimates that he’s spent well over $100,000 on hospital and ambulance bills and rehab to try to save his son, who was diagnosed with cannabis use disorder and cannabis-induced psychosis. S. has been in an inpatient recovery center in California for about two months, and he’s doing better, M. says, but he still has months of treatment ahead of him.

There are moments when M. can envision a future for his son again: Maybe S. will attend community college, when he’s ready. Maybe he’ll study a foreign language — S. has sometimes said he’d like to live overseas, to get away from marijuana. “I’ve accepted the fact that he may never play [sports] again,” M. says, “but I really hope he does, because it really anchors him. It centers him. But I don’t know what’s going to happen.”

The rest of the family is still recovering, too. “It’s all so traumatic. We all have PTSD, we all have guilt, we’re all in counseling,” M. says. “This is what this does to a family.”

Amy, the mother from Connecticut, said she watched her son “slowly unravel” during his college years as his marijuana use continued to accelerate, leading to a psychotic break in November 2021. For the next year, William was in and out of emergency rooms, psychiatric wards and treatment centers, she says, a time she describes as all-consuming darkness.

“I was talking to all these doctors all around the state and around the country, all these residential treatment centers,” Amy says. “My purpose in life was to keep him alive until we could get him treatment that stuck.” He was diagnosed with severe cannabis use disorder, and doctors told Amy that his psychotic symptoms could be due either to bipolar disorder or cannabis-induced psychosis — the only way to be certain, they said, was to see if the symptoms abated once he was sober for a prolonged period of time.

Finally, in October, Amy and her husband brought their now 22-year-old son to Florida, where he is receiving treatment at an inpatient rehabilitation facility. Amy and her husband are staying with relatives nearby; Amy promised her son she’d stay close, that she’d wait for him to get better.

“They say that for the brain to heal, it literally could take a full year,” she says. “His improvement is vast, but he has a long way to go still.”

In the three years since Johnny Stack died, Laura Stack has seen the demand for her presentations grow. There are now more than 10,000 parent ambassadors affiliated with her nonprofit, she says, and a support group for parents of teens with cannabis-induced psychosis has grown to more than 500 members. She has become adept at reciting the latest research and the most startling statistics. She has learned what to share and what to say to help steer young lives in a safer direction.

But when she reflects on her own story, there are still questions she isn’t sure how to answer. Would it have mattered if they hadn’t lived in a place where it was so easy for her son to access these products? “But it’s everywhere,” she says, “so it really doesn’t matter where you live.” Then she wavers: “I don’t know, though. I wish I had moved.” She is quiet for a moment. “What I know,” she says, “is I would have done anything.”

The legalized drug crisis is harming young people far more than most realize→

The data is in and it’s becoming increasingly clear that the impacts of commercial marijuana industry are even worse than we thought, particularly for America’s young people. A new report released by Smart Approaches to Marijuana shows the reality in "pot-legal states" paints a vastly different picture than the common sales pitch of the industry and supporters of legalization. 

The marijuana industry, which spent billions to lobby elected officials and bankroll legalization referendum campaigns, is following the playbook pioneered by Big Tobacco. They recognize that the road to big profits runs through the heaviest users. As such, they have increased potency of the drug by more than four times since 1998, hoping to hook kids while they are young and vulnerable. The numbers show that it’s working. 

Usage rates have reached record highs among those who are most vulnerable to marijuana’s long-term health effects. The National Institute on Drug Abuse warned, "Past-year, past-month, and daily marijuana use (use on 20 or more occasions in the past 30 days) reached the highest levels ever recorded" among those aged 19 to 30. The percentage of 8th, 10th and 12th graders who used marijuana daily has more than tripled between 1991 and 2020. 

Daily marijuana use is indicative of a marijuana use disorder, also known as addiction to marijuana. For all the talk about how pot is not addictive, in 2021, 1.3 million individuals between the ages of 12 and 17 had a marijuana use disorder, accounting for more than 46% of users in that age group. Legalization is also associated with a 25% increase in marijuana use disorder among them as well. 

Jeremy Baldwin tags young cannabis plants at a marijuana farm operated by Greenlight, Oct. 31, 2022, in Grandview, Mo. Voters in North Dakota and Arkansas have rejected measures to legalize marijuana, while those in Maryland have approved legalization. Similar measures also were on the ballot in Missouri and South Dakota. (AP Photo/Charlie Riedel, File)

As usage rates, potency and addiction have increased, the adverse effects have also increased. Though supporters of legalization like to downplay the risks of marijuana, the drug caused more than 70,000 individuals younger than 18 to have marijuana-related emergency department visits in 2021. 

The industry told parents and politicians that they would not target kids. That’s turned out to be false. From "Pot Tarts" to "Stoney Patch Kids," the packaging of edibles laced with high-potency THC often looks like traditional snacks. Not surprisingly, between 2017 and 2021, there was a 1,375% increase in at-home exposures to marijuana edibles involving children younger than 6.  

More minors are driving under the influence of marijuana too. In 2021, 10.67 million people admitted to driving under the influence of marijuana, including 1.36 million who were between the ages of 16 and 20. There were 2.41 times more minors on the road under the influence of marijuana than were under the influence of alcohol. 

Minors have also gravitated toward marijuana vapes, products engineered to include a near-pure form of THC. Between 2017 and 2020, the percentage of 12th graders who vaped marijuana increased from 9.5% to 22.1%. Among 10th graders, it increased from 8.1% to 19.1%, and among 8th graders, it increased from 3.0% to 8.1%. A 2022 study found, "cannabis vaping is increasing as the most popular method of cannabis delivery among adolescents in the United States." and frequent use is increasing faster than occasional use. 

The marketing scheme of the industry has been to engineer a more potent drug, in forms easier to consume and while stoking the perception that it’s harmless. In 1991, 78.6% of 12th graders believed that using marijuana regularly puts one’s health at great risk. But in 2021, only 21.6% held this viewpoint. Those who hold that point of view are six times more likely to use it than individuals who perceive it as being high risk. 

By 2021 nearly seven in 10 12th graders seemingly approve of marijuana use. 

We all want the best future for our children. Yet, the growth of the pot industry has provided kids with greater access to a drug that medical science links to psychosis, depression, suicidality, and lower IQ at a time when the brain is still developing. Regular users are nearly five times more likely to develop a psychotic disorder and users of high-potency marijuana are four times more likely than users of low-potency products to become addicted. 

More young people are becoming addicted to marijuana, and it is sending more of them to the hospital. More of them are using a more potent form of the drug. It is past time for our nation to reverse course and advance drug policies that protect our children, rather than allow them to be collateral damage for another Big Tobacco. 

Are scientists missing the forest for the trees on youth marijuana use?→

Are scientists missing the forest for the trees?
Last week, the Journal of the American Medical Association published a study by DM Anderson and colleagues, scientists from universities in Montana, Spain, and San Diego, California. The study finds that legalization does not increase adolescent marijuana use. The researchers analyzed the Youth Risk Behavior Surveillance System (YRBSS) which the Centers for Disease Control and Prevention (CDC) began conducting in 1991.

Youth Risk Behavior Surveillance System (YRBSS)
YRBSS collects data from high school students every two years about behaviors that contribute to unintentional injuries and violence, sexual behaviors related to unintended pregnancy and sexually transmitted infections, alcohol and other drug use, tobacco use, unhealthy dietary behaviors, and inadequate physical activity. Not all states participate in YRBSS, and those that do participate periodically, although in the 2019 YRBSS all but five states did so. Minnesota, Oregon, and Washington State have never participated in YRBSS. The survey asks three questions about marijuana: ever use, current use, and what age students were when they started using marijuana. It began asking about vapor product use in 2015, but never asks what students are vaping.

So far as these limited data are concerned, the researchers’ findings seem true. But two other national surveys show us something more.

The National Survey on Drug Abuse/National Survey on Drug Use and Health
The National Survey on Drug Abuse is the oldest. It began in 1971 and was financed by the National Institute on Drug Abuse (NIDA). Its first two surveys were done under the auspices of the National Commission on Marihuana and Drug Abuse. It began publishing annual data in 1976 and was transferred to the newly created Substance Abuse and Mental Health Services Administration (SAMHSA) in 1992. Technological innovations enabled the survey to be redesigned in 1999 and its name was changed to the National Survey on Drug Use and Health (NSDUH) in 2002. However, the redesign of the renamed survey resulted in an inability to compare its results with findings from the National Household Survey on Drug Abuse.

The NSDUH collects data annually on the use of alcohol, tobacco, marijuana, and other drugs from adolescents (ages 12-17), young adults (ages 18-25), and older adults (ages 26 and older). It combines two years of data to report drug use among these age groups by state but unfortunately not before 2002. RTI is the contractor responsible for administering this survey, which also collect data on the mental health of Americans.

Monitoring the Future (MTF)
The third national survey is Monitoring the Future (MTF), which began in 1975. Financed by NIDA, MTF is the only survey that can give us continuous data from 1976 through today. It collects data about the lifetime, past-year, past-month, and daily use of alcohol, tobacco, marijuana, and other drug by students in grade 12. It added students in grades 8 and 10 in 1990. In 2015, MTF began asking about vaping and two years later asked specifically what kids were vaping – nicotine, marijuana, or just flavoring. Unfortunately, it does not report its data by state. The University of Michigan Institute for Social Research administers this survey.

The chart above shows that drug use among high school seniors peaked in 1978-1979. A 1977 study called Highlights from the National Survey on Drug Abuse estimates that in 1962, less than 2 percent of the US population and less than 1 percent of adolescents had ever tried an illicit drug. Over the next 16 years, “ever-tried” use rose among seniors to 60.4 percent, while 50.8 percent of seniors used the drug in the past year, 37.1 percent used it in the past month, and 10.7 percent used it daily. What drove that astonishing escalation in use among 18-year-olds?

Decriminalization and Drug Paraphernalia
The National Organization for the Reform of Marijuana Laws (NORML) formed in the early 70s and initiated a movement to decriminalize marijuana. Decriminalization then was defined as reducing criminal penalties for possessing an ounce or less of marijuana, enough for personal use. In 1973, NORML persuaded Oregon to decriminalize marijuana and in rapid succession over the next five years,10 more states decriminalized. By 1978, eleven states had reduced marijuana penalties to that of a traffic ticket. Along with decriminalization emerged the drug paraphernalia industry called by some “little learning centers for young drug abusers.” Head shops (shops for “heads” as the industry called drug users) selling child-appealing toys and gadgets to enhance drug use opened in urban and suburban communities across the US throughout the 70s, leaving no doubt in parents’ minds that a drug paraphernalia industry was coming after their kids. Studies showed that children reasoned a government would not reduce penalties for a drug that could hurt them.

The Parent Movement
This gave rise to a national Parent Movement which began in Atlanta in 1976 and spread across the nation. The movement was based on three goals: join with other parents to protect kids from becoming drug users, shut down headshops, and stop decriminalization. Some 3,000 parent groups from the mid-70s to the early 90s formed parent peer groups to protect their children and their children’s friends from using drugs. Many, usually in state capitals, became politically active. Their efforts to persuade legislators to pass laws outlawing drug paraphernalia drove the industry out of business. No more states decriminalized marijuana over the next several decades. NORML’s funding nosedived forcing the organization to severely curtail its decriminalization crusade.

Between 1978-79 and 1992, high school seniors’ marijuana use plummeted:

• Lifetime use was cut nearly in half from 60.4 percent to 32.6 percent.

• Past-year use dropped by more than half from 50.8 percent to 21.9 percent.

• There was a three-fold decrease in past-month use, and a

• five-fold decrease in daily marijuana use.

The first two directors of the National Institute on Drug Abuse, Robert DuPont, MD, and William Pollin, MD, credit the Parent Movement with bringing about this significant reduction in marijuana use among adolescents. But in just four years, these gains reversed:

• Seniors’ lifetime marijuana use rose from 32.6 percent in 1992 to 44.8 percent in 1996-1997.

• Their past-year use nearly doubled over those four years, from 21.9 percent to 38.5 percent.

• Past-month use among seniors did double, and

• Daily use rose more than three-fold.

What made that happen?

Medical Marijuana
In 1992, three billionaires began pumping money into a by-then moribund NORML as well as into two new groups, the Marijuana Policy Project, and a coalition of other groups that became the Drug Policy Foundation. They targeted states that allow ballot initiatives, made unsubstantiated claims about the healing powers of marijuana, bought voters’ signatures, and placed measures to legalize marijuana as medicine on the ballots of states few lived in, leaving taxpayers to pay for the consequences of their actions. A steady stream of media stories across the nation educated children that pot is medicine and they responded in kind. If a government wouldn’t reduce penalties for a drug that could hurt you, that drug surely couldn’t hurt you if it was medicine! The national cacophony that led up to the first state legalizing pot as medicine – California in November 1996 – carried that message and kids heard it loud and clear.

The National Household Survey on Drug Abuse shows much of these same patterns for both adolescents and young adults during the 70s, 80s, and 90s. But since that survey’s data cannot be compared to NSDUH’s, the best we can do is look at the most recent survey, which is the 2018-2019 state estimates. The following two charts are created on the same vertical axis of 0 percent to 60 percent. The first one shows past-year marijuana use among adolescents, the second among young adults.

No, not all of the blue bars are recreational states and yes, some of the yellow bars are. But 36 of these states have legalized marijuana for medical use and that has influenced young people ages 12 to 25 to engage in its use. Like decriminalization in the 70s, the novelty of turning pot into medicine with an intensive four-year campaign championed by national media has not only had a profound effect on the nation’s young people but also introduced a unique way to approve medicines by ballot-iinitiative and, later, legislative fiat rather than through the Food and Drug Administration. Should we worry that advocates are now applying that pattern to other drugs?

Access these graphics here.
Access YRBSS here.
Access NSDUH here.
Access MTF here.
Read National Survey on Drug Use and Health: Summary of Methodological Studies, 1971-2014 [Internet] here.