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U.S. Surgeon General’s Advisory: Marijuana Use and the Developing Brain

I, Surgeon General VADM Jerome Adams, am emphasizing the importance of protecting our Nation from the health risks of marijuana use in adolescence and during pregnancy. Recent increases in access to marijuana and in its potency, along with misperceptions of safety of marijuana endanger our most precious resource, our nation’s youth.

KNOW THE RISKS. TAKE ACTION. PROTECT OUR FUTURE.

Background

Marijuana, or cannabis, is the most commonly used illicit drug in the United States. It acts by binding to cannabinoid receptors in the brain to produce a variety of effects, including euphoria, intoxication, and memory and motor impairments. These same cannabinoid receptors are also critical for brain development. They are part of the endocannabinoid system, which impacts the formation of brain circuits important for decision making, mood and responding to stress1.

Marijuana and its related products are widely available in multiple forms. These products can be eaten, drunk, smoked, and vaped2. Marijuana contains varying levels of delta-9-tetrahydrocannabinol (THC), the component responsible for euphoria and intoxication, and cannabidiol (CBD). While CBD is not intoxicating and does not lead to addiction, its long-term effects are largely unknown, and most CBD products are untested and of uncertain purity3.

Marijuana has changed over time. The marijuana available today is much stronger than previous versions. The THC concentration in commonly cultivated marijuana plants has increased three-fold between 1995 and 2014 (4% and 12% respectively)4. Marijuana available in dispensaries in some states has average concentrations of THC between 17.7% and 23.2%5. Concentrated products, commonly known as dabs or waxes, are far more widely available to recreational users today and may contain between 23.7% and 75.9% THC6.

The risks of physical dependence, addiction, and other negative consequences increase with exposure to high concentrations of THC7 and the younger the age of initiation. Higher doses of THC are more likely to produce anxiety, agitation, paranoia, and psychosis8. Edible marijuana takes time to absorb and to produce its effects, increasing the risk of unintentional overdose, as well as accidental ingestion by children9 and adolescents10. In addition, chronic users of marijuana with a high THC content are at risk for developing a condition known as cannabinoid hyperemesis syndrome, which is marked by severe cycles of nausea and vomiting11.

This advisory is intended to raise awareness of the known and potential harms to developing brains, posed by the increasing availability of highly potent marijuana in multiple, concentrated forms. These harms are costly to individuals and to our society, impacting mental health and educational achievement and raising the risks of addiction and misuse of other substances.  Additionally, marijuana use remains illegal for youth under state law in all states; normalization of its use raises the potential for criminal consequences in this population. In addition to the health risks posed by marijuana use, sale or possession of marijuana remains illegal under federal law notwithstanding some state laws to the contrary.

Marijuana Use during Pregnancy

Pregnant women use marijuana more than any other illicit drug. In a national survey, marijuana use in the past month among pregnant women doubled (3.4% to 7%) between 2002 and 201712. In a study conducted in a large health system, marijuana use rose by 69% (4.2% to 7.1%) between 2009 and 2016 among pregnant women13. Alarmingly, many retail dispensaries recommend marijuana to pregnant women for morning sickness14.

Marijuana use during pregnancy can affect the developing fetus. THC can enter the fetal brain from the mother’s bloodstream and may disrupt the endocannabinoid system, which is important for a healthy pregnancy and fetal brain development1. Moreover, studies have shown that marijuana use in pregnancy is associated with adverse outcomes, including lower birth weight15. The Colorado Pregnancy Risk Assessment Monitoring System reported that maternal marijuana use was associated with a 50% increased risk of low birth weight regardless of maternal age, race, ethnicity, education, and tobacco use16.

The American College of Obstetricians and Gynecologists holds that “[w]women who are pregnant or contemplating pregnancy should be encouraged to discontinue marijuana use. Women reporting marijuana use should be counseled about concerns regarding potential adverse health consequences of continued use during pregnancy”17. In 2018, the American Academy of Pediatrics recommended that “…it is important to advise all adolescents and young women that if they become pregnant, marijuana should not be used during pregnancy”18.

Maternal marijuana use may still be dangerous to the baby after birth. THC has been found in breast milk for up to six days after the last recorded use. It may affect the newborn’s brain development and result in hyperactivity, poor cognitive function, and other long-term consequences192021. Additionally, marijuana smoke contains many of the same harmful components as tobacco smoke22. No one should smoke marijuana or tobacco around a baby.

Marijuana Use during Adolescence

Marijuana is also commonly used by adolescents4, second only to alcohol. In 2017, approximately 9.2 million youth aged 12 to 25 reported marijuana use in the past month and 29% more young adults aged 18-25 started using marijuana23. In addition, high school students’ perception of the harm from regular marijuana use has been steadily declining over the last decade24. During this same period, a number of states have legalized adult use of marijuana for medicinal or recreational purposes, while it remains illegal under federal law. The legalization movement may be impacting youth perception of harm from marijuana. 

The human brain continues to develop from before birth into the mid-20s and is vulnerable to the effects of addictive substances2526. Frequent marijuana use during adolescence is associated with changes in the areas of the brain involved in attention, memory, decision-making, and motivation. Deficits in attention and memory have been detected in marijuana-using teens even after a month of abstinence27. Marijuana can also impair learning in adolescents. Chronic use is linked to declines in IQ, school performance that jeopardizes professional and social achievements, and life satisfaction28. Regular use of marijuana in adolescence is linked to increased rates of school absence and drop-out, as well as suicide attempts29.

Marijuana use is also linked to risk for and early onset of psychotic disorders, such as schizophrenia. The risk for psychotic disorders increases with frequency of use, potency of the marijuana product, and as the age at first use decreases30.  Adolescent marijuana use is often also associated with other substance use3132. In 2017, teens 12-17 reporting frequent use of marijuana showed a 130% greater likelihood of misusing opioids23. Marijuana’s increasingly widespread availability in multiple and highly potent forms, coupled with a false and dangerous perception of safety among youth, merits a nationwide call to action. 

You Can Take Action

No amount of marijuana use during pregnancy or adolescence is known to be safe. Until and unless more is known about the long-term impact, the safest choice for pregnant women and adolescents is not to use marijuana.  Pregnant women and youth--and those who love them--need the facts and resources to support healthy decisions. It is critical to educate women and youth, as well as family members, school officials, state and local leaders, and health professionals, about the risks of marijuana, particularly as more states contemplate legalization.

Science-based messaging campaigns and targeted prevention programming are urgently needed to ensure that risks are clearly communicated and amplified by local, state, and national organizations. Clinicians can help by asking about marijuana use, informing mothers-to-be, new mothers, young people, and those vulnerable to psychotic disorders, of the risks. Clinicians can also prescribe safe, effective, and FDA-approved treatments for nausea, depression, and pain during pregnancy. Further research is needed to understand all the impacts of THC on the developing brain, but we know enough now to warrant concern and action. Everyone has a role in protecting our young people from the risks of marijuana.

Information for Parents and Parents-to-be

You have an important role to play for a healthy next generation.

Information for Youth:

You have an important role to play for a healthy next generation.

Information for States, Communities, Tribes, and Territories:

You have an important role to play for a healthy next generation.

Information for Health Professionals:

You have an important role to play for a healthy next generation.

 

Marijuana’s Ecological Impact

The staggering cost to environment (and on energy and water consumption) by Cannabis production (driven by demand just to get high??) is never raised by pro-weed lobby!

No true environmentalist would promote pot! Cannabis the Climate Catastrophe??

A Powerful New Resource from NFIA

What Would Legalizing Cost Executive Summary

What Would Legalizing Marijuana Cultivation Cost

RMHIDTA Impact Report September 2018

Cultivating Disaster:

The Effect of Cannabis Cultivation on the Environment of Calaveras County

 
 
 
We now have a Silent Poison in our foothills that is polluting our water quality and it will take years if not decades to clean up. The purpose of this paper, Cultivating Disaster, is to assess the damage to the environment caused by marijuana production. This report includes in-depth analysis by scientists, government regulators, and respected news organizations.
 
 
 
USA: National Survey on Drug Use and Health 2015-2016 – National Maps of Prevalence Estimates, by State
 
The 112 national maps presented here show the 2015-2016 National Survey on Drug Use and Health (NSDUH) estimates for 29 substance use and mental health outcomes, by age group, for 50 states and the District of Columbia. Each web link in the table of contents can be used to navigate to all of the maps (for all of the age groups) for the outcome listed in that row. The color of each state on the U.S. maps indicates how the state ranks relative to other states for each measure. States could fall into one of five groups according to their ranking by quintiles. Because 51 states were ranked for each measure, the middle quintile was assigned to 11 states, and the remaining quintiles were assigned 10 states each. In some cases, a "quintile" could have more or fewer states than desired because two (or more) states had the same estimate (to two decimal places). When such ties occurred at the "boundary" between two quintiles, all of the states with the same estimate were conservatively assigned to the lower quintile. Those states with the highest rates for a given measure are in red. Those states with the lowest estimates are in white. The upper and lower limits of each quintile shown in the map legend collectively define a continuum and are not necessarily the actual values of a particular state. For example, in Figure 1a, the values on the boundary in the lowest quintile correspond to Iowa (6.76 percent) and New Jersey (8.13 percent) and are displayed in the legend. In the next to lowest quintile, Virginia (8.28 percent) and South Dakota (9.06 percent) are the states with the lowest and highest values; however, in the continuum of the legend, the lower limit was assigned a value of 8.14 percent because the upper limit of the quintile below it is 8.13 percent.
 

COMPREHENSIVE STUDY FINDS MARIJUANA LEGALIZATION DRIVES YOUTH USE

The Moral Hazard of Lifesaving Innovations: Naloxone Access, Opioid Abuse, and Crime
The United States is experiencing an epidemic of opioid abuse. In response, many states have increased access to Naloxone, a drug that can save lives when administered during an overdose. However, Naloxone access may unintentionally increase opioid abuse through two channels: (1) saving the lives of active drug users, who survive to continue abusing opioids, and (2) reducing the risk of death per use, thereby making riskier opioid use more appealing. By increasing the number of opioid abusers who need to fund their drug purchases, Naloxone access laws may also increase theft. We exploit the staggered timing of Naloxone access laws to estimate the total effects of these laws. We find that broadening Naloxone access led to more opioid-related emergency room visits and more opioid-related theft, with no reduction in opioid-related mortality. For complete article see PDF

 

COMPREHENSIVE STUDY FINDS MARIJUANA LEGALIZATION DRIVES YOUTH USE
COMPREHENSIVE STUDY FINDS MARIJUANA LEGALIZATION DRIVES YOUTH USE

The Legalization and Regulation of Marijuana and Implications
for Local Government
MARIJUANA CULTIVATION IS SERIOUSLY DAMAGING THE ENVIRONMENT
OF CALIFORNIA AND THE WEST SILENT POISON PRESENTS THE FACTS

The Legalization and Regulation of Marijuana and Implications
for Local Government
Canada: The Legalization and Regulation of Marijuana and Implications for Local Government A Literature Review – Academics have given Local Government and Community policy makers an excellent evidence-based report that must inform cannabis management policy in a healthy, productive and socially responsible manner.

The Legalization and Regulation of Marijuana and Implications
for Local Government
Canada: The Legalization and Regulation of Marijuana and Implications for Local Government A Literature Review – Academics have given Local Government and Community policy makers an excellent evidence-based report that must inform cannabis management policy in a healthy, productive and socially responsible manner.

The Pied Piper of Pot

The Pied Piper of Pot Effects