JAMA. Published online July 16, 2018. doi:10.1001/jama.2018.8401
Increasing public attention has recently been paid to the opioid epidemic and attendant effects on prenatally exposed infants and children. 1Current literature has emerged proposing marijuana as a safe alternative to opioids in addressing pain 2 and cannabis legalization as a way to decrease opioid fatalities. 3 As a result, perceptions of cannabis safety have increased, and the prevalence of marijuana use among pregnant women has expanded; past-month cannabis use among pregnant US women increased from 2.4% to 3.9% between 2002 and 2014. 4 Further, cannabis potency has been substantially increasing over the past 4 decades in the United States, and will likely continue to do so as extraction procedures of active components improve.
Although cannabis does have known medical utility for some conditions, its associated acute and long-term psychoactive effects on brain function are also known. Expanding use of cannabis among pregnant and lactating women (as likely will occur with legalization) may lead to increased risk from fetal and child exposures if the teratogenic potential of cannabis remains underappreciated …The exogenous supply of cannabinoids resulting from THC exposure can adversely affect fetal growth as well as structural and functional neurodevelopment. 6
Prenatal THC exposure has been documented to adversely affect infant neurobehavior and child development up through the teen years,5and postnatal exposures may compound prenatally acquired deficits. Neurobehavioral effects associated with prenatal THC exposure range from dysregulated arousal and motor difficulties at birth to disturbed sleep, memory impairment, aggression, and other developmental and behavioral concerns in childhood. 5
Despite these risks, it appears that clinicians are not addressing cannabis use during pregnancy or lactation; in one study of 74 lactation professionals, 85% encouraged breastfeeding among marijuana-using mothers. 7 Most national breastfeeding guidelines (eg, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists) have remained steadfast in recommending against cannabis use during lactation….
The medical community should advise pregnant women to avoid perinatal THC exposure and intervene for women needing treatment, for children at risk for neurobiological and developmental problems, or for dyads at risk for negative outcomes associated with an untreated substance use disorder. Advice from medical professionals should be consistent: pregnant and lactating women should be advised to avoid cannabis use, and women (and men) caring for developing children also should be advised to maintain abstinence. Treatment programs for women with CUD should be available and accessible, and gender and culturally specific, particularly during pregnancy and postpartum periods. Converging, systematic research is necessary at both the preclinical and clinical levels to address insufficient evidence regarding maternal cannabis use 9 and to fully understand the short- and long-term effects of perinatal THC exposure, the effects of maternal cannabis use on fetal outcomes, and the consequences of polysubstance use in treatment and intervention efforts.
We wanted to make sure you had seen four key studies just into play
Additional Resources on Link Between Marijuana and Opioids
These articles follow other warnings from medical professionals: the recent editorial published in the Journal of the Society for the Study of Addiction, which cautions against drawing policy conclusions from population studies, and the editorial comment from the American Society of Addiction Medicine on February 20, 2018. And don't forget NIDA's rigorous study showing pot users are twice as likely to have abused opioids and have an opioid use disorder than non-marijuana users.
SAM has published a one-pager describing the overwhelming link between marijuana and opioid abuse. While not every marijuana user will go on to use heroin, nearly all heroin users previously abused marijuana. We need smart policies that discourage use, get people back on their feet, and restore people to participate in and contribute to society. States that have legalized marijuana, by contrast, see increased drugged driving, increased arrests of minority youth, and increased emergency room visits. Colorado is experiencing the highest number of drug overdoses in its history. Legalization is a failed experiment.
Sincerely, Dr. Kevin Sabet President, Smart Approaches to Marijuana (SAM)
Affiliated Fellow, Yale University
Translational Psychiatry volume 8, Article number: 89 (2018)
There is a strong association between cannabis use and schizophrenia but the underlying cellular links are poorly understood. Neurons derived from human-induced pluripotent stem cells (hiPSCs) offer a platform for investigating both baseline and dynamic changes in human neural cells. Here, we exposed neurons derived from hiPSCs to Δ9-tetrahydrocannabinol (THC), and identified diagnosis-specific differences not detectable in vehicle-controls. RNA transcriptomic analyses revealed that THC administration, either by acute or chronic exposure, dampened the neuronal transcriptional response following potassium chloride (KCl)-induced neuronal depolarization. THC-treated neurons displayed significant synaptic, mitochondrial, and glutamate signaling alterations that may underlie their failure to activate appropriately; this blunted response resembles effects previously observed in schizophrenia hiPSC- derived neurons. Furthermore, we show a significant alteration in THC-related genes associated with autism and intellectual disability, suggesting shared molecular pathways perturbed in neuropsychiatric disorders that are exacerbated by THC.
In summary, we found significant associations of THC- related pathways to autism and intellectual disability. Furthermore, we have used a dynamic, human-relevant system to demonstrate a phenotypic link between THC treatment and schizophrenia. We hypothesize that THC exposure, by impacting many of the same synaptic and epigenetic pathways already associated with psychiatric disorders, may serve as an additive risk to existing genetic/ epigenetic risk factors.
All Young Cannabis Users Face Psychosis Risk (Medscape and JAMA Psychiatry) June 15, 2018
Cannabis use directly increases the risk for psychosis in teens, new research shows. A large prospective study of teens shows that "in adolescents, cannabis use is harmful" with respect to psychosis risk, study author Patricia J. Conrod, PhD, professor of psychiatry, University of Montreal, Canada, told Medscape Medical News.
The study included 3720 adolescents from the Co-Venture cohort, which represents 76% of all grade 7 students attending 31 secondary schools in the greater Montreal area.
Cannabis use, in any given year, predicted an increase in psychosis symptoms a year later, said Conrod. This type of analysis is more reliable than biological measures, such as blood tests, said Conrod. "Biological measures aren't sensitive enough to the infrequent and low level of use that we tend to see in young adolescents," she said.
The effect was observed for the entire cohort. This finding, said Conrod, means that all young cannabis users face psychosis risk, not just those with a family history of schizophrenia or a biological factor that increases their susceptibility to the effects of cannabis.
"The whole population is prone to have this risk," she said.
In light of these results, Conrod called for increased access by high school students to evidence-based cannabis prevention programs.
The study was published online June 6 in JAMA Psychiatry.
First things first — how is marijuana vaped?
Vaping refers to the inhalation of an aerosol produced by heating a liquid/oil or substance in a compact electronic portable vaporizer. While many young “vapers” say they inhale flavored liquids like Gummy Bear, German Chocolate Cake and Cotton Candy, youth can vaporize marijuana – either the ground plant itself, waxes often referred to as dabs, or THC and CBD oils.
Selling equipment to vape marijuana in its leaf, dab or oil form is a booming business with many new entrants. Pax Labs, formerly Ploom, was founded over a decade ago and is a relatively well-known brand for vaping dry leaf marijuana. The company has introduced the Pax 3, which they describe as the “Apple I-Phone” of vaporizers as it allows you to vape both dry leaf and wax concentrates. It includes a free Android or iOS app to control temperature, play, free games, manage firmware and lock the device.
In California, a company called EAZE sells disposable all-in-one marijuana vape pens and cartridges. Flavors include Blueberry Kush, Lemon OG and Mango Passion Fruit. They market these as wellness products with advertising that reads, “Hello Marijuana, Goodbye Insomnia” or “Hello Marijuana, Goodbye Hangover.”
Although not a vape per se, another company, Aeroinhaler, has developed a product that looks exactly like an inhaler one would use to treat asthma. It’s marketed as a healthy alternative to vaping or smoking combustible marijuana, delivering a metered dose with each puff. The company says that their product uses concentrates of 80 percent THC potency.
Juul can also be used to vape marijuana; however, it should be noted that as of now, Juul does not offer marijuana products. The device has to be hacked in order to use it with THC oils and, as with most things, there are YouTube videos demonstrating how. There are also companies making pods that fit a Juul, so a THC oil pod may be in the future.
Marijuana is used recreationally and medicinally, so what’s the big deal for adolescents and young adults?
It turns out that the brain of an adolescent or young adult is still growing, and therefore on a mission to increase efficiency and to develop critical skills related to problem-solving, impulse control, anticipating consequences and more. Marijuana can get in the way of this development, causing brain circuits to wire in a less optimal way.
One way to think about this is comparing the developing brain and its neural connections to your home electrical wiring grid. You want the best possible wiring for your house, so that when you need to use your appliances, everything works as it should with no shorts or blown fuses. The house can still function if everything isn’t up to code, but it won’t be ideal. Marijuana use can impact the wiring of the brain in a similar way, with the impact being subtle in some cases and more severe in others.
According to the CDC, marijuana use may have long-lasting or permanent effects on the developing adolescent brain. Negative effects include:
It’s really important for parents and caregivers to note that these impacts of marijuana differ from the impacts on a fully mature adult brain. Delaying substance use of any kind, including marijuana, gives your child the best opportunity to have optimal brain functioning.
How can I recognize use, especially if there is no smoke and telltale smell?
Vaping can be difficult to detect as there is no smoke, minimal odor (although you may catch a whiff) and the vapor produced dissipates rapidly. However, just like smoking, vaping marijuana can result in bloodshot eyes, dry mouth and thirst, increased appetite and shifts in behavior and mood. Sometimes, there is a noticeable change in friends and a decrease in activities that were once enjoyed.
You may also find vaping paraphernalia such as devices that look like flash drives, gel jars that contain dabs, and pods or cartridges that contain THC oil. There’s a lot of high-tech-looking equipment that can accompany vaping, so if you’re not sure, it might be time to talk to your child about what you found.
What can I do if I suspect my child is at risk for vaping or is already vaping marijuana?
Given the growth of marijuana use and vaping among American youth, it’s a good idea to explore your son’s or daughter’s views on vaping and perceptions of the risks.
1. Have conversations often. Before any talk, it helps to be able to share
facts, but don’t assume that an information download to your child will translate into healthy behaviors.
2. Look for good opportunities to have a discussion. You can do this when passing a vape shop, smelling marijuana on the street, seeing someone vaping on TV or in person or seeing one of the ads for vapes.
3. Try to listen, rather than give a lecture. Open-ended questions can be a great way to get your child’s perspective, i.e. “I understand that some kids are vaping marijuana. What are your thoughts about it?” If you know they are already vaping marijuana, you might ask “What does vaping marijuana or THC oil do for you?” Perhaps it’s a way to fit in, handle social anxiety or address boredom. Get to the root of “why.”
4. Set clear expectations. Express your understanding of the risks, but also why a person may want to vape. Share why you don’t want him/her vaping, and remember, it’s important to avoid scare tactics. Be honest.
5. Teach refusal skills. It’s likely that your teen or young adult will be introduced to vaping marijuana by a friend or older sibling. It helps to rehearse what he/she will say if that happens.
6. Have your loved one talk to other trusted adults who can reinforce your message. Sometimes, messages coming from your pediatrician, school counselor, favorite aunt or uncle, etc. can be more impactful.
7. Model healthy behaviours. If you come home from work and discuss what a tough day it’s been while popping open a beer, pouring a glass of wine or smoking a joint, you are conveying this is how you handle stress. It’s healthier for your child — and you — if you take a walk with the dog or a bath or go for a run rather than turn to substances as stress busters.
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Presentations, Statements & Conference Resources from WFAD 2018 Forum