Impact of cannabis legalization on child and youth mental health…
Impact of cannabis legalization on child and youth mental health practitioners
What is cannabis and why was it legalized?
Comes from the plant, cannabis sativa, containing over 100 chemicals (cannabinoids) which have effects on cell receptors in the brain and body that affect how the cell's behave and communicate (Canada, 2020)
Delta-9-tetrahydrocannibinol (THC) is responsible for the high feeling and can be harmful, and cannabidiol (CBD) does not produce the high. THC and CBD are the two primary components of cannabis.
Tentative recommends for CBD use for social anxiety and schizophrenia, improve sleep and PTSD, however evidence is weak (Sarris et al., 2020)
Negative health effects on teenagers
Evidence linking chronic cannabis use with increases risk of developing psychosis and schizophrenia with genetic predisposition (Konefal et al, 2019)
Heavy cannabis use over time will not compensate but rather escalate [neurocognitive] deficits, while delaying natural coping mechanisms and possibly reducing benefit from psychotherapy (Stuart-Mayer, 2020)
Cannabis use in youth is strongly liknked to "cannabis dependence and other substance use disorders; the initiation and maintenance of tobacco smoking; an increases presence of mental illness, including depression, anxiety and psychosis; impaired neurological development and cognitive declined; and diminished school performance and lifetime achievement (CPS, 2017)
significant associations observed between frequent cannabis users and elevated internalizing and externalizing symptoms (Girgis et al, 2020)
Substantial decrease in corticol thickness and surface area over time in ages 13-19 for individuals who remained abstinent from cannabis use by young adulthood (Infante, Country, Castro, Squeglia & Jacobus, 2018; Jacobus et al., 2016)
Larger left lateral orbitofrontal cortex volume measures from ages 12-15 (prior to cannabisu initiation) was linked to greater reward responsiveness and predicted classification as a regular cannabis user by age 22 (Wage et al., 2019)
Nguyen (2015, 2017) found that more recent cannabis use (within the past year) was associated with worse neurocognitive perofrmance during young adulthood
Evidence suggessts recency, frequency, and age of onset of cannabis are likely key variables in predicting not only poor neural health and cognitive functioning, but emotional wellbeing as well (Jacobus et al., 2017)
Cannabis can increase the risk of suicidality even in the adbsence of a preexisting condition (Konefal et al., 2019)
What mental health agencies need to consider moving forward?
Feedback from a social worker for high risk youth and their families
Parents are more accepting of their youth using recreational marijuana
Increased acuity of substance abuse (ie. more admissions to specialized care)
Youth prefer it for anxiety and ADHD as it "helps slow things down" than using evidence-based psychoactive medications
No longer viewed as a child protection issue by child protection agencies
Need to monitor and screen for usage more closely
Screen for at-risk dependency at any age
Provide more education and discuss health risks more with families (Grant & Belanger, 2017)
Engage in psychoeducational and motivational interviewing techniques for all students who report substance use, and concrurrently treat mental health concerns and substance use problems with existing tools and techniques, screen high risk youth and initiate referral when necessary (School Mental Health Ontario, 2019)
Encourage youth to access services they would not have accessed without guidance from their healthcare provider (George & Vaccarino, 2015)
Educational material outlining the effects of adolescent cannabis use would be useful to teachers and other youth service providers who can also participate in prevention delivery (CCSA, 2017)
Integration of more screening questionnaires to structure discussion and identify adolescents who may benefit from more specialized interventions. Appraising youth's willingness to change risky behaviours is key aspect to care, along with supportive goal-setting and helping families (CPS, 2020)
Need for standardized measurement tool for cannabisu use (Konefal et al, 2019)
Recommended for clients who do utilize over-the-counter cannabisu products advertised for mental health treatment to inform the client of the lack of research on the efficacy of these products (Stuart-Mayer, 2020)
For clients who self-administer cannabis as part of their ongoing treatment plan. Clinicians should consider their own thoughts, feelings, and biases regarding cannabis, and how it may impact both the therapeutic relationship and the manner in which they discuss the client's cannabis use (Stuart-Mayer, 2020)
Considerations for Government
Develop and implement rigorous and strong education and prevention programs for adolescents and their families
Acquire different types of knowledge from mulitple sources, including experiences of general public, other countries who have legalized, businesses already in cannabis production, clinicians and experts.
Use cognitive skills in critical thinking to acquire different types of knowledge on cannabis
Ensure clinicians are well supported and educated in order to adequately convey proper information to their clients
Develop strong systems for monitoring the effects of legalization on youth and their families
Ensure evidence-informed information is being spread and work considerably hard to curb the amount of misinformation that is readily available to the general public on social and traditional media outlets.