Marijuana Messaging During weekly classroom time with students around the world, Hazelden Betty Ford's Prevention Solutions hears them wrestling with the topic of teen marijuana use. Young people these days are trying to make sense of the issue for themselves, and they are constantly dealing with the messages about marijuana that they hear all around them. We know from research that when students become confused about the consequences of teen substance use, they are more likely to use than a child who is clear about these issues. To reverse this risk and protect our teens, we must know the truth and consistently speak about it with them. Explore with us some of the common misperceptions students hold about marijuana use, and learn health-based realities behind these misconceptions. Common Fictions and Health-Based Facts Fiction: Marijuana is not an addictive drug. Fact: Marijuana is both a psychologically and physiologically addictive drug. Studies show that THC, the main psychoactive chemical in marijuana, causes dopamine levels in the brain to rise. This disturbs the brain's natural reward system and opens the door for addiction. In fact, research by the National Institute on Drug Abuse (NIDA) finds that roughly one in 10 persons who use marijuana will become addicted to the drug. It is also a fact that most people across the world, including most teens, do not use marijuana. Among those who use, however, according to NIDA, over four million Americans met clinical criteria for dependence. This number is more than twice the number for prescription pain relievers and four times the number for cocaine. Not only is marijuana a potentially addictive drug, it has been shown to be more addictive for teenagers than adults. Because their brains are still developing, people who start using marijuana during the teen years raise their risk of addiction from one in 10, to one in six. Fiction: When someone stops using marijuana, there are no withdrawal symptoms. Fact: There are withdrawal symptoms from marijuana use, and they can be intense. For those that develop an addiction to marijuana, refraining from use is likely to cause mood swings, depression, sleep disruptions, anxiety, appetite disturbances, tension and irritability. People dependent on marijuana are additionally likely to experience a significant loss in energy. They will probably be less able to tolerate discomfort. These symptoms promote more marijuana use, in order to stop the symptoms temporarily. More use leads to greater dependence, and greater dependence leads to stronger symptoms of withdrawal when use stops, coupled with an even stronger urge to use, and in larger amounts and more often, than before. This pattern of marijuana addiction— that of use, discomfort, and increased use—was modeled by a study team from Australia and the United States. Researchers found that marijuana withdrawal is clinically significant and associated with impairments to normal daily activities. The research team also found that the greater a person's withdrawal symptoms, the more likely the person is to relapse and start using marijuana again, despite his or her stated desire or intention to no longer use. The compulsive and repetitive use of a substance despite negative consequences such as these, due in large part to withdrawal symptoms, is the hallmark of the disease of addiction. Fiction: Marijuana is harmless because you can't "smoke yourself to death." Fact: Marijuana use can substantially deplete the quality of life and future well-being of adolescents. Irreversible health risks of marijuana use, especially for younger people, do exist. In 2008, nearly 400,000 marijuana-related emergency room visits in the United States were reported. Marijuana-induced psychotic episodes and marijuana-related car accidents, which put the health of the patients and others at risk, were the cause of most of these hospitalizations. In fact, according to the British Medical Journal, marijuana intoxication doubles the risk of a car crash, making use of the substance even riskier for new teen drivers. The U.S. Office of National Drug Control Policy (ONDCP) also states that marijuana can cause problems with concentration and thinking. Many studies about the teenage use of marijuana back up the ONDCP's claim. One such NIDA-funded study at McLean Hospital found that college students who used marijuana regularly had impaired attention, memory and learning skills a full day after they last used the drug. A second study at the University of Iowa College of Medicine found that long-term daily users of marijuana showed deficits in math and verbal skills too. Death is by no means the only measure one should use to determine if a drug affects well-being. Consider the great variety of serious health consequences marijuana can impose on an individual, and particularly a teen. Marijuana is not harmless by any stretch of the imagination. Fiction: The use of marijuana for medicinal purposes suggests that recreational use poses no risk. Fact: Recreational use of marijuana among teenagers is always risky. In a medical setting, patients must weigh the potential dangers of a substance's side effects with the potential medical benefits the drug might produce by relieving disease symptoms. This risk-benefit analysis allows patients to make informed decisions about whether or not they are willing to put certain pieces of their health at risk in order to benefit others through the use of a substance. These health-based decisions, often made by patients with debilitating and terminal diseases, are almost always very difficult. Outside of a medical setting, of course, many substances have no medical benefit. Use in these circumstances is often illegal and is likely to harm health rather than help it. Medicinal marijuana use by people with illnesses does not change the fact that recreational marijuana use by healthy teenagers is so risky. Fiction: Marijuana is natural; it's an herb. Fact: Marijuana disrupts natural brain function like other drugs derived from a variety of sources. A large variety of addictive substances, from the nicotine in tobacco to the opium in poppies, come from nature. The introduction of these addictive substances within the human brain and body systems, regardless of their source, can lead to negative health consequences including an unnatural dependence on these drugs. The body does not know or care whether a drug is man-made or grown in the ground. Marijuana use can lead to memory loss, impaired motor skills, slowed social maturation and substance dependence—not natural conditions of a healthy teen. Fiction: Marijuana is better for your lungs than cigarettes. Fact: Marijuana and tobacco smoke contain many of the same toxic compounds. Marijuana smoke and tobacco smoke are actually rather similar. Benzopyrene, a carcinogen, is found in both marijuana and tobacco smoke, but in greater concentrations in marijuana smoke. Marijuana smoking has not yet been unequivocally linked to lung cancer, but it has been linked to DNA damage, a precursor to cancer, for marijuana smokers. Marijuana smoke typically is inhaled more deeply into the lungs and held in four times as long as tobacco smoke, giving toxins greater access to the cardiovascular system. One study showed that a marker for carbon monoxide in the blood was five times higher after an individual smoked a marijuana joint than after the individual smoked a tobacco cigarette of comparable size. Marijuana contains over 400 chemicals, and smoking marijuana elevates heart rate, suppresses the production of hormones regulating the reproductive system, and unequivocally impairs lung function. All use equals risk, and the healthiest environment for teen lungs is a smoke-free one. Fiction: "Everybody" is using marijuana. Fact: Everybody is not using marijuana. Relatively speaking, hardly anybody is. Despite the fact that marijuana is the most widely used illicit drug by students, the majority of teens worldwide have never used marijuana at all, even once in their lives. According to a recent Monitoring the Future Survey, 66% of U.S. 10th-grade students have never used marijuana during their lifetime, and among European students participating in the most recent European School Survey Project on Alcohol and Other Drugs (ESPAD), 83% have never used the drug. Regular use of marijuana is even more rare among teens. Only 17% of U.S. 10th-grade students, and just 7% of European 15- to 16-year-olds reported having used marijuana in the past month. These statistics make it clear that non-using teens are in the healthy majority of their peers. Fiction: Marijuana cures cancer. It must be good for us. Fact: Smoked marijuana does not cure cancer; it is, in fact, carcinogenic. While there are a handful of laboratory studies exploring how some chemicals within the marijuana plant may have an influence on tumor growth in animals, these studies are both experimental and inconclusive. To date, there is no evidence that marijuana cures cancer. Most likely, teens with the misperception that marijuana cures cancer will not have seen these studies. Instead, kids may have heard that some cancer patients use medically prescribed marijuana to ameliorate the grueling effects of chemotherapy. These students then jump to the conclusion that, instead of reducing the side effects of a cancer treatment process in these patients, marijuana is what is curing their disease. In fact, the American Cancer Society has been very clear that it does not advocate the use of inhaled marijuana for anyone, nor does it advocate the legalization of marijuana. The U.S. Food and Drug Administration has made similarly clear statements, asserting that smoking marijuana increases an individual's risk of coming into contact with cancer-causing agents. Fiction: Marijuana is a "soft" drug that will not harm a teen's mind like a "harder" drug would. Fact: Marijuana is associated with mental health problems, including psychosis. Multiple peer-reviewed research studies have linked teen marijuana use to psychosis later in life. The American Academy of Child and Adolescent Psychiatry (AACAP) stated in a policy paper that "adolescents are especially vulnerable to the many adverse developmental, cognitive, medical, psychiatric, and addictive effects of marijuana." Of great concern to the AACAP is that "adolescent marijuana users are more likely than adult users to develop marijuana dependence, and their heavy use is associated with increased incidence and worsened course of psychotic, mood, and anxiety disorders." The AACAP feels that the medicalization of smoked marijuana in some areas of the world has distorted the perception of the known risks of this drug. Any drug use comes with risk, and the riskiest addictive, psychoactive substance for young people to use is the substance they perceive to be harmless, and the substance that they are therefore willing to use over the long term while their brains and bodies are still undergoing critical development. Fiction: Marijuana use is cool. Fact: Teenagers disapprove of their peers' use of marijuana. As Prevention Specialists who spend a great deal of time with students, we are no longer surprised when middle schoolers know all of the lyrics to popular songs that promote the use of intoxicating substances as the key to fun, prestige, self-expression and/or social acceptance. Pop culture may have the effect of making marijuana and other drugs sound cool to teenagers, but we know from research that the many consequences of marijuana use are anything but cool. Though teens may enjoy the media they consume, drug references and all, they do not actually approve of teenage marijuana use. At a client school in Colorado, we asked students whether they would approve or disapprove of their friends' use of marijuana. While 10% of students said they would approve if their peers used marijuana regularly, 60% of students said that they would disapprove, with most of those students saying that their disapproval was "strong." Within other school communities across the United States and internationally, students are even more quick to disapprove of peers' marijuana use. So while adults may be marketing messages to youth that smoking marijuana is acceptable, most youth feel it is not. Fiction: If marijuana were dangerous, I would not see ads for marijuana shops where I live. Fact: Dispensaries and "pot shops" are for-profit businesses employing consumer marketing strategies. Advertisements for marijuana products do not have to be backed up by an evidence basis, nor will one see any warning labels on marijuana products as have been imposed by regulators of the alcohol and tobacco industries. However, like other industries, the marijuana business will utilize consumer marketing strategies that encourage people to become loyal to their product. Additionally, in the U.S., the advertisements promoting marijuana use may not be connected to a particular shop or product, but may be instead endorsing a ballot measure within the next voting cycle. In this case, the assertions that political ads make about a marijuana measure are considered political propaganda and likewise require no evidence basis under free speech laws. Just as adults have taught students to become media literate about other industries, parents and families can help their kids to see the underlying economic and social interests of marijuana advertisements, lobbying efforts and enthusiast groups. Fiction: Marijuana is healthier than alcohol. Fact: Given the risks of alcohol and marijuana, neither substance is patently "healthy." The marijuana-versus-alcohol debate is a false dilemma. Adolescents need not choose between two addicting, psychoactive substances to feel "grown up," have fun, make friends, feel okay with themselves, or get excited about their futures. Marijuana carries many of its own risks, especially for teens. A 2009 peer-reviewed article in the Journal of Addictive Behaviors found that young people who first used marijuana in adolescence were twice as likely to suffer emotional problems, and seven times as likely to suffer physical problems, as people who first used the substance as adults. At Prevention Solutions we embrace a health perspective and are very strong proponents of delayed use. Dozens of peer-reviewed studies show that the younger a person begins using a drug, including alcohol, the more likely he or she is to have a problem at some point with addiction. This is the reality—all use equals risk, and early use puts a person at greater risk for addiction. The way out of the marijuana-versus-alcohol dilemma is not to pick one's poison, but to encourage delayed use through strong support structures for youth, including solid, community-wide prevention education and substance-free alternatives for teen recreation, stress relief, peer bonding and identity exploration. The Good News When Marijuana Is in the News In the midst of changing laws and cultural messages, young people's confusion about marijuana use is understandable, and the need to provide them with health-based information is critical. The good news is that many teens crave the truth about their health and their well-being. The even better news is that we as adults, so long as we are clear about the potential harm of adolescent marijuana use ourselves, can help our kids and our communities fully understand the risks. We hope this article has prepared you with facts you can use when you're faced with some of the common misperceptions and myths surrounding adolescent use of marijuana.