These aren’t your dad’s joints. Cannabis products today are, on average, around five times stronger than they were a generation ago.
And yet cannabis has never been more widely accepted or easily and legally available. Recreational use by adults is allowed in nearly half of all states. A slew of new products, from vapes to edibles have entered the market in recent years.
Throw in more advanced understanding of teenage brain development, and it’s enough change to leave parents wondering just how safe – or how dangerous – it is for their teens to experiment with cannabis.
Nearly 1 in 3 high school seniors reported using cannabis last year. About 20% of high school sophomores and 8% of eighth graders reported the same. And while teen substance use declined dramatically during the COVID-19 pandemic, it’s held steady over the past year, according to federal survey data from the National Institute on Drug Abuse.
But their experience with cannabis is markedly different from previous generations.
Gen X and millennial teens smoked marijuana that averaged around 4% THC, the main psychoactive chemical in marijuana that causes the sensation of getting high. For Baby Boomers, THC levels were closer to 2%.
But today’s joints now average 15-20% THC. Concentrates and extracts, like those used in vape pens and edibles, can have THC levels of 90% or higher.
“The thing that really accounts for a lot of the higher potency is the onset of vaping,” said Amy McCarthy Baluch, clinical social work director at the Adolescent Substance Use and Addiction Program at Boston Children’s Hospital. “The potency can be a lot higher in the vape oils and cartridges than people who are smoking (marijuana) cigarettes or flower.”
Most teen cannabis users reported using concentrates, according to one recent study. Those concentrates, researchers said, put teens at higher risk for substance use problems than cannabis users who don’t use concentrates.
Reckon spoke with McCarthy Baluch about what parents should know about today’s cannabis and their Gen Z teens, what parents often get wrong about cannabis, and how to start a conversation with kids about substance use.
This interview has been edited for length and clarity.
It feels like we’re seeing more news about the dangers of high-potency cannabis products, particularly for teens. Why is that, when recreational cannabis is now much more widely accepted for adults?
One of the reasons why people are a little more alarmed about substances now for young people is because we know a lot more now than we did 20 or 30 years ago about brain development in teens and young adults.
We understand that the brain is developing until one’s mid-20s. While the brain is still “under construction,” teens are less likely to be able to control and inhibit impulses and impulsive behaviors, and it is harder to think through consequences to their actions.
When young people use substances, it creates a reward pathway where the teen’s brain starts to associate the use of the substance with feeling good. This is due to substances (like cannabis) releasing dopamine into the brain, which is a chemical that makes us feel pleasure and euphoria. When a substance creates that effect, we lose the opportunity to learn other ways to feel good and take care of ourselves.
It also hijacks the brain and causes us to not seek out other alternatives because the power of the substance is so strong. This reinforces the cycle of using more substances to feel better and in many cases, causes someone to seek out substances that will create an even greater effect over time.
The other piece of the puzzle when it comes to the high potency of cannabis products is that the more potent the substance, the more likely it is to make that brain connection.
Delaying the onset of substance use and cannabis use, even by a year, through someone’s early 20s, has shown to significantly reduce the chances of someone living with a substance use disorder chronically and into adulthood.
A conversation I have a lot with young people is to say we’re not asking you to never use substances, or that substances are necessarily bad or good. But if you reduce your use significantly or stop all together while you’re a teen and young adult – while your brain is still developing – your relationship with substances later in life is more likely to be healthy and balanced.
I’ve heard the higher potency of newer cannabis products like vapes could make my teen more likely to develop physical problem or mental health disorder? Should that be a real concern?
We’re seeing this newer phenomenon of cannabinoid hyperemesis syndrome (CHS), which is a condition where users experience cyclical nausea and vomiting that’s pretty severe and can last up to several days. We’re seeing young people brought to emergency rooms or admitted to hospitals because that much vomiting can impact your hydration levels and electrolyte levels in your blood.
The working theory is that the high potency in cannabis vapes is interacting with the gut biome, and the brain and the gut are having these mixed signals that cause vomiting to occur.
Anecdotally we’re seeing increases in incidents of psychosis and psychotic episodes that seem related to substance use, especially the use of cannabis. But is it happening in young people who are predisposed to psychotic or thought disorders, and the use of cannabis just brings that onset at an earlier age? Or is it that the use of cannabis is causing them to experience symptoms of psychosis that they might not otherwise have experienced? We’re not sure yet. But the incidence of psychosis related to cannabis use seems to have increased.
In some cases, people find that cannabis-induced psychosis resolves when they stop using substances; in other cases it does not.
In your experience working with teens and young adults, what kinds of cannabis products are most popular now?
Vapes are the No. 1 thing I hear and see in my work. Edibles come in second place. Those come in all different varieties: chocolates, candies, even beverages infused with cannabis.
And of course, we still hear from people using bud and flower.
Is there a “safe” amount of cannabis use for teens and young adults?
A lot of people think of cannabis as a fairly benign and safe substance, similar to alcohol.
In our practice, we don’t talk about there being a ‘safe’ or responsible use in young people, though we do talk about harm reduction and ways to keep them safer. But we try to really drive home with parents and young people that there’s no guarantee how cannabis might affect their brains as they grow. Based on the available brain science, the risk (of negative consequences) is high for any young person using substances while their brain is developing.
Of course, it’s developmentally appropriate for young people to seek out more risks. And families might think, ‘I used substances when I and I’m OK.’
But I think people should be thoughtful about what we now know about substances that we didn’t know before, and that just because someone used substances and feel they didn’t experience negative consequences doesn’t mean their children’ won’t either.
Will using cannabis have a lasting impact on my teen’s brain?
The brain is so resilient. There’s promising research showing that when young people give themselves 12 months to abstain from substances, recovery is possible and they’re able to bounce back.
But we’ve also seen research out recently from Columbia University showing how even young people who use cannabis but don’t meet the criteria for substance use disorder still show an increased risk of depression and suicide. That’s a big deal to our team, that even casual use can result in negative outcomes for young people.
How do I start a conversation with my teen about cannabis?
Many times, parents fear if they bring it up that will somehow put the idea into their child’s mind, but I don’t think that’s how substance use works. Young people need their families to open a safe, nonjudgmental space where they can talk about substances.
You can start a conversation by asking what they know. Kids are learning a lot in health classes at school, but they’re also learning a lot from their peers. Knowing where they’re coming from can help you gauge where you start.
It’s OK to not know how to respond to a certain question. You can always tell them you’ll get back to the conversation later, or gather your thoughts and then respond. Parents sometimes feel like they need to know everything at one time or they’ll lose their child’s interest or trust. But 30 one-minute conversations can sometimes be better than one 30-minute conversation to help information really sink in.
It’s also helpful for parents not to vilify substances. It’s not that substances are good or bad, or that people who use substances are good or bad. Many of us have amazing people in our lives who use substances. And it’s important to frame substance use disorders as the medical conditions they are.
It’s important for families not to try to scare their child into not using substances. Sharing factual information that could be scary is different from trying to spook your child. Kids will research independently, and if you share information that’s incorrect or designed to scare, they’re not going to trust you or they’ll write you off.
Work with the other people in your child’s life to find that sweet spot between allowing your child to go out and learn independence and decision-making, while still having bumpers up – like in a bowling lane – to support them when they make a mistake or face a challenging situation. It also helps when they have expectations that shape their behavior.
What signs should parents look for that might mean there’s a problem?
One thing we hear often is that parents should notice if their child’s grades are dropping in school, if they have new or different friend groups, if they’re more irritable or withdrawn, more evasive, or spending less time with family and friends. Notice overall changes in their habits and routines, like sleeping more or less, or appetites changing.
But something I think families often don’t look out for but that can be just as important are sudden shifts in which things get a lot better. Sometimes the use of a substance provides a substantial amount of relief to a person. Maybe they’re attending school more often or have a group of friends they’re suddenly getting along with. Parents should pause and reflect about what might be happening. We want our children to be happy and successful, but if it’s a substance bringing them that relief, then in the long run that’s not going to be sustainable.
Young people who experience bullying, who live with ADHD and young people who identify as LGBTQ+ tend to have higher rates of substance use disorders. Connected to those examples are young people who feel disenfranchised, feel they aren’t accepted, or who often get in trouble for not being able to meet the rules and expectations of the adults in their lives.
A lot of families we see at our practice may just suspect their child is using substances, or they’re aware they’ve experimented because they found a substance in their backpack. There doesn’t have to be a major issue (for parents to seek help). It’s good to talk to your teen’s doctor or other professional before you start seeing bigger challenges like a decline in grades or legal troubles.
For parents who feel overwhelmed or like they need guidance or help, where can they go?
I think your child’s pediatrician can be a good starting point because often they’re in the know about places where families can get help.
There are also national and regional groups and online forums where parents can find support.
FindTreatment.gov has a confidential treatment locator where you can search for substance use disorder treatment programs across the country.
Knowing that we’re seeing more instances where even cannabis can be laced with substances like fentanyl, families can consider having NARCAN or naloxone on hand to treat overdose emergencies. You can get it over the counter. Even if you don’t suspect your teen has a substance use disorder, having NARCAN or naloxone is kind of like having a defibrillator or knowing CPR.
It’s one more tool that can save people’s lives in their homes and communities, so it’s smart to have access to it and know how to use it.