Adolescent Psychiatry - Volume 11, Issue 3, 2021

Background Objectives: Thirty-three states and the District of Columbia (DC) have enacted some form of legalized cannabis or cannabinoid for medical conditions (MMJ), 11 of them and DC for recreational use. It has become critical for psychiatrists and other mental health professionals working with adolescents to be aware of the diversion of marijuana (MJ) to youth and subsequent potential adverse effects in environments with widely different regulations. The experience of two office-based psychiatrists in California (the first state to legalize MMJ) through case presentations and an informal practice review illustrate the role that diverted MMJ plays in the clinical presentation of youth for psychiatric care, highlighting clinical implications and guidelines for treators as states legalize MJ for adult recreational use. Methods: Two child and adolescent psychiatrists practicing in California over the last twenty years report on their experiences working with adolescent patients and their families during the period of legalized MMJ. After a comprehensive literature review, they report their clinical observations and make recommendations for treators of adolescents. Discussion: There is general confusion among adolescents and their parents about MJ and MMJ. There is a lack of clear regulatory guidelines and a need for better clinical training for prescribing physicians. Diversion of MMJ to teens during periods of legalization of medical marijuana is common in states where it has not been legislated or regulated sufficiently to provide effective safeguards. This lax approach is demonstrated by our case reports and clinical review. Similar experiences have been reported elsewhere. Increased problems with diversion are expected as legalization efforts continue. Professionals and their organizations need to become more active in advocating policies to protect youth from potential harm related to cannabis use and abuse and carefully evaluate its use among their teen patients.

Background: Between 2010 and 2020, New Jersey went from treating cannabis as an illegal substance in all circumstances to allowing medical use and subsequently recreational use. The Medical Marijuana Program (MMP) was originally very strict and was progressively liberalized. After attempts to legalize recreational use failed in the legislature, voters passed a referendum to amend the New Jersey constitution to allow recreational use. Our objectives are to document this process and provide the perspectives of psychiatrists treating adolescents Method: We describe the legislative process and the multiple pressures for legalization and decriminalization Discussion: Issues germane to youth as a vulnerable population have been inadequately considered by policymakers, the media, and the general population. Greater attention to the process and outcome to mitigate this finding is needed.

Background: Knowledge of the effects of cannabis and of the endocannabinoid system (ECS) has increased greatly in recent years. This information has been brought into debates and decisions regarding the medical use of cannabis, and recreational use of cannabis and cannabinoid products, often with non-science-based conclusions. Health-related effects, especially those related to children, adolescents, and young adults, must be a critical part of the decisions regarding the legalization of cannabis, and current knowledge is a necessity. Objective: The study aimed at providing an overview of cannabis use epidemiology in the United States. The second objective of the study was to provide current research information regarding the effects of cannabis use on decisions related to cannabis use and legalization, highlighting their effects on children, adolescents and young adults. Method: Key features of cannabis-related health benefits and adverse effects have been identified to provide detailed knowledge base related to health, disease, and public welfare. Emphasis is given to the most current research findings and to adverse effects related to youth and young adults. Results: The helpful and harmful effects of cannabis explain contradictory decisions for further legalization of cannabis products. Federal research prohibition has handicapped a timely science-based informed discussion. Concerns are expressed for the protection of adolescents and emerging adults, regardless of cannabis’ legal status. Conclusion: The special vulnerabilities and needs of adolescents and emerging adults need to be considered in current and future discussions in public policy and legislation at all levels of government related to any further legalization of cannabis products.

The process of approving the legalization of cannabis for recreational purposes at the state level in the U.S has been replete with denial and avoidance of scientific evidence. Instead of representing the best interest of public health, many politicians have elected to serve the cannabis industry while using “fake news”. This commentary provides an example, description, and analysis of how and why politicians betray their constituents.

Aims: We aimed to document the clinical rates and correlates of problematic substance use among adolescent inpatients. Background: Adolescents referred to psychiatric inpatient care are likely to present family and social risk factors making them at high risk of substance use disorder. Objective: The objective of this study is to document the rates, clinical correlates, and effects of associated problematic substance use on therapeutic outcomes in adolescents referred to psychiatric inpatient care. Methods: The DEP-ADO questionnaire was used to systematically screen out problematic substance use in two 12-18 adolescent inpatient units between January 2017 to December 2018. Inpatients who were screened positively based on the DEP-ADO questionnaire and/or information gathered from repeated interviews with the youths and their families were reported to the liaison addiction unit for diagnosis. The chart-review procedure was used to document clinical correlates (i.e., suicidal behavior, DSM-5 psychiatric diagnoses, the Clinical Global Impression-Severity score) and therapeutic outcomes (i.e., the Clinical Global Impression- Improvement score, change in Children-Global Assessment Scale score during patients’ stay and length of stay). Results: Over two years, 150 adolescents completed the DEP-ADO questionnaire (Mean Age =14.7 ± 1.7; 42% girls). Thirty percent of adolescent inpatients reported some type of problematic substance use, with a higher likelihood of daily tobacco use (OR=2.4), regular cannabis use (OR=2.3), and occasional opioid/heroin use (OR=9.8) compared to the general population. Adolescent inpatients who misused illegal substances prior to admission were 2.5 times more likely to report suicidal behaviors. A strong association was reported between binge drinking behavior and a discharge diagnosis of bipolar disorder (OR=11.0). Therapeutic outcomes were not statistically different with regards to alcohol or illicit substance use status. Conclusion: Inpatient adolescents were at high risk of associated problematic substance use. Patients with co-existing problematic substance use seem to have more severe and chronic forms of mood disturbances, although the response rate to therapeutics provided during their stay was not found to be lower compared to their counterparts without problematic substance use.