Adolescent Psychiatry - Volume 13, Issue 3, 2023

Youth cannabis use is a major public health crisis. Cannabis laws carry significant health implications for American youth. Relaxing of these laws – through decriminalization, medical and recreational legalization – by a majority of states in the United States (US) over the past 25 years has dramatically shifted societal perceptions and adult use. How cannabis policy changes have affected the population-wide health of US youth and downstream public health implications of cannabis laws remain topics of significant debate. Cannabis is the most commonly used federally-illicit drug by US adolescents and the main drug for which US teens obtain substance use treatment. Adolescent cannabis use is associated with negative long-term consequences for mental health, risk-taking behaviors, and academic/job achievement. As of January 2023, 37 states and the District of Columbia (DC) have enacted medical cannabis laws; of these, 21 states and DC have recreational cannabis laws. Multiple studies have assessed the association between cannabis laws and youth cannabis use; results indicate mostly null effects for medical laws and mixed effects for recreational laws. Little is known about the effects of cannabis laws on mental health and mortality outcomes for American youth. Methodological limitations have made the interpretation of this literature difficult. This article presents a narrative review of current scientific literature investigating the impact of changing cannabis policies on cannabis and other drug use, mental health, and mortality outcomes in US youth. Implications are framed within a larger discussion on national trends in youth drug use, effects of adolescent cannabis exposure on health outcomes, and research-based policymaking.

Cannabidiol (CBD) is a plant-derived cannabinoid found in cannabis and hemp plants with broad psychopharmacologic effects and poorly understood mechanisms of action that may include antioxidant and anti-inflammatory properties and central nervous system (CNS) modulation of endocannabinoid, glutamatergic, and serotonergic neurotransmission. This article reviews existing data on the safety and efficacy of CBD for mental and physical health indications in the pediatric population and for psychiatric disorders in adults, with a focus on clinical trials. Searches of PubMed and PsycINFO for articles through October 2021 focused on clinical trials on "cannabidiol" and "seizure" or "psychiatry" in youth and adults, identifying 686 articles that were then screened and evaluated for relevance. Research into the safety and efficacy of CBD led to the United States Food and Drug Administration's approval of Epidolex, a purified pharmaceuticalgrade CBD medicine, for treating drug-resistant seizures in Dravet syndrome, Lennox-Gastaut syndrome and tuberous sclerosis complex. Beyond treatment for rare seizure disorders, CBD has received growing public interest in recent years as a "natural" treatment for various other medical and psychiatric conditions, resulting in a rapidly expanding multi-billion-dollar US market for CBD dietary/health supplements and a growing number of Americans reporting regular use. However, the growing demand and broad claims of purported benefits have greatly outpaced the body of literature substantiating its use. Further, limited safety data in pediatric populations, drug-to-drug interactions between CBD and prescribed medications, and issues related to mislabeling and contamination have blunted enthusiasm for CBD in the pediatric healthcare community and indicate a need for additional research.

Background: Interest in the potential mental health effects of cannabidiol (CBD) has increased recently, with a surge in commercial and pharmaceutical development of CBD products and a concomitant rise in consumer use. However, despite the widespread and growing use of CBD products by adults and adolescents, the mental health effects of CBD remain largely unknown.Objective: The goals of this review are: 1) to briefly review the evidence base for the mental health effects of CBD, using depression as an exemplar, and 2) to systematically outline complementary study designs needed to test CBD effects, together with challenges and special considerations related to each design.Methods: This review integrates empirical findings related to CBD's effects on mental health outcomes with the literature on intervention trial design and current legal regulations pertaining to CBD.Conclusion: Complementary controlled and observational studies of CBD are necessary to substantiate claims of mental health benefits, including for clinical depression and in pediatric populations. Investigators must consider challenges and opportunities specific to CBD as an intervention, including legal regulations, commercial or pharmaceutical product choice, dosing and bioavailability, and safety.

Background: Adolescents and young adults may use cannabidiol (CBD) products in an attempt to reduce depression and anxiety symptoms, despite little research examining this use. This systematic review evaluated preclinical and clinical research on the effects of CBD on depressive and anxiety disorders in adolescence and young adulthood. To provide context, we discuss CBD’s mechanism of action and neurodevelopmental effects.Methods: PubMed was searched for articles published through June 2022. Preclinical or clinical CBD administration studies with N > 1 that examined depressive and/or anxiety disorders were eligible.Results: Initially, 224 publications were identified. After excluding duplicates and applying eligibility criteria, 6 preclinical (depression: n≈133; anxiety: n≈161) and 4 clinical (anxiety: n=113) articles remained. Due to the low number of studies, results were synthesized qualitatively. The Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence were used to rate each study’s evidence. The preclinical effects of CBD on depression-like behavior appear to differ by sex, early life stress, and duration of use. Despite no evidence that CBD exerts anxiolytic effects in preclinical adolescent models, CBD may reduce anxiety symptoms in human adolescents and young adults with anxiety disorders.Conclusion: The existing evidence suggests that CBD may reduce symptoms of anxiety in adolescents and young adults. However, the evidence is sparse and limited by variations in samples and CBD dosing duration. Further research is needed to understand the potential benefits and/or harms of CBD for depression and anxiety disorders in this population. Implications for clinical practice and research are discussed.