Medical researchers have come to mixed conclusions regarding the safety of marijuana during pregnancy. The same can be said about children and adolescents using Cannabis, but in short, medical marijuana is probably safe for teens and children. That being said, more research is needed on this topic. Concerned parents should seek medical advice from a qualified physician before making a final decision. For many children and teens, the medical benefits outweigh the risks – especially in cases where conventional medications have severe side effects.
Con: Marijuana Alters Brain Structure, Could Change Behavior
In February 2013, Dr. Sharon Levy, MD, MPH, who is currently the Assistant Professor of Pediatrics at Harvard Medical School, addressed an open letter to the Massachusetts Department of Public Health (DPH) in which she expressed a concern that “marijuana does cause changes in the same areas of the brain as other addictive drugs (in particular the nucleus accumbens).”
The nucleus accumbens, sometimes abbreviated to NAc or NAcc, is a group of neurons (nerve cells) clustered in the basal forebrain, which is located near the front and bottom of the brain. The basal forebrain is responsible for producing a chemical called acetylcholine, which impacts neuroplasticity (the ability to form new neural connections) and therefore learning abilities. The nucleus accumbens is what people are talking about when they describe the brain’s “reward center” (i.e. increased dopamine levels). Contrary to popular belief, dopamine levels rise in response to both positive and negative experiences, as indicated by this 2013 study published in the Journal of Neuroscience.
Dr. Levy’s statement appears to have been confirmed by a 2014 medical study – also published in the Journal of Neuroscience – whose title neatly sums up its message: “Cannabis Use Is Quantitatively Associated with Nucleus Accumbens and Amygdala Abnormalities in Young Adult Recreational Users.” (It should be noted that the study examined teens and young adults in the 18- to 25-year-old age range – not children.) The study used a sample size of 20 participants, all of whom reported using Cannabis at least once a week, “but were not dependent.” The study compared MRI scans from the participants against a control group.
The study found that “gray matter density analyses revealed greater gray matter density in marijuana users than in control participants in the left nucleus accumbens… even after controlling for age, sex, alcohol use, and cigarette smoking.” Additionally, the study noted that “significant shape differences were detected in the left nucleus accumbens and right amygdala,” which deals with emotional responses.
The study summarized that “the results… indicate that in young, recreational marijuana users, structural abnormalities in gray matter density, volume, and shape of the nucleus accumbens and amygdala can be observed.”
In a response to the Neuroscience study, Dr. Anne Blood, PhD, from the Massachusetts General Hospital’s Department of Psychiatry, stated that “these abnormal structural changes in the amygdala and nucleus accumbens could indicate that the experience with marijuana alters brain organization and may produce changes in function and behavior. It also is possible that the brain is adapting to marijuana exposure and that these new connections may encourage further marijuana use.”
Are Cannabis Critics Biased?
With all this in mind, there are key two points which must be noted.
First, the 2014 Neuroscience study relies on data drawn from fMRI (functional Magnetic Resonance Imaging) scans. This is problematic because, as we noted in our article on talking to your children about medical marijuana, fMRI scans serve as a poor stand-in for real cognitive effects. In fact, one rather sarcastic study subjected a dead salmon to various images – and sure enough, its non-functioning brain lit up on an fMRI scan. (This fMRI analysis by Dr. R. Todd Constable, PhD, who serves as the Director MRI Research at the Yale School of Medicine’s Magnetic Resonance Research Center, goes into depth discussing the various shortcomings of fMRI technology.)
Second, the supposition that changes on fMRI are harmful, rather than beneficial, is pure bias. In her letter to the Commissioner, Dr. Levy notes she has “personally witnessed the toll of addiction on these young lives as well as on the lives of countless friends, parents and siblings” in her capacity as Director of the Adolescent Substance Abuse Program (ASAP) at Boston Children’s Hospital. The director of a substance abuse program works exclusively with individuals who suffer from addiction, and is therefore not a neutral source of information.
Dr. Levy also states that dispensaries “may legally advertise their services and often produce ads targeted at youth,” when in fact, Massachusetts dispensaries are prohibited from advertising so much as their pricing, let alone marketing fun products for kids. Furthermore, Dr. Levy states erroneously that “there is no safety or efficacy data at all in this age group,” when in fact multiple studies have examined the effects of marijuana on children, teenagers, and pregnant mothers.
A 2015 Dutch study published by the London School of Economics and Political Science, which looked at 54,000 grades from Maastricht University, did find that “the academic performance of students who are no longer legally permitted to buy cannabis increases substantially.” These gains were “larger for courses that require more numerical/mathematical skills.” However, these findings may be biased, because the study compared Dutch locals against foreign students.
Pro: Medical Marijuana Treats Drug-Resistant Epilepsy, Has Benefits for Childhood Autism and ADD
There may be instances where the positive aspects of Cannabis therapy outweigh the potential drawbacks for children and teenagers with severe medical conditions, such as epilepsy. For example, a 2013 study published in Epilepsy & Behavior began by stating the following:
“Severe childhood epilepsies are characterized by frequent seizures, neurodevelopmental delays, and impaired quality of life… This survey explored the use of Cannabidiol-enriched Cannabis in  children with treatment-resistant epilepsy… The average number of antiepileptic drugs (AEDs) tried before using Cannabidiol-enriched Cannabis was 12.”
You read that correctly: participating patients had gone through an average of a dozen unsuccessful prescription medications before trying Cannabis as an alternative. So what did the study find?
“Sixteen (84%) of the 19 parents reported a reduction in their child’s seizure frequency while taking Cannabidiol-enriched Cannabis. Of these, two (11%) reported complete seizure freedom, eight (42%) reported a greater than 80% reduction in seizure frequency, and six (32%) reported a 25-60% seizure reduction. Other beneficial effects included increased alertness, better mood, and improved sleep. Side effects included drowsiness and fatigue.”
Most remarkable was the finding that for two patients, using medical marijuana completely stopped their seizures. The mild side effects of drowsiness and fatigue are, for most parents, a trivial price to pay in exchange for their children suffering significantly fewer seizures, or even no seizures at all.
The study did not note any additional negative side effects, whereas conventional medications for various conditions may cause serious side effects, such as:
- Liver disease (e.g. Dilantin/Phenytoin, for epilepsy)
- Blood clots (e.g. NSAID drugs, for fighting inflammation/pain)
- Increased risk of heart attacks (e.g. Actos, for diabetes)
- Suicidal ideation (e.g. Prozac, for depression)
However, the study also acknowledged the following:
“Safety and tolerability data for Cannabidiol-enriched Cannabis use among children are not available. Objective measurements of a standardized preparation of pure Cannabidiol are needed to determine whether it is safe, well tolerated, and efficacious at controlling seizures in this pediatric population with difficult-to-treat seizures.”
Of course, epilepsy is not the only condition whose effects may be alleviated by use of medical Cannabis among teens and children. According to Dr. Jay Cavanaugh, PhD, National Director of the American Alliance for Medical Cannabis:
“[C]annabis can provide unique help with some childhood disorders including cancer but also attention deficit disorder [ADD] and autism. These latter disorders are currently treated with powerful stimulants such as amphetamine in the first case and with brain numbing toxic preparations such as Haldol in the case of autism.”
Other potentially treatable illnesses which can have onset during the teen years include:
- Crohn’s Disease
- Rheumatoid Arthritis (RA)
Okay, so we’ve established that Cannabis has much milder side effects than those associated with prescription drugs for various childhood and adolescent ailments. But what about the long-term effects of marijuana?
Is Marijuana Really a Gateway Drug?
A very recent study, published in Drug and Alcohol Dependence in 2015, examined a group of men “from adolescence through emerging adulthood” (ages 15 to 26) in order to gauge whether Cannabis users “differed in terms of socioeconomic, social, and life satisfaction outcomes in their mid-30s.” The study also considered the “potential moderating effect of race” on outcomes.
The study found that “groups only differed in terms of partner and friend marijuana use.” (Unsurprisingly, “chronic marijuana users reported the highest proportions of both.”) There were generally no adverse effects on physical or emotional health, earning power, life satisfaction, or other outcomes. The study noted that “frequent and persistent marijuana use was associated with lower socioeconomic status (SES) for Black men only.”
While this finding indicates that higher arrest and incarceration rates among African-Americans are serious issues, it does not in any way imply that Cannabis is hazardous to health. As the ACLU notes, “Blacks are 3.73 times more likely than whites to be arrested for marijuana,” in spite of “roughly equal usage rates.” Racial prejudice is a problem in our society; but medical marijuana is not.
But what about marijuana being a gateway drug? In her letter to the Commissioner, Dr. Levy herself acknowledged that “none of the states with medical marijuana laws that report adolescent use rates through the Youth Risk Behavior Surveillance System (YRBSS) have yet found an increase in gross use rates in the 2-3 years following implementation,” dispelling the myth that children and teenagers will become addicted to Cannabis once they start using it for medical purposes.
Furthermore, an additional 2015 study published in Psychology of Addictive Behaviors found that “the 4 [studied] marijuana use trajectory groups were not significantly different in terms of their physical and mental health problems assessed in the mid-30s.” These “trajectory groups” included “early onset chronic users, late increasing users, adolescence-limited users, and low/nonusers.”
All this being said, marijuana can certainly cause drowsiness and delayed reaction time. Thus, users of all age groups should refrain from driving or operating heavy machinery while using medical Cannabis. Of course, this warning is in no way particular to teens and young adults. Personally, I do not recommend using Cannabis while working or studying – no matter the patient’s age.
At the end of the day, the message for parents is this: if your son or daughter is struggling with ineffective prescription drugs, they might find relief in medical marijuana. The only way to know for sure is to consult with a doctor, because the drawbacks and advantages must be weighed by a medical expert.
Medical marijuana has helped countless patients manage their symptoms and enjoy a greater degree of physical comfort in their everyday lives. If you’re living with chronic pain, chronic insomnia, cancer, arthritis, anxiety, ALS, depression, MS, glaucoma, HIV/AIDS, or are undergoing chemotherapy, you could qualify for medical Cannabis in Massachusetts. Call Dr. Tishler at (617) 477-8886 to start discussing your medical needs in a confidential consultation.