What is the effect of cannabis (marijuana) on pediatric development?

From the Guidelines

Marijuana use during childhood and adolescence should be strongly discouraged due to its potential to significantly impair brain development and increase the risk of mental health issues. The developing brain is particularly vulnerable to THC, the main psychoactive component in marijuana, which can disrupt normal neurodevelopmental processes 1. Regular marijuana use during childhood has been linked to decreased IQ, impaired memory and attention, reduced academic performance, and increased risk of mental health issues including anxiety, depression, and psychosis. Some evidence suggests an association between nondisordered cannabis use and adverse psychosocial events, such as major depression and suicidal ideation 1.

Key points to consider include:

• The adolescent brain undergoes critical development of the prefrontal cortex, which controls decision-making and impulse control, and marijuana can interfere with this process.
• Early marijuana use increases the risk of addiction, with approximately 1 in 6 adolescent users developing cannabis use disorder.
• Cannabis use in early youth is associated with conditions that include neuropsychological and neurodevelopmental decline, elevated risk for psychotic disorders in adulthood, higher risk for later depression, and suicidal ideation or behavior 1.
• Unintentional cannabis exposures are on the rise, particularly among pediatric cases of edible cannabis exposure, which can cause central nervous system depression, vomiting, and tachycardia 1.

Parents and educators should have open conversations with children about these risks, and communities should implement prevention programs targeting youth. If a child is already using marijuana, professional intervention from healthcare providers specializing in adolescent substance use is recommended rather than punitive approaches. Healthcare providers should prioritize evidence-based treatments and counseling to address marijuana use in children and adolescents, while also providing guidance on the potential harms of marijuana use.

From the Research

Effects of Marijuana on Childhood Development

• The use of marijuana among adolescents has been associated with short- and possibly long-term impairments in cognition, worse academic/vocational outcomes, and increased prevalence of psychotic, mood, and addictive disorders 2.
• Converging evidence indicates that adolescent-onset cannabis exposure is associated with dose-dependent relationships, with increased odds of negative developmental outcomes in youth with early-onset, persistent, high frequency, and high-potency Δ-9-THC cannabis use 2.
• Cannabis alters endocannabinoid system function, which plays a central role in modulating the neurodevelopment of reward and stress systems, and adolescent cannabis exposure results in impaired cognition, sleep, and driving ability 3.

Neurobiological Correlates of Cannabis Use

• The primary psychiatric symptoms associated with cannabis use in youth are increased risk for addiction, depressive, and psychotic symptoms 3.
• Cannabis use in the teenage years is associated with a disruption to the brain's reward system, impaired memory and cognition, and the potential for structural brain changes 4.
• Smoking cannabis can have a negative impact on the pulmonary system because it is a respiratory irritant, and teenagers are increasingly using electronic cigarettes, or vaping, to administer cannabis, which delivers a higher concentration of its psychoactive properties 4.

Treatment and Prevention

• Behavioral therapies are currently the mainstay of treating cannabis misuse, with no pharmacotherapies currently approved by the FDA for cannabis use disorder in youth 3.
• Nurses are in a prime position to provide up-to-date, evidence-based education to teenagers, parents, and other health care professionals about teenagers' use of cannabis 4.
• Additional measures that can affect cannabis use in teenagers are screening for other underlying mental health disorders, improving quality of life, self-efficacy, and spirituality, and providing teenagers with opportunities to naturally stimulate the brain's reward center 4.

Medical Use of Cannabinoids

• There is some anecdotal evidence of the potential efficacy of cannabidiol (CBD) in treating epilepsy, but the mechanisms of such action are not entirely clear 5.
• The use of CBD or high-CBD/low-THC products for the treatment of seizures and epilepsy in children and adults requires further data from well-designed studies regarding short- and long-term efficacy and side effects 5.
• A study on the use of cannabidiol in patients with treatment-resistant epilepsy found that it might reduce seizure frequency and have an adequate safety profile in children and young adults with highly treatment-resistant epilepsy 6.