Marijuana Legalization: Protecting Adolescents and Young Adults

In light of the legalization of recreational marijuana for NJ citizens age 21 and above, NJPA is focused on the need to protect adolescents and young adults to age 25 years (AYA) from the harmful effects of cannabis, particularly related to the high percentage and high dose of delta-9-tetrahydrocannabinol (THC) on the developing brain. NJPA is also concerned about, the impact of marijuana on women of child-bearing age; racial disparities in arrests for cannabis possession; maintenance of a viable medical marijuana program; the undue influence of a cannabis industry emulating the tobacco industry in targeting AYA with false advertising; increased THC potency; and the presence of harmful contaminants.

Marijuana affects the developing brain from conception through age 25. Marijuana use before age 18 can increase psychosis by 2-4 times; lead to structural brain changes; results in cannabis use disorder in 17% of marijuana users who initiate use as teenagers; and is associated with increased school dropout, unemployment, risky sexual behaviors, and anxiety. States with legalized cannabis for recreational use have experienced increases in harmful outcomes, e.g., hospitalizations for marijuana abuse, ER visits, diversion to youth, advertising targeting youth, and youth under age 21 years apprehended for possession. Given the urgency of the situation and failure thus far to address the special needs of AYA and women of child-bearing age, immediate action is required to protect these vulnerable populations.

New Jersey Psychiatric Association recommends:

1. Regulations for implementation must be guided by science. Governing bodies must include input from experts in child and adolescent addiction and development. Minorities and populations affected by the war on drugs are disproportionately impacted and must also be represented in all policy deliberations in order to achieve health equity and protect vulnerable populations.
   
2. Protection of AYA to include: limitations on THC concentration above 15% to mitigate harmful effects for brain development and addiction; establish limits for amounts of permissible possession to reduce diversion to youth under 21; restrict packaging that may be enticing to children and require universal symbols on labels; limitations on maximum THC amounts per single package of edibles; and create significant penalties for adult distribution to youth under age 21. In addition, mandate substance evaluation and brief intervention for all youth under 21 years charged with possession and/or distribution prior to any sentencing.
   
3. A sufficient portion of cannabis tax revenue should be designated for education, training, evidence-based prevention and treatment, conducting annual surveys of youth substance use in New Jersey, and social market research to maximize health messaging. Public education campaigns should present a science-based perspective to children and AYA of known benefits and harm related to cannabis use. Additionally, campaigns must be instituted to target pregnant and breastfeeding women. Emergency room, primary care and other health and mental health professionals should be alerted to signs and symptoms of cannabis-related use and made aware of resources and evidence-based treatments.

Ghosh,T., et al. (2017). Lessons learned after three years of legalized, recreational marijuana: The Colorado experience. Preventive Medicine, 104:4-6.

Margaret Haney. (2020) Perspectives on Cannabis Research—Barriers and Recommendations. JAMA Psychiatry Vol.77 (10), p.994-995.

National Survey on Drug Use and Health. 2019. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/release/2019-national-survey-drug-use-and-health-nsduh-releases