It’s the end of summer and my office is filled with teens. The baby who wouldn’t feed is now sitting in front of me as a teenager, skeptically listening to my advice — soon double-checking my recommendations on his phone.
As a mother and pediatrician, negotiating the world of transitioning kids to independence can be challenging, especially when they are of age to know about drugs and alcohol. Our kids don’t live in a bubble. They drive past the same marijuana clinics that we do. They may have traveled to one of the 30 states where there is legal medical cannabis, or any of the nine states where marijuana is legal for adult use. They drive past liquor stores and know that alcohol is legal in all 50 states. They know about Juuls, e-cigarettes, and other things that are ubiquitous in schools.
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As pediatricians, we do the HEADSS assessment which is an acronym for topics of discussion — home, education, activities, drugs, suicidality, and sex. We speak with teen patients confidentially so they can feel safe in their answers. We are not there to judge but, rather, to give them the best evidence-based advice we have to keep them healthy and safe. Yet, how do we approach these topics as parents with our children?
Research has shown that “authoritative parenting” — where parents have rules and guidelines but also express love and affection — is related to the decreased risk of substance use. These parents recognize the need for some flexibility and encourage more responsibility and freedom with age. That reads well on paper but is a scary concept for many parents who are afraid that “a little give” will lead to children running amok and that affection will make them less effective when there is a need for discipline. Ongoing communication is key — even if it only happens when you have them trapped in the car.
What we know about teens and marijuana from early studies in Colorado is that use from ages 12 to 17 has not increased. However, the perception of harm from marijuana use has decreased which could be important over time. Even in legal states, cannabis is illegal under the age of 21 (like alcohol) and teens are not even allowed inside of dispensaries. Adolescents who use cannabis might be arrested, which could affect schooling, college acceptance, and future jobs. Any driving under the influence of cannabis is treated as seriously as driving under the influence of alcohol. Both will be prosecuted. Teens need to know this.
Like the rest of a teen’s body, the adolescent brain is still developing. Some studies show that cannabis can cause abnormal brain development in teenagers, primarily in those who start young and are heavy users. There is a risk of mental-health disorders, particularly in teens where there is a genetic risk of psychosis and/or schizophrenia.
The only studies of medical cannabis on children have been those with severe seizure disorders. For adults, the National Academy of Science found in 2017 that there is evidence to support some relief for patients with chronic pain and multiple sclerosis, and for the nausea and vomiting associated with chemotherapy. None of this has been studied in children.
In an open conversation, a teen may ask about a parent’s use. The Academy of Pediatrics recommends brief and honest answers. Only answer what is asked — no need to divulge details about that time you followed the Grateful Dead on tour. Parents are their children’s most important role models. Try to limit any drug or alcohol use in front of children. If you are currently using, keep all marijuana products away from children. Multiple studies have shown that more parental drinking of alcohol leads to more and earlier drinking in their teenagers, the same is assumed for cannabis.
As I watch my now-college sophomores head out the door on a Saturday night, I hope I have armed them with the tools they need to make good choices. Will they make mistakes? Of course, and as parents we should be prepared for that. But you can also take comfort in knowing that you have provided them with the right information and guidance so that if they fall, it won’t be too hard for them to get back up.