Talking to teens about cannabis as a doctor

The risks associated with cannabis use by youth are well documented. They include acute psychosis, onset of depression, increasing anxiety, cognitive problems resulting in poorer academic performance and earlier school leaving, motor vehicle accidents, and cannabis hyperemesis syndrome (CHS). However, family physicians are well-positioned to connect with and employ harm reduction strategies with their younger patients regarding cannabis use. Presentations in the emergency departments for acute psychosis and CHS have increased significantly in Ontario since commercialization of cannabis. The likelihood of developing cannabis use disorder is 50% greater among teens than adults. Surveys have found that more than a third of Grade 12 students in Canada will have used cannabis in the 12 months previous to the survey, and up to 10% use cannabis daily.It is a challenge with this age group, who consider cannabis to be harmless. Here are some pointers for physicians.Learn about the effectsLearn as much as you can about cannabis and its side and adverse effects, including the short- and long-term risks. The Schizophrenia Society of Canada sponsors several excellent online presentations, including “Cannabis and Psychosis—Exploring the Link” and a course that youth can take called “Cannabis and Mental Health.” These should be recommended to your patients and their parents. Be alert for opportunities to discuss the topic with your adolescent patients. This might be while updating their cumulative patient profile during an office visit, and you inquire as to their substance use in a conversational, non-threatening fashion. If they are using cannabis, ask if they have any concerns from its use. Reassure them about confidentialityReassure them any information shared is treated confidentially. Inform them that you are open to discussing any aspects of cannabis or other substance use in a non-judgemental fashion.Adopt a collaborative attitude with the kids. Teens respond to good information delivered in a non-stigmatizing and non-authoritarian fashion; they will likely know more about cannabis than you do, so be prepared to learn from them! It is a chance to strike a collaborative relationship that will be very productive by working together.Mental healthEnsure there are no underlying mental health or other social problems that your young patient may be experiencing. If they are, caring for these issues trumps focusing solely on stopping or reducing cannabis. Cannabis use is often the first line of defence for an adolescent struggling with emotional and behavioural problems. It is the “duct tape” of recreational substances as part of coping with stress—it gives immediate results but is no good in the long run. Focusing on cannabis reduction alone may backfire because it may add to anxiety and makes the adolescent feel trapped and stop attending your care.If a young patient is attending you for anxiety or depressive problems and they are using cannabis, it is important to inform them that cannabis use itself could be complicating things and they should try to taper off the substance during treatment. It is not unusual to meet resistance to this as many teens feel cannabis has been helping them but “just isn’t working any longer.” It is important to explain that with chronic cannabis use, the normal mechanisms we have to cope with stress are partially shut down as the cannabis takes over this task, and when someone reduces and stops cannabis use, it can take several weeks for the brain to recover normal function (upregulation of CB1 receptors). However, you can reassure them this reflects our brains’ marvellous plasticity and resiliency, and that you are optimistic this will be helpful in the long run.Resources and information protocolsDevelop information protocols in your office. For example, information pamphlets and posters in the waiting and exam rooms may prompt a patient to bring the topic up themselves. Carry “Canada’s Lower Risk Cannabis Use Guidelines” in your office.Don’t forget the parents/guardians! DrugFreeKidsCanada.org have excellent publications and online resources, including one where a parent can practice talking with teens online, before approaching their own child. They also have information products that can be provided in your office.

Talking to teens about cannabis as a doctor

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