Alcohol, holiday celebrations & teens

Over at the Seattle Mama Doc blog, Dr. Swanson writes about alcohol and the holidays.  She starts with:

Our children are growing up with mixed messages about alcohol and drugs, at least that’s how it feels to me here in Washington. It seems to me we’re grappling with using pot and what to do with alcohol as a community. As our state legalized marijuana use this past year, we sent a big flare into the sky. It’s possible we really do one thing and then say another in front of our children and teens, particularly at times of celebration. No question they are watching. Can you seriously imagine a pro football game without beer ads or a holiday party without booze? I can’t. The great luck is that we have profound influence over our children (tah dah!); we have a huge opportunity to help them survive.

Click here to read the entire post.

Understanding the current marijuana market

The RAND Drug Policy Research Center released a report this week about our state's current marijuana market.  Most of the media attention about the report focuses on the finding that pot consumption among Washingtonians is higher than previously thought.  Other findings include:

Adult & Youth Access: The primary way that adults and youth who use marijuana get marijuana is through friends.  Friends provide marijuana to adults for free and for purchase -- about 80% of adults who purchase marijuana get it from friends.  Sixty-eight percent of Seattle high school students who use marijuana report getting it from a friend and 38% report consuming marijuana that came from a dispensary.  The report notes, "It is not surprising that such a large number of marijuana users in Seattle's public high schools report consuming marijuana that came from a dispensary; there are a lot of dispensaries in the Seattle Metro Area."  

Age: About 12% of current marijuana consumers are 12 to 17 years old and about one-third are between 18 and 25 years old.  One-third of "heavy" users (those who use 21-30 days per month) are 25 years old and younger.

Use Rates: Washington past month marijuana use rates rose by about 40% between 2008 and 2011 while use rates increased by about 10% nationally during that time.  People who grow marijuana consume "considerably greater" amounts of the drug than others.  King County residents account for 30% of all marijuana consumers in the state.

Potency: Low-potency marijuana that was the norm prior to 2000 accounts for a small share of the current marijuana market in Washington.  It is likely that the marijuana used in our state is more potent than marijuana used in other states. Forty percent of past month marijuana users and 52% of heavy users report consuming/"dabbing" concentrates (hash oils) with very high THC levels.

Interaction with Tobacco & Alcohol: Heavy marijuana users smoke tobacco at higher rates than non-heavy users.  Alcohol use among marijuana users is more prevalent than among the general population.  Alcohol use seems to increase with the amount of marijuana consumed.

Today's marijuana can have stronger effects on developing teen brain

Despite marijuana being the primary reason teenagers enter substance abuse treatment programs and the primary reason for visiting hospital emergency departments for drug misuse or abuse, most high school seniors think regular marijuana use is not harmful according to 2013 Monitoring the Future results.

The survey reports that 39.5 percent of 12th graders view regular marijuana use as harmful, down from last year’s rate of 44.1 percent, and considerably lower than rates from the last two decades.



The rates of marijuana use also show significant changes in the past two decades, with 6.5 percent of seniors smoking marijuana daily compared to 6 percent in 2003 and 2.4 percent in 1993.

“This is not just an issue of increased daily use,” said NIDA Director Nora D. Volkow, M.D. “It is important to remember that over the past two decades, levels of THC — the main psychoactive ingredient in marijuana — have gone up a great deal, from 3.75 percent in 1995 to an average of 15 percent in today’s marijuana cigarettes. Daily use today can have stronger effects on a developing teen brain than it did 10 or 20 years ago.”

Nearly 23 percent of seniors say they smoked marijuana in the month prior to the survey, and just over 36 percent say they smoked it during the past year.  For 10th graders, 4 percent say they use marijuana daily, with 18 percent reporting past month use and 29.8 percent reporting use in the previous year. More than 12 percent of eighth graders say they used marijuana in the past year.

“We should be extremely concerned that 12 percent of 13- to 14-year-olds are using marijuana,” Volkow added. “The children whose experimentation leads to regular use are setting themselves up for declines in IQ and diminished ability for success in life.”

Marijuana & adolescent health

Data from the Substance Abuse and Mental Health Services Administration show how teen marijuana use can be harmful.  Marijuana is the second most commonly used drug (after alcohol) by teenagers who use drugs.

Emergency Department Visits
The chart below shows that marijuana is the most frequently identified drug among adolescents visiting a hospital emergency department for a drug-related problem on a typical day.

Number of Emergency Department (ED) Visits for Drug Misuse or Abuse on a Typical Day for Patients Aged 12 to 17

Substance Abuse Treatment
Though alcohol is the drug of choice among adolescents, marijuana is, by far, the number one drug identified by adolescents entering substance abuse treatment.  This is different from adults -- alcohol is the primary drug identified by adults entering treatment.

Number of Adolescents Aged 12 to 17 Admitted to Publicly Funded Substance Abuse Treatment Facilities on a Typical Day

Marijuana public consumption bills sent to City Council

Bills about pubic consumption of marijuana and public smoking were discussed during yesterday's City Council Housing, Human Services, Health, and Culture Committee meeting.



Discussion about Council Bill 117989 regarding public consumption begins at around 57:00 and Council Bill 117998 regarding public smoking begins at around 74:00.

To strengthen the public consumption bill so that it supports public health goals for helping youth access substance abuse-related services they may need, two items should be changed.

1. The bill should specify how the law will be enforced among minors.  While the first “Whereas” in the bill states that Initiative 502 legalized adult possession, the ordinance does not specifically distinguish between the enforcement of marijuana laws among adults (21 and older) from enforcement among minors (20 and younger).  

For example:

~ The bill states, “A person who violates this section is guilty of a class 3 civil infraction under RCW Chapter 7.80.”  The word “person” should be replaced with “adults 21 years old and older” since the law is different for minors.  Minors are to be referred to the King County Juvenile Diversion program and are not to be charged with a civil infraction.  The diversion program can help at-risk teenagers link with drug education or treatment services that may be needed.  

~ The bill  states that SPD intends to “provide a first warning for persons violating the provisions”.  Since the police play such an important public health role when it comes to linking teenagers to the substance abuse services they may need, warnings should be given to adults who are 21 years old and above but minors under the age of 21 should be referred to the King County Juvenile Diversion Program. 

Any City ordinance dealing with the enforcement of minors in possession of alcohol should be updated to include marijuana.  To reduce community risk factors for underage use and to link at-risk youth with services they may need, these laws should be enforced and the policy of referring youth to the diversion program should be followed.  

2. Define public use:  Council Bill 117989 states, “It is unlawful to open a package containing or consume marijuana, usable marijuana or a marijuana-infused product in view of the general public.”  Though the fiscal note attached to this ordinance says that the intent is to bring marijuana laws in line with alcohol laws, the language is different than alcohol-related language that states that public use of alcohol is illegal.  The ordinance should define what is meant by “in view of the general public” so that it is clear to citizens what will be enforced and what won’t be enforced when it comes to marijuana use outside of personal residences.  

Adult behavior impacts youth behavior.  All children, even teenagers, look to adults to determine how they should act.  One of the reasons tobacco smoking rates are down among youth is because they are not exposed to adults smoking tobacco as much as they were prior to the many smoke-free policies adopted throughout our communities.  The same holds true for alcohol and other drugs – the more teenagers see use as a normal part of adult life, including public life, the more likely they are to use the substances.  

Both bills were referred to the full Council.

Preventing initiation of drug use: What works

Community-based efforts to prevent substance use, like the work done by Prevention WINS, are an essential component of promoting health during adolescence and later life according to an article published in the most recent edition of JAMA – Pediatrics. 

The article discusses findings from a study conducted by the UW Social Development Research Group.  They looked at communities that used Communities That Care (CTC), a system similar to the Strategic Prevention Framework used by Prevention WINS.  During the study, coalitions of community stakeholders received training to use CTC.  They used data to identify elevated risk factors and depressed protective factors for adolescent problem behaviors in the community.  Like Prevention WINS, they implemented tested and effective programs for middle school youth, their families, and schools to address risks specific to their community.

The study showed that by spring of 12th grade, students in CTC communities were more likely than students in control communities to have abstained from any drug use, including alcohol and tobacco.  Using the CTC system continued to prevent the initiation of adolescent problem behaviors through 12th grade, 8 years after implementation of CTC and 3 years after study-provided resources ended.

The article goes on to note, The enduring effects of CTC through 12th grade were observed with little preventive programming targeting the high school years. Because CTC communities were asked to focus their prevention plans on programs for youths in grades 5 through 9, and continued to do so following study support, few students in the longitudinal panel were exposed to tested and effective programs beyond ninth grade. It is noteworthy that initiation of alcohol use, tobacco use, delinquency, and violence in the panel was prevented through 12th grade in CTC communities.

Targeting preventive interventions during middle school, a developmentally sensitive time for drug use and delinquency initiation, appears to have prevented the onset of alcohol and tobacco use . . . through high school. However, the present findings suggest that continued preventive interventions during high school may be needed to lower the current prevalence of substance use, delinquency, and violence among those who have initiated these behaviors. 

Underage drinking & driving awareness event held at Ballard High School

December is National Impaired Driving Prevention Month and Ballard High School hosted an assembly about the problem.  The My Ballard blog reported about it:

Today was a memorable day for the over 500 students who filled Ballard High School auditorium to hear UW Huskies’ tight end Austin Seferian-Jenkins and group of community members speak about the dangers of driving under the influence of drugs and alcohol. The assembly was a moving event that allowed all audience members to grasp the dire consequences that can result of making poor decisions before getting behind the wheel.

The assembly started with the emotional and intimate perspective of local mom Kelly Jones who tragically lost her son Kellen Jones in an alcohol related car accident outside Ballard Taco Time restaurant on April 4, 2010. Jones wanted students to hear the important message “from the heart of a mom” and impacted the attentive audience with images of the accident scene and the response of family and friends to the tragic deaths. “You have the obligation to yourself and to your family and friends to drive and ride responsibly,” said Jones to the students. Since the tragedy, Jones founded the Drive. Ride. Responsibly. campaign to spread awareness of the importance of both driving and riding responsibly.

Liberty Mutual has a great info-graphic about teenage drinking and driving on New Years Eve.  Here's the top part of it:

Prevent underage drinking and driving

December is National Impaired Driving Prevention Month.

What is the problem?
In Seattle, 18% of 10th grade students and 20% of 12th grade students report recently riding in a car with someone who has been drinking (2012 Healthy Youth Survey).  Last year, Prevention WINS released a video about how drinking and driving affected one NE Seattle teenager.

According to the Centers for Disease Control and Prevention (CDC):

• 85% of teens in high school who report drinking and driving in the past month also say they binge drank. In the survey, binge drinking was defined as having 5 or more alcoholic drinks within a couple of hours.
• 1 in 5 teen drivers involved in fatal crashes had some alcohol in their system in 2010. Most of these drivers (81%) had alcohol levels higher than the legal limit for adults.

Driving under the influence (DUI) is not only about alcohol  It's also about driving under the influence of prescription medications and marijuana.  According to the Washington State Toxicology Lab, marijuana impairment among drivers under the age of 21 is a serious problem.

• One quarter of DUI cases that are marijuana related are aged under 21 years.
• Marijuana is the most frequently detected drug in those under 21 years (including alcohol).

What can be done?
In proclaiming December National Impaired Driving Month,  President Obama states:

Everyone has a role to play in keeping our roads safe -- from parents, schools, and businesses to faith-based and community organizations. Together, we can teach young people, friends, and fellow citizens how to avoid a crash brought on by impaired driving. I encourage all Americans to designate a non-drinking driver, plan ahead for alternative transportation, or make arrangements to stay with family and friends before consuming alcohol. Americans should also know what precautions to take if using over-the-counter or prescription medication. 

Parents, in particular, have a significant role to play.  From the CDC:

Parental involvement, with a focus on monitoring and restricting what new drivers are allowed to do, helps keep new drivers safe as they learn to drive. Parents can consider creating and signing a parent-teen driving agreement with their teens. Research has shown that when parents establish and enforce the “rules of the road”, new drivers report lower rates of risky driving, traffic violations, and crashes.

Learn more at the CDC webpage about Teen Drinking and Driving.

Parent norms affect teen drug use

Norms and availability are two of the strongest predictors of youth marijuana use (see previous posts for details).  While the availability risk factor is relatively well known, the risk factor of "norms" is less well known.

"Norms" refers to what people think is normal and acceptable behavior.  If a certain behavior is considered normal or acceptable, it can shape human behavior.  Norms are present in different domains -- community, family, school, and peer groups.  The strongest predictors of youth marijuana use are peer norms followed by community and parent norms.  Following is more information about parent norms and how they affect teenage drug use.

Parental attitudes and behavior toward drugs . . . influence the attitudes and behavior of their children.  Parental approval of young people's moderate drinking, even under parental supervision, increases the risk of the young person using marijuana. . . . Further, in families where parents involve children in their own drug or alcohol behavior -- for example, asking the child to light the parent's cigarette or get the parent a beer from the refrigerator -- there is an increased likelihood that their children will become substance abusers in adolescence.  (From: Substance Abuse Prevention: The Intersection of Science and Practice, page 20)

In NE Seattle, Eckstein Middle School 8th graders report that parents think it is wrong from them to use marijuana or alcohol.  (WA Healthy Youth Survey)  Parents have been good at getting their attitude about kids not using drugs across to their young teenage children.

While the Prevention WINS coalition will continue to monitor NE Seattle student's perceptions about their parent's attitudes, we are also interested in how other adults in the community affect youth drug use.  While young teens still overwhelmingly perceive that adults think that their use of drugs is wrong, between 2010-12 there was a dip of 5 percentage points when 8th graders were asked about marijuana.  

Pot shop stings won't be enough to prevent marijuana availability among teenagers

Availability and norms are two of the strongest predictors of youth marijuana use.  An article in the Seattle Times discusses one form of availability (or, if you want to use the Department of Justice’s terminology: “distribution”): availability through buying marijuana in stores, expected to open in the middle of next year.  

Teenagers obtain marijuana from friends

What the article does not discuss is the primary way that youth who use marijuana actually get marijuana: through personal connections.  According to results from the 2012 Youth Risk Behavior Survey, the most common way that Seattle high school students who use marijuana get marijuana is from friends.  About as many of these high school students report getting marijuana from their home as they do from a medical marijuana retail access point. 

One ounce of marijuana
Photograph: Justin Sullivan/Getty Images 

Distributing an ounce of marijuana

Though substance abuse treatment providers have been witnessing an increase in youth using edible and vaporized marijuana products, I am going to use the “traditional” form of marijuana  as an example.

If a parent, older sibling, or older friend buys an ounce of marijuana (the legal limit for a sales transaction), it looks something like the photo on the left.  From a quick Google search about how many joints can be made from an ounce, it appears as if the number is anywhere from 30 to 100 joints with 50 to 60 being the most common answer.  This means that a consumer who buys an ounce likely will not use the entire stash at one time leaving quite a bit of marijuana left-over.  This is similar to liquor -- most people who drink alcohol do not drink an entire bottle of vodka all at once.  So, what happens to the left-overs?

If it belongs to a parent, will it end up in a cabinet, waiting to be used again?  We know with alcohol and with prescription medications, this can be a significant source for youth.

If it belongs to an older sibling or friend of a teenager, what stops them from sharing it with people under the age of 21?  Or selling it to them?  Lately, community members have been sharing stories of people taking liquor orders from teens and then stealing or buying it for them.  What prohibits people over the age of 21 from taking marijuana orders from minors and buying it for them? 

These are a few examples of availability that will not be addressed by the Liquor Control Board (LCB) conducting sting operations in pot shops.  These are examples of availability that are much more likely to be a problem than teenagers buying pot in stores.

So, while it’s essential that the LCB keeps an eye on pot shops to ensure they don’t sell to minors, policy makers and communities need to do more to curb availability.

Drug companies sue King County over secure medicine return program

As part of a comprehensive strategy for preventing teen prescription drug abuse, the King County Board of Health adopted a secure medicine return program earlier this year.  Last week, drug companies, who are held responsible for running the program, filed a lawsuit against King County in an effort to stop the program from being implemented.  

As part of the King County Take Back Your Meds Coalition, Prevention WINS advocated for the secure medicine return program.  Prescription drug abuse is a community problem that requires a multi-faceted prevention strategy.  As coalitions know, everyone has a role to play and the King County program is a perfect example of the role drug companies can play in preventing teen drug abuse.