Teenagers and marijuana-infused foods, beverages

In this news story, Lisa Sharp from Seattle Public Schools and Yolanda Evans from Seattle Children's Hospital discuss the consumption of marijuana-infused foods among adolescents.  The story highlights the need to educate parents about marijuana-infused products and marijuana concentrates.

How do teenagers get marijuana and alcohol?

Marijuana retail stores are expected to start opening in our state next week.  As an adolescent drug use prevention coalition, Prevention WINS is interested in how youth access drugs, including marijuana.  What we know is that minors who use alcohol and marijuana mostly get the drugs from their friends.

Results from the 2012 Seattle Public Schools Youth Risk Behavior Survey (YRBS) indicate that most high school students who use marijuana get it from friends.  This is true for alcohol, as well.  Most Seattle high school students who use alcohol report getting it from a friend or at a party, according to the Washington State Healthy Youth Survey.

When marijuana stores open, it is expected that teenagers will get marijuana like they currently get alcohol: socially, including through family.  Increased access among adults who are willing to sell or give marijuana to teenagers leads to increased distribution to teenagers.  Increased parental use means more marijuana in the home for teenagers to take with or without permission.    

The YRBS results support this.  When high school marijuana users were asked if they ever used marijuana that came from of dispensary, 39% said yes and 23% were not sure, despite only 6% buying it from a dispensary.  Among those who said yes, it is likely that an adult or friend with a medical marijuana authorization provided the drug to them after purchasing it at a dispensary.  

Will marijuana stores sell to minors?  Likely not, at least as this new market gets up and running.  If the legal recreational market is to be successful, businesses need to show that they are responsible.  But adults who have easy access to marijuana, and teenagers who have medical marijuana authorizations, need to be held responsible, too, if distribution to minors is to be prevented.  

Policies that reduce drug availability are part of a comprehensive approach to drug prevention

Drug overdose deaths, particularly those caused by prescription painkillers, declined in Florida after state policy changes were made, according to the Centers for Disease Control and Prevention (CDC).

Their success provides a perfect example of how drug prevention is not only about school-based programs and parenting, it’s also about adopting policies that reduce the availability of drugs and enforcing those policies. 

From a New York Times article about the decline in deaths:

"Dr. Thomas Frieden, director of the C.D.C., said the pattern provided a hopeful example of the effect that policy could have on one of this country’s most entrenched public health problems, one that takes the lives of more than 20,000 Americans a year."

“This tells us that policies and enforcement work,” Dr. Frieden said."

From the CDC's report on the decline in drug-related deaths:

“. . . policy changes in Florida were followed by declines in the prescribing of drugs, especially those favored by Florida prescribing dispensers and pain clinics, as well as by declines in overdose deaths involving those drugs. Florida has reported that approximately 250 pain clinics were closed by 2013, and the number of high-volume oxycodone dispensing prescribers declined from 98 in 2010 to 13 in 2012 and zero in 2013. Law enforcement agencies in Florida also reported that rates of drug diversion (i.e., channeling of prescription drugs to illicit markets) declined during 2010–2012.

Like the most effective substance use prevention strategies, Florida took a multi-pronged approach to preventing drug-related deaths.  The approach relied heavily on policies that reduce access to prescription painkillers and the enforcement of those policies.  

Communities need to support parents with a "no drug use" message for teens

Yesterday, KING 5 broadcast a story about how parents can talk to their children about not using marijuana.



Parents need the support of other adults in the community so that teenagers get consistent messages that support healthy youth development.  In the KING 5 story, Dr. Leslie Walker says, "Just like parents should be doing with alcohol.  This is not a safe for you at this stage in your life.  It can possibly cause permanent damage to you as an adolescent with a developing brain.  I do not want you to use marijuana at this time."  People and institutions in our community need to express this message, too.

Prevention research evolved a great deal since the "just say no" days and we now know that we must provide teenagers with the tools they need to be able to follow through on family rules against drug use.  Adults can coach children:

• Role play situations where they are offered drugs, including marijuana, by a peer.
• Help them to find the right words to express their intention not to use.
• Help them suggest an alternative to drug use.  (This is why it is important for communities to have alternative activities readily available.)
• Tell them that is fine to walk away from someone, including a friend, who is offering drugs and, if needed, to call for a ride home.  

More about preventing underage marijuana use is available here.

Teen marijuana use prevention: It takes a community

“Legislature should find the will to fund teenage marijuana use prevention” reads a recent Seattle Times editorial headline. 

The editorial states: “Just Say No” messages won’t work in this era."

Adolescent substance abuse prevention has evolved a great deal over the past twenty years thanks to prevention research and has not been about “Just Say No” for quite a while.   What does research tell use about how to effectively prevent adolescent substance use, including marijuana use?

For parents:

Prevention needs to start early.  Parents should start talking to their children about not using drugs by the end of elementary school and at the latest by the end of middle school.  A locally-developed parent guide can provide parents with information on what to say.  Among the research-backed strategies: 

• A “no use” attitude is important.  Children whose parents have a positive attitude toward marijuana use are five times more likely to use marijuana by 8^th grade. 

•  Be clear about family rules against using drugs, including marijuana, and set clear guidelines.

• Make sure those guidelines are followed and follow through on reasonable consequences if rules are broken.  

• Monitor your own behavior – parents are role models for their children. 

For lawmakers:

As the editorial states: “With other budget pressures, Olympia will be tempted to tap into future marijuana tax revenues that I-502 specifically dedicated to prevention.”  In recent years, the legislature cut and then eliminated funding for the statewide Community Mobilization program, an evidence-based prevention program.  Most prevention funding now comes from the federal government and they, too, are always looking to cut expenditures. 

In addition to funding, lawmakers can be a part of a comprehensive prevention strategy.  Examples of policies that prevent teen drug use include: 

• Enforcing marijuana laws, both medical and recreational.  Seattle drug use prevention coalitions have heard from kids that they can get marijuana easily through retail dispensaries.  Among Seattle high school students who use marijuana, 39% report using marijuana that came from a dispensary, likely through friends who bought it legally (with a recommendation) or illegally (without a recommendation.) 

• Enacting and enforcing social host laws for both marijuana and alcohol to prevent parents from providing teenagers with the drugs. 

• Supporting limits on the number of retail outlets in jurisdictions and neighborhoods within those jurisdictions. 

For communities:

Adolescent substance use prevention is most effective when multiple sectors of the community implement a variety of strategies.  To guide the selection of prevention strategies, communities can look at their local Healthy Youth Survey (HYS) data which not only provides data on use rates but information about risk factors that are specific to their community. 

For instance, the Prevention WINS coalition recently started planning to address the risk factor of “decreasing perception of risk” associated with marijuana use.  Since 2006 the coalition has tracked risk and protective factors specific to NE Seattle and every two years HYS data indicated that perceptions of risk decreased.  Data-driven decisions worked in NE Seattle in the past and continue to guide future prevention activities. 

The video below, featuring Dr. J. David Hawkins from the University of Washington, provides more information about what communities can do when working together and guided by local data.  

The Communities That Care system is very similar to the Strategic Prevention Framework used by most WA communities that have a drug use prevention coalitions.  

Liquor Control Board to limit marijuana-infused products appealing to children

Today, the Washington State Liquor Control Board adopted emergency rules adding a requirement that all marijuana-infused products, packaging, and labeling be approved by them.  The rules are to clarify the types of marijuana-infused products the board will allow to be produced and sold.  The board's issue paper on the emergency rules states:

"Many marijuana-infused products on the medical marijuana market today are appealing to children.  Products such as lollipops, gummy bears, and cotton candy are very appealing to children too young to read a label."

To gain approval from the board, marijuana processors must submit a picture of the product, its label, and packaging to them.  The board will not approve products that appeal to children.

Marijuana-infused products that look like foods and beverages that children commonly eat and drink have been a concern for Prevention WINS members even prior to the I-502 vote.  Concerns were expressed to the Liquor Control Board during their rule-making process and as they developed recommendations for reconciling the recreational and medical marijuana systems.  During rule-making, Prevention WINS included the following in our letter to the board:

Recently, a report published in the Journal of the American Medical Association – Pediatrics discussed the increase in unintentional ingestion of marijuana among children in Colorado.

As the Board knows from experience, many flavored malt beverages are fruit flavored and particularly attractive to minors. In one survey about underage drinking, when asked what one type of alcohol drink they would most prefer, 30% of teens said “alcopops” (the term used to describe these flavored alcoholic beverages – a combination of “alcohol” and “pop”).

In the past, the Board has banned the sale of certain alcohol products because of the high likelihood that the products are attractive to minors. A similar ban should be placed on marijuana-infused products that are attractive to minors and resemble products primarily consumed by children. Examples of such products, many of which currently may be sold in medical marijuana access points, include but are not limited to:

• Snow-cones,
• Hard candy, lollipops, and cookies shaped like animals, people, cartoon and other characters, Christmas trees, snowmen, stars, etc.,
• Soda-pop,
• Juice,
• Candy bars,
• Pop-Tarts,
• “Gummy” candies shaped like worms, bears, etc.

Some flavored tobacco and alcohol products are also banned because of their potential to attract young people. The Board should ban marijuana products containing flavorings such as fruit, candy, and vanilla.

The emergency rules also include guidelines regarding serving sizes.  The new rules read:

"Marijuana-infused products in solid form that contain more than one serving must be scored to indicate individual serving sizes, and labeled so that the serving size is prominently displayed on the packaging."

"Marijuana-infused products must be homogenized to ensure uniform disbursement of cannabinoids throughout the product."  

Prevent teen drug use, prevent teen DUIs

Earlier this year, the Washington State Toxicologist reported that the primary drug, including alcohol, detected in DUI cases among people under the age of 21 is marijuana.  A recent study confirms that marijuana-related driving crashes are a significant problem among younger drivers. From the Robert Wood Johnson Foundation: 

The profile of a drugged driver has changed substantially since 1993, according to a new study released today in the journal Public Health Reports, which shows that more drivers are now testing positive for prescription drugs, marijuana and multiple drugs.

. . . The study examines trends in the characteristics of U.S. drivers who were involved in fatal crashes between 1993 and 2010 and tested positive for drugs.

. . . Almost 60 percent of cannabis-only users were younger than 30 years.  (About 36% of meth users and 25% of prescription drug and cocaine users were younger than 30.) 

We see that cocaine and methamphetamine are becoming less and less prevalent. Drugged drivers now would be much more likely to be using marijuana and prescription drugs, and they would probably be more likely to be mixing those drugs with alcohol. We see that overall fatalities are going down, perhaps because people are more likely to be in seat belts, but the mixing of alcohol with drugs is not trending down. It’s becoming more of a problem. 

The author notes that “these trends are likely to continue into the future given . . . increasing initiatives to legalize marijuana.”   

One way to prevent DUIs among people under the age of 21 is to prevent drug use, including marijuana and alcohol, among adolescents. Young drivers who do not use drugs don't drive under the influence. 

Underage Marijuana Use Prevention Toolkit now available online

An Underage Marijuana Use Prevention Toolkit was recently launched by the Washington State Division of Behavioral Health and Recovery to help educate people about the new law and the risks associated with adolescent use of the drug.  The toolkit is available online and includes several posters, including these two.

Since no current funding exists for a full scale educational campaign, DBHR is relying heavily on community-based organizations, including coalitions and their partners, to use the toolkit to educate parents, youth, and the wider community about the new law and how marijuana impacts adolescent health.  

Teen marijuana use is risky

As the Prevention WINS coalition plans for addressing the decreasing perception of risk associated with marijuana use among teenagers in NE Seattle, understanding what the risks are is important.

An article about the adverse health effects of marijuana use was published in the New England Journal of Medicine earlier this month.  It especially highlights the harmful effects of marijuana use among teenagers.  From the article:

Intoxication: When under the influence of marijuana, it can interfere with memory, perception of time, and coordination which can lead to consequences such as motor vehicle crashes.

Addiction: One in six people who start using marijuana as teenagers become addicted to the drug.  Among those who use marijuana daily, 25 to 50% become addicted.

Brain development: Frequent use of marijuana from adolescence into adulthood is associated with significant declines in IQ.  This may be due to fewer connections established in the brains of people who used marijuana regularly during the teen years compared to people who did not.  These long lasting brain changes can hinder academic and social achievements.  

Yes, teen alcohol, tobacco, and opiate use are risky, too.  Like most drug use prevention programs, the Prevention WINS coalition addresses multiple substances used by teenagers and provides information about the harms associated with all of them.  The current focus on marijuana is a result of the declining perception of risk among NE Seattle teens who receive messages from adults in the wider community that marijuana is a safe drug to use.  

Prevention WINS to address decreasing perceptions of risk

Over the past few months, the Prevention WINS coalition has been conducting a community assessment so that we may address new risk factors contributing to teen drug use in NE Seattle.

The coalition started by analyzing WA Healthy Youth Survey data to determine why alcohol and marijuana use rates and prescription drug abuse rates are increasing in our community.  Among several risk factors identified, coalition members chose to focus on the decreasing perception of harm/risk associated with drug use.  Perceptions of risk are well-documented indicators of teen drug use.

During last month's meeting, coalition members identified factors that may be contributing to these decreasing perceptions of risk.  The drafted logic model below outlines factors coalition members identified.  One of the next steps is to collect data to confirm that these factors are indeed affecting risk perceptions among NE Seattle teens.  

Coalition members formed a workgroup that will meet later this month to take a closer look at perceptions of risk, identify ways to collect local data, and begin to identify prevention activities to address the perceptions.  For more information about the meeting, contact the Prevention WINS coordinator.

When the logic model is complete, it will accompany a comprehensive plan for preventing teen drug use in NE Seattle,  In addition to coalition prevention activities, the plan will outline activities others in NE Seattle may conduct to address additional risk factors.  Other NE Seattle risk factors include increased access to alcohol and marijuana and perceptions among teens that they won't be caught by police if using alcohol and marijuana.