'Behind the 8 ball': How research is trying to catch up on cannabis and kids

About one-third of 12th graders across the country reported using marijuana over the past year, according to a study released March 12. 

During that same period, about 11% of 12th-grade students reported using a lesser-known product, delta-8-THC, a psychoactive substance typically derived from hemp. It can produce a fuzzy, euphoric high similar to — but typically milder than — the THC effects delivered in cannabis. 

The 74 found that Delta-8-THC is of particular interest because despite health risks, it's still widely considered to be legal at the federal level after the 2018 farm bill removed hemp from the list of controlled substances. It's legal in 22 states and Washington, D.C. with limited regulation, and in a number of states — including Illinois and New Jersey — there are no age restrictions at all on purchasing it. Concerns are compounded by the fact that it can be found in kid-friendly products, like gummies and chocolates, and can be bought online or from easily accessible vendors, like gas stations.

The results on pot and delta-8-THC use came from the newly released Monitor the Future study, which annually surveys teens across the U.S. and is conducted by researchers at the University of Michigan. The study, which was the first to report the extent of delta-8-THC use, included 22,318 surveys given to students enrolled in 235 public and private schools across the country between February and June 2023. Questions about delta-8-THC were administered to a randomly selected one-third of 12th-grade students, or 2,186 seniors in 27 states.

"(Eleven percent) is a lot of people — that's at least one or two students in every average-sized high school class who may be using delta-8. We don't know enough about these drugs, but we see that they are already extremely accessible to teens," National Institute on Drug Abuse Director Nora Volkow said in a statement. "Cannabis use in general has been associated with negative impacts on the adolescent brain, so we must pay attention to the kinds of cannabis products teens are using, educate young people about potential risks, and ensure that treatment for cannabis use disorder and adequate mental health care is provided to those who need it." 

The latest study adds to the understanding of how young people are using cannabis and related products at a time when legalization is far reaching and overwhelmingly favored — 74% of Americans now live in a state where marijuana is legal for either recreational or medical use and 88% support legalization for those two purposes, according to two Pew Research Center analyses released over the last month. 

Ryan Sultan, assistant professor of clinical psychiatry at Columbia University and a cannabis-use expert, said the current climate calls for a more nuanced approach to marijuana's effects.

"The narrative of cannabis as a 'reefer madness' and ruining everyone's life — that one was a lie," he said. "And the narrative that cannabis is a magical, natural, benign panacea for everything — that one is also not true."

At the same time, Sultan warns that young users remain particularly vulnerable. 

"The biggest consequence that we think about in the field of child development … is that using substances that are potentially psychoactive and addictive and have effects on development … the younger you are, the more problematic they might be," he said. "And cannabis is included in that."

A number of teenagers believe that marijuana is helpful for anxiety and depression, which doesn't appear to be true in the long term, Sultan said. "The problem is that chronic use seems to not do that. Chronic use seems to actually result in a worsening of that symptomatology." 

Cannabis today is far more potent than it was decades ago, allowing it to bind to receptors in the brain more effectively. So when you stop using it, you end up with even worse symptoms, according to Sultan.

Sultan published a study last year showing that adolescents who recently used cannabis but did not meet the criteria for a marijuana use disorder had two to four times greater odds of major depression, suicidal ideation, difficulty concentrating, lower GPA and a number of other negative outcomes. These results reinforce those of earlier studies as well. 

Sultan analyzed responses from 68,263 adolescents between the ages of 12 and 17 from the National Survey on Drug Use and Health between 2015 and 2019. He noted, though, that the study did not demonstrate causation: it's not clear that the marijuana use directly led to these mental health issues and other outcomes.

"It's more like a cycle," he said, in which people who are depressed and anxious are more likely to use cannabis in the first place to self-medicate their symptoms but this can end up "spinning out of control."

"So rather than which came first, the chicken or the egg? They both came and they're both happening and they're both interacting with each other."

Yet, most adolescents don't think of weed as harmful: Over the past decade, the perceived risk of harm decreased by nearly half, while use for people 12 and over increased from about 12% to about 18%. Several studies demonstrate that they think of edibles, in particular, as less harmful, failing to account for concerns around potency, regulation and delayed effects. 

A 2023 study at UC Davis Health and the University of Washington, which surveyed teens over a six-month period, found that they get high for enjoyment and to cope. Those who used it to forget their problems typically experienced more negative consequences like difficulty concentrating. Lead author Nicole Schultz noted that understanding teens' motivation for getting high is an important first step in developing strategies to intervene early. 

Post-pandemic, marijuana remains one of the three most common substances used by adolescents, along with alcohol and nicotine vaping. 

In 2022, the percentage of young adults 19 to 30 years old who reported marijuana use reached record highs, according to a National Institute of Health-funded study: About 44% of those surveyed reported use in the past year — a significant increase from the 25% who reported the same in 2012. Young adults also reported a record-high use of marijuana vaping in 2022: 21% up from 12% in 2017, when the measure was first added to the study.

A meta-analysis published in 2020 found that adolescents and adults who vape nicotine were also more likely to also use alcohol and marijuana. In adolescents, the relationship was much stronger: those who vaped were 4.5 to six times as likely to report alcohol and marijuana use and were particularly likely to report binge drinking.

According to a recent paper, vaping has emerged as one of the two most popular methods for teens to get high, despite its unclear long-term health implications. In fact, it may actually be associated with greater risk than smoking for lung injuries, seizures and acute psychiatric symptoms. 

Vaping is also a more accessible and discreet way to consume marijuana, allowing teens to use it in more settings, including schools, without getting caught. New York City teachers and students have reported more and younger students are coming to school high and are smoking throughout the day, with some educators hypothesizing that kids are using weed to blunt residual pain and anxiety from the pandemic. 

This harder-to-detect delivery method puts a lot of pressure on individuals to manage how often they're using it, according to Sultan, which is particularly challenging for adolescents who may struggle with impulse control. 

Ultimately, though, much of the research that exists on cannabis generally is outdated because it's based on weaker strains of the substance from years ago, Sultan said: "We are behind the eight ball on cannabis."