Does the legalization of medical marijuana give young Minnesotans the impression that the drug is harmless — or at least as safe or even safer than other substances like alcohol or cigarettes?
Though recent studies have shown that legalization for medical purposes has not led to an increase in adolescent use of marijuana in the United States, does decriminalization of the drug change young people’s attitudes about its safety?
Carol Falkowski, CEO of Drug Abuse Dialogues, a Minnesota-based organization that offers education and training on drug abuse issues, said that if a drug is declared legal for medical use by lawmakers, it may inadvertently send the message that its recreational use is also safe for young people.
Teens may be particularly vulnerable to these messages, Falkowski said: Research conducted by the National Institute on Drug Abuse [PDF] found that when a teen’s sense of a substance’s perceived harm goes down, his/her rate of use of that substance goes up.
In 1993, for instance, 35.6 percent of 12th graders polled believed there was a “great risk” in smoking marijuana occasionally. That same year, 26 percent of teens polled reported using marijuana. In 2014, those numbers had changed dramatically: 19.5 percent of 12th graders polled saw great risk in occasionally smoking marijuana, while 36.4 percent had used the drug.
“I think it’s pretty easy to assume that the fact that 23 states and Washington, D.C., have legalized medical marijuana and four states and many cities have legalized recreational marijuana contributes to the increased perception among teens that marijuana use is not harmful to them,” Falkowski, said. “More teenagers now smoke marijuana than cigarettes. It’s great that fewer kids smoke cigarettes, but we should all be concerned that more kids are smoking marijuana. The earlier the onset of use, the more likely the development of addiction.”
This week, I spoke with Falkowski and three other prominent addiction and recovery experts. I asked them if they thought that legalization changes teens’ attitudes about marijuana. Here’s what they said:
Michael Durchslag, director, P.E.A.S.E. academy:
As director of P.E.A.S.E. Academy, Minneapolis’ quarter-century-old recovery high school, Durchslag works with young people who have plenty of experience with drugs and alcohol and are actively seeking sobriety.
He said that “99 percent” of his students have smoked marijuana in the past, and so they may not be a good barometer of the shifting attitudes in the general teen population. “The adolescents I come across on a daily basis,” Durchsla said, “are definitely a subset of the culture.”
That said, he believes that P.E.A.S.E. students do reflect overarching societal perceptions about drug use.
“The attitude that I get from kids here,” Durchslag said, “and this has been for a long time, is, ‘It’s just pot. It’s not bad. It’s actually natural. It’s not even a drug. It’s just pot.’ I think that’s the prevailing attitude among teens everywhere — and even the teens’ parents.”
Durchslag said that attitudes like that concern him. “Pot is stronger than it’s ever been,” he said. “It keeps getting stronger. The pot from the ’90s is not the pot from 2015. The pot from 2000 is not the pot from 2015. It just keeps getting stronger.”
Marijuana can be addictive, Durchslag said, and he’s concerned about the long-term effects that heavy use of the drug can have on the developing adolescent mind.
“I work with a population that has learned that whether it’s legal or not, they can’t use marijuana successfully,” Durchslag said. “For 46 percent of my students, the primary drug that they’ve sought treatment for is marijuana. People forget that marijuana can be addictive. It actually changes the physical chemistry within your brain.”
Durchslag believes that it is “just a matter of time before marijuana is decriminalized nationwide. I think this ball is already rolling. I don’t think it is going to stop.” Because of that reality, he said he hopes that people will not lose sight of the fact that for some individuals at least, use of any drug — including marijuana — will never be a good idea.
“I’ve seen an increase in the number of kids using opiates and heroin,” Durchslag said. There is a huge amount of public concern and activism around this shift, he added, but “attitudes toward marijuana haven’t changed in the 20 years I’ve been here. It’s always been, ‘It’s not a big deal,’ but for a lot of kids, it is.”
Joseph Lee, M.D., medical director for youth continuum, Hazelden Betty Ford Foundation:
In the last 20 years, young Americans’ view of marijuana and its use have changed significantly, Lee said.
“The attitudes about marijuana have become more lax among youth,” he said. “That’s not up for debate.” And while he believes that “the sky hasn’t fallen in states that have recreational marijuana,” Lee says that an increased sense of the relative safety of marijuana use will eventually bring with it an increase in use in young people.
“When kids find substances to be more harmful they use less,” Lee said. “Cigarettes can be a good objective barometer for that. When kids think things are more risky, like they did with cigarettes, they tend to use less. When they perceive a substance to be safe, they use more.”
Though not every young person who smokes marijuana will become addicted or suffer negative effects from the drug, Lee is most concerned about those who start using the substance at a young age. Earlier onset of drug use is a greater indicator of future addiction, he added.
“It’s not like every kid who uses substances is going to have terrible outcomes,” Lee said. “The kids who use at an earlier age are sub-selected for the behavior and are at a higher risk for later issues. When young people start to use at an early age, they are showing their risk for a negative life outcome. A 14-year-old smoking cigarettes is self-electing for this behavior.”
As marijuana becomes decriminalized in more parts of the United States, Lee thinks it will be important to develop “clear, smart messaging” around the drug and the dangers associated with its use for young people, especially those at high risk for addiction.
“Adult use has gone up in the country,” he said. “There will be some trickle down of attitudes from adults to kids. We know that parental attitudes about various substances do influence behavior in kids.”
That trickle-down message needs to be delivered in an honest, clear way, Lee said. If marijuana will one day become legally available nationwide, we need to learn how to communicate about its risks in a way that won’t alienate teens.
“We no longer live in the age where the stork delivers babies,” he said. “You have to have messaging that’s really smart. What we’ve done with tobacco is smart. Cigarette use is going down due to smart messaging around cigarettes an their dangers. There’s hope for high-risk youth around marijuana use, too, but we have to be smart.”
Scott Washburn, assistant director and licensed alcohol and drug counselor StepUP, Augsburg College:
Prior to 2008, when Washburn came to StepUP, Augsburg College’s program for students in addiction recovery, he worked as a prevention specialist at Minnetonka High School. The attitude he saw among teens even then was a growing perception that marijuana use was generally low risk.
The students he sees at StepUP are a different story, Washburn said: “The population I work with now, they are in recovery and they realize that marijuana is highly addictive and its use can be problematic.”
Washburn contends that as long as young people believe that a substance presents a low risk of negative side effects, they are more likely to use it.
“For the past 30 years there’s this dynamic between perception of risk of using a substance and the actual use,” he explained. “There is an inverse coloration.”
Take cigarettes, for instance. Washburn points to data collected over 24 years from the Monitoring the Future study.
“In the 2014 study, they compared the use of cigarettes and marijuana amongst 12th graders from 1975-2014,” Washburn said. “What’s noteworthy is that in 2010, those two lines crossed. Tobacco use started to decline in 1998 continuing up to 2014. But marijuana use continued to go up and eventually was higher than tobacco use.”
Today, more American teens smoke pot than cigarettes.
“By 2014, the rate of cigarette use among 12th graders was 13.6 percent, whereas 21.2 percent of the same population has used marijuana,” Washburn said. “You can see in our culture there’s been a significant shift in attitude about marijuana use.”
At Augsburg, Washburn teaches a class titled Addiction and Recovery. He encourages his students to look at the issue of drug use and legalization from all sides of the argument.
“I tell my students that just because a drug can harm you doesn’t also mean that it can’t help you,” he said. “I don’t think and of this is a black-and-white thing. There’s good, solid research coming out that there is legitimate medical use for cannabis. Whether that means it should be totally legal for recreation is another discussion altogether.”
Washburn said that in classroom discussions about medical marijuana, he likes to talk about issues surrounding the use — and abuse — of other well-known drugs.
“Vicodin and oxycodone are legal drugs,” he said, “but just because they are prescribed by physicians for valid reasons doesn’t mean that they can’t be harmful and dangerous when used incorrectly. Alcohol is legal if you are over a certain age, but that doesn’t meant it can’t be harmful if it is misused and abused.”
This thoughtful discussion-based tactic is the most helpful way to talk about drug use with young people, Washburn said. He hopes that’s the direction that conversations about marijuana use will take going into the future.
“My experience over my years of working in the schools was that I found that just having a genuine adult conversation and not being extreme on either end was helpful,” he said. “It gave kids room to grapple with the messages that they hear and make sense of it all. That’s the best way to approach the issue.”