A mixed bag

Come November, California could join Alaska, Colorado, Oregon and Washington by becoming a state where adults can legally buy, possess and use cannabis recreationally as well as medically.

What would this mean for kids and teens? We now may have an idea.

Colorado was the first of these states (plus the District of Columbia) to enact laws calling for such blanket legalization, passing Amendment 64 in 2012. Two recent reports focused on Colorado—one on teenage use, one on kids’ accidental ingestion—offer a mixed picture.

The report on teens, released July 20 in the 2015 Healthy Kids Colorado Survey from the state’s public health department, shows marijuana use among teenagers has not increased since legalization. In fact, the research shows it has decreased, from 25 percent in 2009 to 21 percent, just below the national average.

The report on children, published July 25 in the medical journal JAMA Pediatrics, shows the number of visits to emergency rooms and calls to poison control centers about children ingesting edibles—products such as baked goods and candies—has risen 150 percent since 2014.

California has allowed medicinal use of marijuana, under Proposition 215, since 1996; currently, 24 other states have similar laws. Advocates of full, statewide legalization have put forth an initiative for the Nov. 8 ballot.

Proposition 64, known as the Adult Use of Marijuana Act (AUMA), would allow adults 21 and over to possess up to 1 ounce of cannabis and grow up to six plants; impose a 15 percent tax on sales, directed to a specific fund mainly for youth treatment and outreach services; downgrade legal penalties; impose packaging and labeling requirements; and legalize hemp.

Dr. Amanda Reiman is manager of the Marijuana Law and Policy for the Drug Policy Alliance, a nonprofit that’s one of Prop 64’s backers. In a phone interview, she said those who drafted the initiative “definitely considered early adopters” such as Colorado and Washington. Among the lessons: including regulatory provisions for packaging that safeguards children and clear labeling. Prop 64 also dictates strict penalties for selling to anyone underage.

Even so, the prospect of legalization concerns some children’s health professionals.

Dr. Ejaz Ahmed, a Chico pediatrician, draws distinctions between medicinal use and recreational use, as well as use in children and adults. Also, akin to tobacco, he’s worried not just about direct intake but also the secondhand-smoke effect.

Ahmed acknowledges the therapeutic uses for marijuana, citing relief for chronic pain, appetite stimulation for chronic debilitating diseases (such as AIDS and various cancers) and muscle-spasm control for multiple sclerosis. However, he also understands cognitive growth: A child’s brain continues to develop into his or her 20s, and habits modeled by parents can set patterns for life.

As such, he said by phone, “I don’t see it changing in the future that the American Academy of Pediatrics would ever support using marijuana until the age of 21. So I advise parents who are using … be very careful. They might not see it today, but they don’t want their children to pick up their behavior … and we don’t know what the outcome will be for those children.”

The recent reports on youth and cannabis have drawn particular interest because Colorado, with several years of history, offers the largest and most scientifically valid population to research. Regarding teens, Reiman says a dozen studies have yielded similar findings: no increases in the number or frequency of teens using marijuana.

“In some places, we’ve even seen a slight decrease in use,” said Reiman, whose doctorate is in social welfare. “So it’s safe to say that legalization does not result in an increase in teen use.”

Reiman says legalization decreases access due to “illicit sources drying up” and legal vendors requiring proof of age for purchases. Also, the youthful sense of rebellion tends to diminish when a behavior gets normalized—moved from the underground into the mainstream, stripped of the “cachet” of doing something forbidden.

“Once we see adults no longer have to hide it, we’re going to see young people losing interest in it,” Reiman said. “Of course, the Drug Policy Alliance does not advocate for the use of cannabis by those under 21, unless for a specific medical purpose, but we do feel the regulations like those proposed in Prop 64 will be more effective at keeping cannabis out of the hands of teens seeking to access it than prohibition.”

As for the report about children accidentally ingesting cannabis, Reiman pointed to findings that 75 percent of the toddlers and youngsters whose parents brought them to the hospital or called poison control either had no side effects, minor side effects, minimal side effects or side effects unrelated to marijuana.

“Of course, it doesn’t downplay that some children have had some major effects,” she said.

Preventing such accidents motivated the push for child-proof packaging and clear labels in Prop 64.

The Healthy Kids Colorado Survey shows another possible upside to legalization. Before 2012, just 19 percent of Colorado parents indicated a willingness to reach out to health professionals or poison control should their child ingest cannabis; that figure now is 56 percent.

Ahmed still has reservations. A pediatrician for 30 years, 18 spent locally, he doesn’t want more minors exposed to the drug, particularly because he’s seen multiple teen patients escalate from cannabis use into hard drug addiction.

“I hope that we are all on the same page,” he said, “making sure we are making an environment safe for our young kids and the growing generation.”