Judith Palfrey: Marijuana and Kids—Is Occasional Use OK?

There is a big push to legalize or at least decriminalize recreational marijuana use, in part because it is so widely used among young people. What is your advice to young people who are occasional pot users? And, as a pediatrician, do you discuss an adolescent's pot use with Mom and Dad?

Judith Palfrey: At the Children's Hospital in Boston, we are very fortunate to have the Center for Adolescent Substance Abuse Research. CeASAR expert Dr. Sharon Levy gave me this advice:

"We recommend that young people avoid use of marijuana entirely. While marijuana does not cause severe withdrawal symptoms seen with other drugs, the syndrome of marijuana dependence is well described in the medical literature, is every bit as powerful as addiction to other drugs, and causes great harm to young people. Marijuana addiction is characterized by lack of motivation, poor functioning in school and at work, disruption in family relationships and friendships, and loss of control over how much is used and how often. Several large scientific studies have shown those who use marijuana during adolescence are at much greater risk of developing depression and schizophrenia, and adolescents who become addicted to marijuana have poorer outcomes relative to education, career, and family goals than their siblings. Unfortunately, because of slow and insidious onset, symptoms are often not recognized. Recent research has demonstrated that, as with alcohol, adolescents who begin using marijuana early are much more likely to develop an addiction than fully mature adults. Parents should not permit their adolescent children to use marijuana—in the end, the messages they give have a greater impact on their children's behavior than the law. They should see the laws prohibiting marijuana use as a means to support them rather than an end in itself."

As to confidentiality, Levy recommends heathcare providers respect the confidentiality of adolescents who seek substance use treatment without parental consent. She added, however, that teenagers who can work openly with their doctors and parents have the best success. Finally, if a provider believes that the teenager is at risk of hurting himself or others (if the provider suspects, say, binge drinking, suicidal gestures, or driving while intoxicated), the young person's parents must be informed.