The Cannabis Closet: A Child Psychiatrist's Fears

A reader writes:

I think pot should be legalized. I am for Prop 19. I just think that the push to make this happen draws people into minimizing the risks associated with smoking marijuana - particularly for adolescents.

The downside to Prop 19 is that it is going to create and increase some public health problems, particularly among teenagers and among the broader mentally ill population. I get that the measure would keep weed illegal for those under 21 and impose heavy penalties on anyone who facilitated kids getting weed. But let's not kid ourselves; more kids will have more access to weed, and this is a problem for which we need to prepare. You will forgive me, I hope, for being a bit skeptical about seeing a concomitant increase in funding for substance use treatment programs or mental health in general.

As someone who is finishing my training as a child and adolescent psychiatrist and as someone who used to smoke a fair bit in college and medical school, I really do see both sides of this.

On the one hand, I have kids tell me that MJ can truly salve their anxiety and even, occasionally, treat their ADHD. Some of them can even use it appropriately for this or just straight social purposes. It sure as hell helped me relax and connect with people in ways that were otherwise hard to do when I was a teenager.

But then weed didn't cure my anxiety. Therapy did (yes, I get that this doesn't work for everyone). Still, I have yet to see a kid show up stoned saying, "Let's do some therapy and figure this shit out." In my work I see kids whose depression or anxiety keeps getting worse as they smoke more and more. I see kids who have had their first psychotic break while smoking marijuana and are never quite the same afterwards. Onset of psychosis or other major mental illness left aside, I most often see kids who are determined to use weed (and alchohol, and a bunch of other stuff) to avoid whatever rage or sadness or both that they are sitting on.

I've attached a few papers. You can no doubt find contrary studies with a Google Scholar search. The weight of the evidence though, is that cannabis use - particularly frequent use at vulnerable periods like adolescence (which, neuro-developmentally speaking, often runs well past 21) - is pretty consistently associated with worse outcomes over time. It isn't necessarily the cause, and the rates aren't dramatic, but they are real. When we increase weed's availability then we increase the frequency of these outcomes, and that means that there is a social and a human cost. As I said above, I agree that in the end these specific costs are worth what we save in other areas. I do think it behooves us, however, to think about how to tend to these issues.