Cannabis/Marijuana and the Adolescent Brain.ppt

Effects of cannabis on the adolescent brain

1. MARIJUANA AND
THE ADOLESCENT
BRAIN

2. A coalition of schools, human service agencies, local
government, law enforcement, businesses, faith-based
organizations, parents and youth
that holds the vision that:
Franklin County and the North Quabbin Region be a
place where young people are able to reach their full
potential and thrive with ongoing support from
schools, parents and the community.

3. North Quabbin Drug Free Community Project
Mission: is to combat youth substance use across the nine towns of the North
Quabbin Region. The project does this by bringing together key stakeholders
to comprehensively analyze and impact the existing local continuum of
prevention, intervention, treatment and recovery resources. Through the
creation of a Youth Action Council, the expansion of a Parent Advisory Council
and communication across coalition programs the task force will implement
the prevention framework strategies to combat youth substance use, delay the
age of first use, and to increase community connectedness.
PART Task Force (prevention, addiction, recovery and treatment)
Youth Action Council
Parent Advisory Council
NQCC Full Coalition and Whole Community

4. Roadmap
•The (remarkable!) adolescent brain
•Substance use and the brain’s reward system
•Adolescence and the roots of addiction
•Marijuana and its acute effects
•Longer-term impact of regular marijuana use
on youth development
•Trends in youth substance use
•Prevention

5. Teens really are different!
Compared to childhood and adulthood,
adolescence is a time of heightened:
Sensation- and reward-seeking
Risk-taking and impulsivity
Peer influence
Mood swings
Capacity to learn
Exuberance

6. Maturation of the human brain,
age 4-21

7. The imbalance between
the prefrontal cortex
and the limbic system
Wheeeee!
Whoa!
limbic
prefrontal

8. Creating neural super-highways
through pruning & myelination

9. The “use it or lose it” principle
"If a teen is doing music or sports or academics,
those are the cells and connections that will be
hardwired. If they're lying on the couch or
playing video games…, those are the cells and
connections that are going to survive.”
Jay N. Giedd, M.D., Chief of Brain Imaging,
Child Psychiatry Branch, National Institutes of Health

10. The heightened importance of rewards

11. The brain’s reward system

12. Chocolate
Normal
baseline
Return to
baseline
Dopamine level, normal brain

13. 0
50
100
150
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Time (min)
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Fiorino and Phillips, J. Neuroscience, 1997.
Natural Rewards Elevate Dopamine Levels
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Sample
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12345678
SEX
Female Present

14. Comparing dopamine levels from natural rewards and drugs of abuse
baselinefood sexnicotinecocainemeth
100
150
200
250
350
1000

15. From the neuron’s point of view
(Wow! Yikes!)

16. So what’s wrong with feeling good?

17. When the brain’s
reward system
is repeatedly
overstimulated,
it adjusts to reduce
dopamine levels.
Turn it
down!!

18. Person w/ substance
use disorder
Healthy subject

19. Addiction is a brain disease
These changes in brain chemistry are at the root of
addiction. For more on addiction, search YouTube for
“Physiology of Addiction by Dr. Ruth Potee.”

20. The reward system is
particularly active in
the teen brain.
The centers for
logic and reasoning

are still developing.

21. Teens are more likely to start using illicit
drugs than other age groups
% of never users
who initiated use
in the past year

22. The reward system is
particularly active in
the teen brain.
The centers for
logic and reasoning

are still developing.
Adolescent brains are
building super-highways
for the pathways
used regularly.

23. •People who begin using alcohol, marijuana, or
other drugs in adolescence are more likely to
develop dependence than those who begin in
adulthood.
•The younger the age of onset, the greater the
likelihood of later problem use.
Early onset of substance use
Addiction
Addiction is a
developmental
pediatric
disease

24. Dependence on substances is
highly correlated with early use
40% of those who begin
drinking at age 15 will
develop an alcohol use
disorder.
7% of those who begin
drinking at age 21 will
develop an alcohol use
disorder.

25. What is marijuana?
How does it affect the body?

26. The marijuana plant
(Cannabis sativa)
•480 natural chemical compounds
•80 cannabinoids, including THC and CBD
Like most drugs,
cannabinoids
mimic natural
brain messengers.

27. There are receptors for
these natural cannabinoids
all over the body…
and throughout the brain…
and THC, CBD and other
cannabinoids from
marijuana can bind with
them and alter natural
signals.

28. So how does marijuana affect the
brain and body?
It depends!
What strain of marijuana?
What is the THC content?
The CBD content?
How is it being consumed?

29. 196019651970197419751978198019831984198519861992199319951996199719981999200020012002200320042005200620072008200920102011
0
2
4
6
8
10
12
14
M
A
R
IJ
U
A
N
A
P
O
T
E
N
C
Y
CBD:
Non-Psychoactive
Ingredient
Average THC & CBD
levels
in the US: 1960 - 2011
Data from the NIDA-sponsored Potency Monitoring program at the University of Mississippi, showing average THC and
CBD levels in samples of marijuana seized by federal, state and local governments in each year shown.
THC:
Psychoactive
Ingredient

30. THC Concentrates
“Budder”
“Shatter”
“Ear Wax”
“Green Crack” wax
Hash Oil Capsules
Butane Hash Oil (BHO)

31. Ways to
consume
marijuana

32. Acute effects of using marijuana
(during intoxication)
Altered judgment
Slowed reaction time
Euphoria
Impaired memory
Increased appetite
Impaired coordination
Panic/paranoia/
psychosis
Altered pain sensitivity
Anti-nausea effects

33. What about its medicinal properties?
People have used marijuana as a medicine for thousands
of years, and animal studies and cell cultures suggest
promise for marijuana for the treatment of a variety of
conditions, for example:
* Glaucoma * Nausea *
* AIDS-associated wasting syndrome *
* Chronic pain * Inflammation *
* Multiple sclerosis * Epilepsy *
Good clinical studies are needed; the DEA is currently
considering whether to reschedule marijuana.

34. Marijuana and driving
•Marijuana affects skills
necessary for driving, such as
motor coordination, reaction
time & judgment.
•Lab and simulator studies
show that marijuana impairs
driving skills, and the more
THC, the greater the
impairment.
•How this impairment of skills
affects real world crash risk is
unclear.
Colorado DOT campaign

35. Marijuana and driving
•Marijuana used with
alcohol causes greater
impairment than either
alone.
•In Colorado in 2014, of
drivers testing positive for
THC, 2/3 had alcohol
and/or other drugs in
their systems as well as
marijuana.
marijuan
a only;
33%
mj & other
drugs,
15%
mj, other drugs &
alcohol, 15%
marijuana
& alcohol,
37%

36. Marijuana and driving
Source: Monitoring the Future

37. What are the longer-term effects of regular
marijuana use on youth development?

39. Prospective longitudinal studies
Assess during childhoodMonitor marijuana use
from onset
Assess again in
adulthood

40. One thing researchers agree on…
Frequent marijuana use
during adolescence
has more serious
consequences
than use by
adults

41. Potential longer-term effects of regular
marijuana use on youth development
•Issues with attention, memory and learning
•Poorer educational and life outcomes
•Loss of IQ for persistent heavy users
•Potential for addiction to marijuana and
increased risk of addiction to other drugs
•Increased risk of risk of psychosis

42. Deficits in cognitive functioning
among active users
Many studies show that adolescents who
use marijuana heavily tend to score worse
than non-users on tests of:
•attention
•verbal learning
•memory
•processing speed
… even when
they are not high.
non-usersmarijuana
users
0
10
20
30
40
50
60
non-usersmarijuana
users
0
2
4
6
8
10
12
14
Messinis, et al 2006
Verbal learningDelayed recall

43. •Deficits are larger for those who use more,
and for those who begin using younger.
•With sustained
abstinence,
functioning is
largely restored.
Deficits in cognitive functioning
among active users

44. Does marijuana use alter brain structure?

45. Unemployed age 21-25
College grad by age 25
0%5%10%15%20%25%30%35%40%45%
0
1-99
100-199
200-299
300-399
400+
Adult life outcomes affected by
marijuana use in adolescence
# occasions used
marijuana, age 15-21
Fergusson DM & Boden JM, Cannabis use and later life outcomes. Addiction. 2008 Jun; 103(6):969-76
Increasing use of marijuana from age 15-21 was
also associated with lower relationship quality and
lower life satisfaction at age 25.

46. Loss of adult IQ associated with marijuana
dependence in adolescence
The most comprehensive study of marijuana
and cognitive function to date:
•Dunedin study followed 1037 individuals from birth
to age 38
•assessed IQ at 13 and at 38
•assessed marijuana use and dependence at five
points in time from age 18-38
•controlled for use of alcohol and other substances,
socio-economic status and years of education

47. Loss of adult IQ with marijuana dependence
in adolescence
Findings:
•Those who developed marijuana dependence before
age 18 showed IQ decline in adulthood.
•The longer their dependence persisted, the greater the
decline, with a decline of 8 IQ points for the most
persistent users.
•Those who began using in adulthood did not show IQ
decline.
•Quitting in adulthood did not restore functioning in
those who began in adolescence.

48. Other studies show no association between
marijuana use and IQ loss
Mokrysz, et al, 2016:
•Prospective cohort study of 2235 young people in Bristol, UK,
considered impact of marijuana use on IQ between age 8 and age 15.
•No association found between teen marijuana use and IQ, after
adjusting for various confounders, most notably cigarette smoking.
Isen, et al, 2016
•Study of 789 pairs of twins followed from preadolescence (age 9-12)
to late adolescence (age 17-20).
•Marijuana users experienced declines – as did their non-using twins.
•The authors conclude the decline was related to factors other than
marijuana.

49. nicotine heroin cocaine alcoholmarijuana
32%
23%
17%
15%
9%
% of users (of all ages)
who develop dependence
Is marijuana addictive?
And 17% for
those who start
in their teens

50. The consequences of marijuana dependence are not as severe as
those for alcohol or opioid dependence, but:
•Like other drugs of abuse, marijuana acts on the reward
system and causes dopamine to be released.
•Marijuana is reinforcing: animals will self-administer it.
•People show clinical signs of addiction, e.g.,
otolerance
owithdrawal syndrome
ousing more than intended
owanting to cut back on use
•In 2014, the NSDUH found 4.2 million Americans had a
marijuana use disorder within the past year.
Cannabis use disorder (DSM-5)

51. Are tobacco, alcohol & marijuana
“gateway drugs”?
There is a
correlation
between use
of tobacco,
alcohol and
marijuana
and use of
other drugs
of abuse.
cigarettes alcohol marijuana
Of those who do
not smoke, 1%
Of those who do
not drink, 1%
Of those who do
not use mj, 0%
Of those who
smoke cigarettes,
16%
Of those who drink,
8%
Of those who use
mj, 11%
What percent of each group
use prescription narcotics?
SOURCE: 2015 FC/NQ PNA

52. 0 1 2 10 <50 >50
30
20
10
0
Number of times marijuana used
C
a
s
e
s
o
f
s
c
h
iz
o
p
h
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n
ia
p
e
r
1
,
0
0
0
Marijuana use at age 18 and later risk of
schizophrenia (n=45,570)
Marijuana, psychosis and
schizophrenia

Andréasson, 1987

53. not susceptiblenot susceptiblesusceptible
0
1
2
3
4
5
6
7
8
never users
used weekends or less
daily users
Geneotype – susceptibility to schizophrenia
O
d
d
s
r
a
ti
o
Marijuana, psychosis and
schizophrenia
Regular
marijuana use
increases
schizophrenia
risk in those
with gene for
schizophrenia
DiForti, 2012

54. How common is
youth marijuana use?

55. 919293949596979899000102030405060708091011121314
0%
10%
20%
30%
40%
50%
60%
Percentage of U.S. 12
th
grade students
reporting past month use of
cigarettes, marijuana and alcohol
SOURCE: University of Michigan, 2014 Monitoring the Future Study.
Cigarettes
Marijuana
Alcohol

56. 2003 2006 2009 2012 2015
0%
10%
20%
30%
40%
50%
19%
Cigarettes
9%
47%
Alcohol
30%29%
Marijuana 22%
Percentage of local middle & high school students
reporting past month use of
cigarettes, marijuana and alcohol
SOURCE: Franklin County/North Quabbin Prevention Needs Assessment.

58. 2003 2006 2009 2012 2015
0%
20%
40%
60%
80%
100%
73%
mj use is risky
43%
32% it's hard to get
mj
42%
62%
it's wrong to
use mj
60%
Perceptions of marijuana
among local middle & high school students
SOURCE: Franklin County/North Quabbin Prevention Needs Assessment.

59. Prevention:
Factors in the community, family and schools influencing youth use

60. Prevention in the community:
Laws and norms

61. https://malegislature.gov/Document/Bill/189/Senate/SD2479/DocumentAttachment/sd2479.pdf

62. Some considerations affecting youth
if recreational use is legalized
Minimum legal sales age
Use in public
Driving under the influence
Types of products allowed
Packaging and labeling
Advertising and marketing
Location and density of vendors
Use of revenue for prevention

63. Vaping
•What is vaping?
•Vaping is the act of inhaling and exhaling the aerosol (often called vapor) produced by an
e-cigarette or similar battery-powered device.
• 
•What are other names for e-cigarettes?
•They are also known as e-cigs, vape pens, e-hookahs, e-pipes, tanks, mods, vapes,
electronic nicotine delivery systems, or ENDS, and more. Some people refer to vaping
devices by their brand name such as JUUL, BO, Blu, and others.
•What kinds/types of e-cigarettes are there?
•E-cigarettes come in many different sizes, types and colors.
•Some e-cigarettes are made to look like regular cigarettes, cigars, or pipes. Some
resemble pens, small electronic devices such as USB sticks, and other everyday items.
The products that are designed to resemble small electronic devices are often compact and
allow for discreet carrying and use – at home, in school hallways and bathrooms, and
even in classrooms
 

64. What is in e-cigarettes? My child
says its simply flavored water,
what’s so bad about it?
•E-cigarettes contain pre-filled pods or e-liquids/e-juices the user adds to the
device. E-liquids generally consist of propylene glycol, glycerin, water, nicotine,
and flavorings. Many of these pods and e-liquids come in fruit and candy flavors
that appeal to youth.
•E-cigarettes produce an aerosol, commonly called vapor, which users inhale
from the device and exhale. The aerosol can contain harmful and potentially
harmful substances, including:
oNicotine
oUltrafine particles that can be inhaled deep into the lung
oFlavoring such as diacetyl, a chemical linked to a serious lung disease
oVolatile organic compounds
oCancer-causing chemicals
•Heavy metals such as nickel, tin, and lead

65. Why did you try vaping?
44.4%
33.3%
15.9%
3.2%
3.2%
E-cigarettes I was attracted
to the flavor
I saw others
using it and
was curious
Other
I saw an ad for
it and it looked
cool
65.5%
24.5%
10.0%
If e-cigarettes and cigars were NOT available in
flavors (i.e. grape, apple, cherry, bubblegum,
chocolate, etc.), would you use them?
No
I am not sure
Yes

66. Where are e-cigarettes sold and
how are youth getting them?
E-cigarettes are sold in many places including convenience stores,
corner stores, gas stations, vape shops, and online. Stores should ask
for identification (ID) of anyone who appears to be under 27 and
refuse a sale to anyone who does not present ID or who is under the
legal sales age. Online retailers are required to ask for age
verification.
Just like other tobacco and nicotine products, youth may get
e-cigarettes from many sources. Youth who use these devices may not
purchase them directly from a retailer; they may have access to e-
cigarettes through friends who vape or from online stores that accept
gift cards, for example.

67. Products & packaging:
Like this?

68. Or this? (Products at the Northampton dispensary)

69. Sales outlets/dispensaries
A dispensary in Colorado …
now painted gray after community complaints that the mural enticed children

70. The Northampton dispensary

71. The future Greenfield dispensary

73. The Northampton dispensary

74. Advertising/promotions

77. Prevention in the family
very wrong wrong a little bit wrongnot wrong at all
64%
16%
12%
8%
Percent of students who used marijuana recently,
by parent attitudes (FC/NQ PNA 2015)
used mj in
past 30 days
did not use
How wrong do your parents think it is for you to use marijuana?
7%
used
38%
used
59%
used
75%
used
very wrong wrong a little bit wrongnot wrong at all
64%
16%
12%
8%
Students’ report on their parents’ attitudes
How wrong do your parents think it is for you to use marijuana?
SOURCE: Franklin County/North Quabbin Prevention Needs Assessment.

80. Prevention in schools

81. LifeSkills is a substance abuse and violence
prevention curriculum
for middle school students
Year 1
6
th
/7
th
15 classes
Year 2
7
th
/8
th
10 classes
Year 3
8
th
/9
th
5 classes

82. LifeSkills Teaches Life Skills:
Self-Image & Self-Improvement
Making Decisions
Coping with Anxiety
Coping with Anger
Communication Skills
Social Skills
Assertiveness
Resolving Conflicts
Media Influences
Advertising
Violence and the Media
Resisting Peer Pressure
…as well as:
Smoking: Myths and Realities
Alcohol: Myths and Realities
Marijuana: Myths and Realities
Drug Abuse and Violence:
Causes and Effects

83. LifeSkills Prevents Substance Use
Randomized trials
show LifeSkills reduces
tobacco, alcohol and
marijuana use among
participants relative to
controls:
up to 87% for tobacco use,
up to 60% for alcohol use, &
up to 75% for marijuana use.
tobaccoalcoholmarijuana
0%
5%
10%
15% controlLST
P
e
r
c
e
n
t
o
f
s
t
u
d
e
n
t
s
r
e
p
o
r
ti
n
g
p
a
s
t
3
0
d
a
y
u
s
e
87%
less
use
60%
less
use
75%
less
use
SOURCE: Various studies cited at http://www.lifeskillstraining.com/

84. Screening, Brief Intervention & Referral to
Treatment

85. What municipal leaders can do
•Assess zoning and Board of Health regulations on
medical marijuana
•Take a stand on legalization of recreational
marijuana use
•Educate the community through meetings, town
newsletters, editorials, etc.
•Support the implementation of LifeSkills and SBIRT
in the schools
•Stay abreast of legislation on recreational marijuana
use.

86. Resource list
Adolescent brain
•David Dobbs, “Beautiful Brains,” National Geographic,
October 2011,
http://ngm.nationalgeographic.com/2011/10/teenage-
brains/dobbs-text
•Laurence Steinberg, Age of Opportunity: Lessons from the
New Science of Adolescence, 2014.
•Frances E. Jensen with Amy Ellis Nutt, The Teenage Brain. A
Neuroscientist’s Survival Guide to Raising Adolescents and
Young Adults, 2015.
 
Prevention
•US Surgeon General, National Prevention Strategy,
Preventing Drug Abuse and Excessive Alcohol Use,
http://www.surgeongeneral.gov/priorities/prevention/str
ategy/preventing-drug-abuse-excessive-alcohol-use.html
•Trust for America’s Health’s Reducing Teen Substance
Misuse: What Really Works, 2015,
http://healthyamericans.org/assets/files/TFAH-2015-
TeenSubstAbuse-FnlRv.pdf
•Community Anti-Drug Coalitions of America. The Coalition
Impact: Environmental Prevention Strategies
http://www.cadca.org/sites/default/files/resource/files/e
nvironmentalstrategies.pdf
Addiction
•Dr. Ruth Potee, Physiology of Addiction (video),
https://www.youtube.com/watch?v=eySb0etE1PA
•National Institute on Drug Abuse, Drugs, Brains, and
Behavior: The Science of Addiction,
https://www.drugabuse.gov/publications/drugs-brains-
behavior-science-addiction/drug-abuse-addiction
 
Marijuana
•Commonwealth of Massachusetts, Report of the Special
Senate Committee on Marijuana, March 8, 2016,
https://malegislature.gov/Document/Bill/189/Senate/SD
2479/DocumentAttachment/sd2479.pdf
•MA Department of Health, Medical Use of Marijuana
Program (including Guidance for Municipalities),
http://www.mass.gov/eohhs/gov/departments/dph/programs/
hcq/medical-marijuana/

•Colorado Department of Public Safety, Marijuana
Legalization in Colorado: Early Findings, March 2016,
http://cdpsdocs.state.co.us/ors/docs/reports/2016-SB13-
283-Rpt.pdf
•National Institute on Drug Abuse, Drug Facts: Marijuana,
March 2016,
https://www.drugabuse.gov/publications/drugfacts/mari
juana
•National Organization for the Reform of Marijuana
Laws
 (NORML),
http://norml.org/
 

87. Heather Bialecki-Canning Executive Director
[email protected]
Amanda Mankowsky Youth and Family Engagement
Coordinator
[email protected]
Sarah Collins Drug Free Community Project Coordinator
[email protected]

North Quabbin Community Coalition
251 Exchange St.
Athol, MA 01331
978-249-3703 www.nqcc.org