Cannabis might still be banned federally, but most U.S. adults (88%) say it should be legal, according to a Nov. 22 Pew Research Center poll—and in nearly half of states, it is. Like any psychoactive substance, however, cannabis comes with some health risks, especially for children and adolescents.
Over the last two decades, cannabis cases have flooded hotlines U.S. Poison Control Centers—facilities across the country staffed by toxicology experts who provide 24-hour-a-day guidance to both the general public and health professionals. According to a new study published in Clinical Toxicology on Dec. 5, which reviewed records of nearly 339,000 poison control cases, the number of calls involving marijuana rose 245% among 6- to 18-year-olds between 2000 and 2020. Over 80% of exposures were among adolescents 13 to 18.
The study did not describe the health issues caused by or associated with cannabis in these cases, but physicians who work with children say they can be serious, including episodes of psychosis. Other problems associated with cannabis are less dramatic, but also concerning, including memory problems, worsened mood problems, and trouble in school.
Why were more cases involving children and cannabis reported?
Cannabis cases rose by about 25% between 2010 and 2017, but jumped 40% between 2017 and 2020. This period coincided with the legalization of cannabis in many U.S. states, notes Dr. Adrienne Hughes, an assistant professor of emergency medicine at Oregon Health and Science University and the lead author of the paper. In that time frame, Michigan, Illinois, Arizona, and 10 other states all legalized recreational or medical marijuana use. “Obviously, it’s only legal for adults, and not children, but I think that we can probably agree that it has rendered the drug more accessible to children, and probably contributing to the perception that it’s safe as well,” says Hughes.
Another problem is that over the last few years, young people have increasingly used cannabis in newer forms, including in vapes and as edibles, the authors note. Edibles, in particular, have become more common among calls to Poison Control Centers. Though studies have shown that teens believe they’re less harmful than the traditional method of smoking marijuana, edibles pose their own set of risks. It can be difficult to manage your dose when consuming edibles, and they may take hours to kick in—which means that kids may unwittingly eat more to try and feel their effects.
More from TIME
What are the risks of cannabis for kids?
Marijuana is safer than many other illicit substances like cocaine or opioids, but that is not to say that it is 100% safe. Research suggests that kids may face greater mental health risks like worsened depression and anxiety, poor attention and memory problems, and cannabis use disorder than adults, as their brains are still developing.
In some cases, cannabis can even land children in the hospital. Dr. Willough Jenkins, a psychiatrist at Rady Children’s Hospital-San Diego, the largest children’s hospital in California, says that she’s seen a dramatic increase in the number of older children being hospitalized after consuming cannabis in the last five years. She now sees several adolescent patients a week with cannabis hyperemesis syndrome, a condition involving severe vomiting which is caused by prolonged exposure to cannabis, which puts people at risk of weight loss, dehydration, and malnourishment. Patients are typically treated with IV fluids or, in some extreme cases, feeding tubes.
Jenkins also sees two or three cases a month in which cannabis use appears to have triggered a psychotic episode. “You have a youth coming into the hospital very confused, usually very disoriented, not knowing where they’re at, hallucinating,” she says. “These youth come in not able to feed themselves, not being able to get to the bathroom.”
How should I talk to my child about cannabis?
Building trust with your kids and creating a “sense of safety” is essential, says Emily Jenkins, who researches youth substance use and is an associate professor in the School of Nursing at the University of British Columbia in Canada (and is not related to Dr. Willough Jenkins). Ideally, you can avoid a specific, serious talk about it, as that could very well make a teenager shut down to anything you’re saying— it’s better to bring up these conversations more frequently and in a more casual way, such as when marijuana is mentioned in a television show.
“We can create a space that’s open, and where young people feel safe to be able to disclose their substance use or cannabis use decision making considerations and practices,” she says. If parents are too harsh when they talk about cannabis, or, on the flip side, if they are too permissive, children may be left with “nowhere to turn when they need advice or guidance,” she says.
How can I help my child to make their cannabis use safer?
Emily Jenkins notes that Canada, where she lives and which has legalized cannabis, offers a list of guidelines designed to make consuming cannabis safer. In particular, she says, parents should recognize that the greatest risks come when kids are younger—under 16, per the Canadian guidelines—and using cannabis too frequently (daily or almost every day). Jenkins adds that choosing cannabis products with a lower THC content (experts often classify a THC level of 15% or more as high potency) as well as avoiding smoking to avoid breathing in carcinogens, can also help.
Dr. Willough Jenkins, the California psychiatrist, says she sometimes works with adolescent patients to adopt healthier ways of smoking, such as reducing the amount they consume or the amount of time they spend using cannabis. Some children are also using marijuana as a way to cope with mental health challenges, such as depression or anxiety, and may need help to address their underlying condition. Experts generally agree that parents should watch for red flags to show their child’s cannabis use is getting out of control, such as missing school or showing up intoxicated; excessive coughing; or acting paranoid. It’s also essential that some teens don’t use cannabis at all—including children with conditions like cystic fibrosis, who are taking other medications and might be at risk of dangerous drug interactions, or who have a family history of psychosis.
Jenkins emphasizes that cannabis use is not “safe.” Even if it doesn’t land most users in the hospital, it comes with very real risks, including addiction. However, when she encounters a patient using cannabis heavily, she does what she can to help them make their use safer. “If I told them you can’t use marijuana, they’d say, ‘see you later,’ which isn’t what I want,” she says. “So even though I would hope they would get to a place where they didn’t need to use marijuana, I work with them where they’re at.”
More Must-Reads From TIME