When it comes to substance use, kids aged 12-21 are turning to marijuana more often than cigarettes and alcohol. Here's what parents need to know.

American family pot smoking change
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Findings from a research article published in Springer's journal Prevention Science could serve as an important heads-up to parents of tweens, teens, and young adults. Though cigarette and alcohol use in this age group has always been of concern, a new trend appears to be taking hold. More young people are turning to cannabis as their first substance of choice, rather than smoking cigarettes or drinking alcohol, notes researcher Brian Fairman of the National Institute of Child Health and Human Development in the US. And this is especially the case among young men of specific racial and ethnic groups, he notes.

What the research found

Fairman and his research team analyzed nationally-representative, cross-sectional survey data available as part of the US National Survey on Drug Use and Health. The data was based on info from over 275,500 individuals aged 12 to 21 and was collected between 2004 and 2014. Survey respondents were asked about their use of marijuana, cigarettes, alcohol, and other forms of tobacco or illegal drugs. The respondents also disclosed which they started using first and at what age. And researchers found that in 2004, 4.8 percent of respondents said marijuana was the first drug they ever used, while in 2014, the number had jumped to 8 percent.

Meanwhile, there was a noticeable decline in kids choosing cigarettes first (a drop of about 21 percent in 2004 to 9 percent in 2014).

"We also observed a significant increase in youth abstaining from substance use altogether, which rose from 36 percent to 46 percent, and therefore, it is unclear the degree to which increases in those initiating marijuana first could be due to youth abstaining or delaying cigarettes," Fairman elaborated.

He and his team also noted that those using marijuana first were more likely to be male and Black, American Indian/Alaskan Native, multiracial, or Hispanic. Another key finding: Young people who used marijuana before other drugs were more likely to become heavy users later in life.

In his article, Fairman concluded that drug prevention strategies might be tailored to these findings. And if the trend continues, "there may be an increasing need for public interventions and treatment services for marijuana-related problems," he explained.

"Parents might mistakenly believe that their child is unlikely to have tried marijuana if that child has also never smoked cigarettes or consumed alcohol," Fairman tells Parents.com. "Therefore, our study suggests that parents should be aware of the health risks associated with marijuana smoking and communicate those risks early to their children in the same way they might do so for tobacco and alcohol. Parents can find resources at https://teens.drugabuse.gov/parents."

What pediatricians and psychiatrists say about the trend

Christian Hietanen, DO, Clinical Assistant Professor of Pediatrics at Touro College of Osteopathic Medicine in Middletown, New York says he has seen proof of these findings in his own practice. "In my pediatric office, we give all adolescents a screening form to fill out that includes questions about drug use, alcohol use, and smoking," Dr. Hietanen explains. "When it comes to smoking, it used to ask, 'how many cigarettes per day?' I remember quite vividly about four years ago, I was talking to a teenage patient, and he said to me, 'You need to change your forms, doc, no one smokes cigarettes anymore. We all smoke pot.' Anecdotal evidence in my practice would point to marijuana use in at least 30 percent of my high school-aged patients. This ranges from using it once or twice, to using it almost daily."

Dr. Hietanen attributes this change to legalization of medical and recreational cannabis and simultaneously shifting attitudes around the drug.

While legalization and less stigma is good news for many adult cannabis users, experts say we can't lose sight of the fact that frequent use, especially for kids, has been linked to negative side effects. "Essentially, the motto we’ve been using is 'No cannabis for anyone under 21,'" says Timothy Fong, MD, Professor of Psychiatry, and Faculty Director, UCLA Cannabis Research Initiative, at the University of California Los Angeles. "This is not a substance that adolescent brains should be exposed to, as the risks far outweight the benefits. Some have posited that they’d rather have adolescents using cannabis instead of alcohol and other substances citing safety reasons and less likelihood of death/overdose, but the reality is that cannabis intoxication can still result in all sorts of medical/psychological problems such as accidents, falls, psychotic states, impulsive behaviors, etc."

Addictions psychiatrist Michael D. McGee, MD, Chief Medical Officer, The Haven at Pismo agrees. "The truth is that cannabis is similar to alcohol in that just like alcohol, regular daily use impairs functioning and can lead to permanent brain damage, including permanently lowered IQ scores. Regular use can also trigger addiction in genetically-vulnerable individuals. People who use daily have a lower quality of life." Dr. McGee also points out that daily or weekly cannabis use predicts future depression and anxiety disorders.

What parents can do

It bears noting that while heavier use patterns may be of greater concern, it is not always a sign of misuse or mental illness, says Sean Luo, MD, PhD, psychiatrist and Assistant Professor of Clinical Psychiatry at Columbia University Medical Center in New York. Still, Dr. Luo recommends a proactive approach. "Whenever parents have significant concerns of an adolescents’ marijuana use, the first step is to seek a full comprehensive evaluation from a licensed treatment provider," he advises.

Ideally, Fairman's findings and additional research on the subject will raise awareness and increase access to that kind of care.

In the meantime, taking a "sensible" approach works best, says Dr. McGee. "Saying how terrible it is and you should never smoke does not work," he says. "Providing education, recommending caution and moderation, and pointing out any vulnerability to addiction are most useful. It is more useful to talk about what is good rather than what is bad—to provide a positive solution to the challenges of youth: connection, belonging, being involved in fun, challenging, stimulating, meaningful, and rewarding activities. Having friends. Having a sense of unconditional positive self-regard. What parents need to do most is provide these positive solutions so that youth have positive choices."