Teen cannabis vaping: How doctors can counter the rising trend

Sara Berg, MS , News Editor

Even as a mysterious vaping-related lung illness claims young lives, more teenagers are vaping cannabis than before, according to a recent research letter. While nicotine use is most common, delta-9-tetrahydrocannabinol, or THC, which is the principle psychoactive constituent of cannabis, is also being vaped. This increased use is raising concerns about potential health effects.

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Published in JAMA, the research letter, “Trends in Reported Marijuana Vaping Among U.S. Adolescents, 2017-2019,” found that 3.9% of eighth graders reported use of cannabis vaping products. That represents an increase of 1.3% from 2018. Cannabis vaping was also used by 12.6% of 10th graders, a 5.6% increase. The highest rise in use was seen in 12th graders who experienced a 6.5% increase, reaching 14%.

The use of e-cigarettes and vaping is part of a public health epidemic. With the rise in cannabis vaping, the AMA is urging e-commerce CEOs to vigorously enforce their existing policies to keep illicit vaping products off their platforms. This includes being vigilant against the sale of empty vaping cartridges and other items used to create counterfeit vaping products.

The AMA has called for a total ban on all e-cigarette and vaping products that do not meet FDA approval as cessation tools.

“As the number of adolescents who vape cannabis increases, so too does the scope and effect of any associated health consequences, which may include lung injury when using black market formulations,” says the JAMA research letter. “The rapid rise of cannabis vaping indicates the need for new prevention and intervention efforts aimed specifically at adolescents.”

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Cannabis is commonly used by adolescents, second only to alcohol, according to the U.S. surgeon general’s advisory on cannabis use and the developing brain. While the use of vaping products continues to increase, high-school students’ perception of harm from regular use has continued to fall over the last decade.

This poses a greater risk for adolescents because the human brain continues to develop from before birth into the mid-20s, making it vulnerable to the effects of addictive substances. Frequent cannabis use during adolescence can be associated with changes in attention, memory, decision making and motivation.

Doctors who treat teenagers are in an influential position to address adolescent cannabis use. In the office setting, physicians can educate and counsel their patients to prevent and address cannabis use.

Here are six tips from the American Academy of Pediatrics (AAP) Committee on Substance Use and Prevention that can advance the conversation.

Screen for substance use. It is recommended that physicians screen adolescents and preteens for substance use. The AAP suggests using the Screening, Brief Intervention, and Referral for Treatment technique as part of routine care in pediatric practices.

Discourage use of vaping. For adolescents who do not use cannabis, try motivational techniques to elicit reasons for abstaining from use. Physicians should also discuss resisting peer pressure in a manner that supports their decision to abstain, while working with parents to establish a proper prevention plan.

Address regular or heavy use. If adolescents regularly or heavily use cannabis, they may meet the criteria for substance use disorder. For these teenagers, target reduction while continuing the conversation. A mental health or behavioral counselor can also help address this issue with the patient and parent.

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Determine extent and severity. To determine the extent and severity of use, ask the adolescent how much and how often they use cannabis. You can also ask about the circumstances and motivations behind their decision for using this substance.

Take a detailed history. When discussing with teenagers, take a detailed history that includes identifying concerns associated with cannabis use. Most teens use cannabis for positive euphoric effects or for self-medication, such as addressing sleep problems or anxiety. If teens use cannabis for self-medication, it can signal a mental health disorder, which can benefit from treatment.

Pose a challenge. If an adolescent does not report regular use and denies problems, the AAP suggests physicians offer a “challenge” to their patient. This can be asking them to quit for a brief period. If they stop completely, ask if it made them feel better, worse or the same. And if they were unable to quit, work with them to explore triggers and high-risk situations that might be barriers to success.