CT Approves Recreational Marijuana Despite Studies Raising Concerns on Youth Impact

The actions come despite studies released earlier this year in the U.S. and Europe that some suggested provided sufficient reason to pause before moving forward, and despite warnings from the Connecticut State Medical Society, among other organizations.

The “conclusion and relevance” of one study, published in January in the Journal of the American Medical Association (JAMA) Pediatrics, specifically indicated that its “findings should be considered as states contemplate” legalization.

That report found heavy use of marijuana by teens and young adults with mood disorders -- such as depression and bipolar disorder -- is linked to an increased risk of self-harm, suicide attempts and death. Unintentional overdoses, suicide and homicide were the three most frequent causes of death, the research found.

Another study, conducted in Europe and published late in 2020, found that young Europeans are drinking less alcohol and also smoking less— but are increasingly dabbling with cannabis.

“Smoking and drinking among 15- to 16-year-old students are showing signs of decline, but there are concerns over potentially risky cannabis use and the challenges posed by new addictive behavior,” according to the European School Survey Project on Alcohol and Other Drugs (ESPAD).

"The perception is that marijuana is safe to use, but we need to educate parents and kids that there are risks involved, particularly with heavy and high potency cannabis use," said study author Cynthia Fontanella, an assistant professor in the department of psychiatry and behavioral health at the Ohio State University's (OSU) College of Medicine, in a CNN story on the JAMA Pediatrics-published study findings.

In a follow-on article published by the OSU Wexner Medical Center and written by Fontanella summarizing the study, she noted that “in particular, patients who were older, male, Black, bipolar or “other” mood disorders, with a prior history of self-harm and previous mental health service use, including psychiatric hospitalization and emergency department visits, had a significant association with abusing marijuana.”

The analysis included included 204,780 Ohio youth (age 10 to 24 years) diagnosed with mood disorders between July 1, 2010 and Dec. 31, 2017 and followed for up to one year from the initial claim until the end of enrollment, the self-harm event or death.

Fontanella added that “unfortunately, while our observational study calls attention to these associations, it’s unable to contribute to our understanding of causality or mechanism. That’s why we plan to do more studies on the role of marijuana laws on youth mental health outcomes.”

Regarding the study of European youth across multiple nations, only 10% of those questioned said they smoked cigarettes on a daily basis — down by half compared with 25 years ago in the face of anti-smoking campaigns. The study also found more than three-quarters of those questioned had used alcohol and 47% had consumed in the past month — but the trend is downward, compared with 91% and 63% respectively in 2003.

The study found, however, that 16% of those participating in the survey admitting to trying cannabis — compared with 11% in 1995.

In the United States, marijuana use is widespread among adolescents and young adults, according to the National Institute on Drug Abuse, an agency within the federal government’s National Institutes of Health. The agency’s Monitoring the Future survey—an annual survey of drug use and attitudes among the Nation’s middle and high school students— found last summer that in in 2019, there was a significant increase in daily use in the younger grades. In addition, teens’ perceptions of the risks of marijuana use have steadily declined over the past decade.

In 2019, 11.8% of 8th graders reported marijuana use in the past year and 6.6% in the past month (defined as current use). Among 10th graders, the agency’s Marijuana Research Report found, 28.8% had used marijuana in the past year and 18.4% in the past month. Rates of use among 12th graders were higher still: 35.7% had used marijuana during the year prior to the survey and 22.3% used in the past month; 6.4% said they used marijuana daily or near-daily.

The report also notes that “Some research suggests that marijuana use is likely to precede use of other licit and illicit substances and the development of addiction to other substances.” But it points out that “the majority of people who use marijuana do not go on to use other, ‘harder’ substances,” adding that “further research is needed to explore” whether marijuana is a “gateway” drug.

The State of Massachusetts web page summarizing the “health effects of marijuana” notes that “your brain doesn’t finish developing until you are in your mid-20’s, so using marijuana before then can interfere with that. It can affect memory, learning and attention, and make problem solving harder,” adding that “we still have a lot to learn about whether marijuana use leads to mental health problems.” Marijuana is legal in Massachusetts for people 21 and older, and has been available since late 2018.

Published reports indicate that as of last fall, a total of 689 licenses have been approved in Massachusetts, which includes 268 retail establishments. In total, the state’s commission regulating marijuana has received 904 completed applications to operate in over 160 municipalities. As of last October, 77 dispensary locations have begun operations in the state.

In April, the Connecticut State Medical Society renewed its concerns about the public health dangers of legalization.

“Chronic marijuana use has long-term cognitive effects,” warns Dr. Gregory Shangold, President of the Society, in an interview on the Connecticut Medical Society podcast. Shangold, an emergency physician, pointed out that the potency of the current marijuana substances is much higher than years ago, and “we’re seeing the effects of that.”

In testimony before the legislature’s Public Health Committee, the Society offered forceful opposition.

“CSMS is fiercely opposed to the legalization of recreational marijuana. We have significant concerns about the lack of scientific evidence that supports recreational marijuana use by adults and young adults,” the testimony stated.

“We must look at the potential effect legalization will have on overall use and significant harms, including impaired driving and accidents, creation and worsening of severe mental health issues, and negative impacts on developing minds. The rush towards legalization of recreational marijuana ignores how profit-driven corporations hooked generations of Americans on cigarettes and opioids, killing millions and straining public resources. We need to learn the lessons from history to ensure that any legalized marijuana product does not become the Big Tobacco of the 21st Century.”

On the podcast, and in the testimony, much of the focus was on youth.

“Research on adolescent brain development has found that brain maturation, particularly that of the prefrontal cortex, proceeds into the mid-20s. The earlier an adolescent experiments with marijuana, the more at risk they are for increased substance use later in life,” the testimony stated.

Shangold, in the podcast interview, said that “one of the dangers of ongoing discussion of legalization of recreational marijuana in recent years is that, particularly among youth, we’ve “lowered the impression that this is a harmful substance.” In Connecticut, and particularly in states that have already legalized, Shangold said, “we’re seeing the results… The truth of the matter is that youth are now using it more.”

He noted in the podcast a recent study published by the Journal of the American Medical Association that indicates impairment among youth can linger for up to 5 hours after use, which he says can be particularly dangerous if young people are driving during that time. He underscores that the state has taken steps through the years, through motor vehicle laws, to protect the safety of young drivers. Legalizing recreational marijuana would do just the opposite.

He also pointed out that state government has an infrastructure – and funding – in place to discourage youth from smoking cigarettes. No such effort exists regarding marijuana, which also heightens concern among physicians as to what might occur if legalization were to proceed.

In an op-ed appearing in The Hartford Courant, Shangold indicated that “since the state of Washington legalized the recreational use of marijuana studies have shown that 23% of youths who committed suicide had marijuana in their systems – up from 14%.” He also noted that “cannabis user disorder in young people has grown 25% in states that have legalized marijuana.”

“This isn’t a theoretical,” Shangold stressed in the podcast. “Many states have passed this, and we’ve seen the deleterious effects. This is what will happen to Connecticut if we pursue legalizing recreational marijuana.”

In the event this legislation does move forward, the Society urged a number of steps to lessen the impact on public health, particularly the health of Connecticut’s adolescents and youth. They urged the legislature to:

Raise the legal age of marijuana use and purchase to 25

Ensure dispensaries are not within close proximity to college campuses

Restrict marketing efforts overall and in particular to individuals under the age of 25

Restrict purchase amounts for consumers between the ages of 21 and 25

It is unclear whether any of those proposed limitations have been included.

“We believe Connecticut should not sacrifice the health and well-being of our youths for the unproven promise of increased revenues,” Shangold emphasized in the op-ed. “Allowing the recreational use of marijuana is bad science, bad policy and dangerous to Connecticut’s public health.”