Dr. Carol-Ann Saari (biography and disclosures)
What I did before
I used to buy into the idea that marijuana use was nothing to get too worried about. “It’s a soft drug…. all the kids are doing it… there are few repercussions from using pot”. I didn’t focus too much of my time on marijuana use. Cocaine, heroin, crystal methamphetamine – those were the drugs that needed the attention. If the youth stopped those and continued with marijuana, it seemed to me to be a “safer” choice. I didn’t aggressively target marijuana use from a harm reduction perspective. I’m not sure, looking back, whether I even really asked the questions about how much, how long, and how often used…
What changed my practice
I began consulting to the Provincial Youth Concurrent Disorders Program at BC Children’s hospital. I was seeing youth from 12-25 with anxiety, psychosis, depression, sleep disorder – all in the context of marijuana use.
Through this, I became aware of the high rate of concurrent mental health and substance use disorders in youth (about half of youth with a substance use disorder have a comorbid psychiatric disorder). I discovered that marijuana is one of the top 3 substances used by youth (the others being cigarettes and alcohol), and that early age of onset use is increasing (use as early as 9 years old was 1% in 2003, increasing to 3% in 2008). I learned more about the stages of cognitive development in youth and how substances can affect a developing brain. I learned about the horticulture of marijuana in today’s society and how marijuana may be more potent than in previous years and that THC increase could be associated by a corresponding decrease in cannabidiol, a natural antipsychotic in marijuana (see “Downside of High” on The Nature of Things). Perhaps most persuasively, as a front-line observer, I watched as a functioning youth became more and more psychotic as he smoked large amounts of marijuana every day, and I saw how difficult it was to treat his psychosis even after the marijuana stopped.
What I do now
I no longer think of marijuana as a benign drug. I ask about it every time I see a patient. I counsel harm reduction. I educate about the potential consequences of marijuana use on a developing youth’s brain. I assess for a co-morbid mental health condition. I talk to my kids about drugs (as naturally as I can) with a determined purpose – to warn them and educate them. The longer they can let their brains develop without exposure to drugs, the healthier their brains will be. I encourage early detection of problem marijuana use and referral on for assessment and intervention as a high priority. I aggressively treat it. I don’t want to see potential “wasted” on marijuana.
Smith, A., Stewart D., Peled, M., Poon, C., Saewyc, E. and the McCreary Centre Society (2009). A Picture of Health: Highlights from the 2008 BC Adolescent Health Survey. Vancouver, BC: McCreary Centre Society.
The Downside of High Documentary directed and written by Bruce Mohun, story-produced by Maureen Palmer, and produced by Sue Ridout for Dreamfilm Productions of Vancouver, The Nature of Things with David Suzuki, 2010.