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.
References:
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.
http://www.mcs.bc.ca/pdf/AHS%20IV%20March%2030%20Final.pdf
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.
CBC Documentary: Nature of Things, Down side of high
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I’ll print this article to show patients – especially those asking for medical marijuana
good article to show patients
I agree that marijuana is a bigger risk to developing brains than was thought.
agree with the content
This is a compelling article on an important topic. It may change practitioners’ practices, but will it have any effect on outcomes? Unfortunately, without offering a tangible method by which we can close the loop — in the form of evidence for and resources through which a practitioner may learn effective screening and brief intervention techniques — this compelling article may not actually be particularly useful. I.e. the author presents ‘some’ compelling evidence for why she has changed her practice (and hence encourages us to do so also); but cites no evidence for practice change. Without links to brief screening and intervention evidence (and ideally the methodology tested in that research), this really important topic presentation fails to meet reasonable standards for CPD. And that is a crying shame, because this is a topic in need of more air-time! UBC CPD: Where is the rigour and consistency of presentation?:^(
it reminded me of what i was allready doing.
With so many drugs, there is a huge difference between use and abuse, the young psychotic male, was abusing it in order to treat his psychosis, and mj does not work so well, usually as part of a psychiatric history we are taught to ask about drugs and alcohol, mj is a drug, and a lot of people try to self medicate with it
I see more and more marijuana induced psychosis and anxiety in the youth in my practice. Now that the genetic link has been shown to put 1 in 4 marijuana smokers at risk for psychosis, my resolve to more forcefully give insight to the kids in my practice has definitely increased.
i think abuse needs to be treated but 1-2 cig a week wouldn’t need agressive interference
Thanks for your inquiries. I hope you will find the following information helpful.
Effect on Outcomes
There has been long term research into prevention for drug abuse. The National Institute on Drug Abuse has published Preventing Drug Use among Children and Adolescents: A Research-Based Guide for Parents, Educators, and Community Leaders. This booklet presents prevention principles for those learning about prevention. Some of these principles include enhancing protective factors and reversing or reducing risk factors, family-based prevention to enhance family bonding, relationships and parenting skills and drug education and information.
At http://ncpic.org.au/ncpic/publications/research-briefs/article/evidence-based-interventions-for-cannabis-use-disorder there are summaries about research into intervention. Several Randomized control trials suggest that brief interventions—which may involve the provision of information (including to parents), motivational enhancement techniques, and cognitive behavioural skills training—are effective in reducing cannabis use and dependence in adolescents. Extended therapies, which often incorporate significant family involvement (such as multidimensional family therapy), can also be effective in reducing cannabis use and dependence in adolescents (but, interestingly, they might not be any more effective than brief interventions – in other words, it doesn’t take much work to achieve the best results). Contingency management also shows promise in enhancing treatment engagement in adolescents.
The Justice Institute of BC offers courses on motivational interviewing, cognitive behavioural therapy and drug and alcohol use disorders. http://www.jibc.ca
Additional Resources, Information and Guidance
The National Institute on Drug Abuse http://www.nida.nih.gov/nidahome.html website has information on drugs of abuse, up to date research on substance abuse, downloadable reports and educational materials including books for order such as Marijuana:Facts for teens and Marijuana: What parents need to know. Nida’s site for medical professionals http://www.drugabuse.gov/nidamed has links to online screening tools and the aforementioned guide on preventing drug abuse. Their youth focused website http://teens.drugabuse.gov offers education using youth friendly language, free downloads, and blogging sites. At http://www.nida.nih.gov/parent-teacher.html there are materials for educating children from kindergarten to grade 9 about how substances can affect a developing body and mind.
The CRAFFT screening questionnaire for youth can be found at http://www.ceasar-boston.org/CRAFFT/selfCRAFFT.php It has been translated into multiple languages.
In B.C., community health centers provide drug and alcohol counseling to youth and young adults. For additional support and information there is the drug and alcohol referral line at 1-800-663-1441. BC’s website http://heretohelp.bc.ca offers information and education. Youth with suspected drug and alcohol disorders and mental health concerns can be referred to the Provincial Youth Concurrent Disorders Program at BC Children’s hospital.
http://www.bcchildrens.ca/Services/ChildYouthMentalHlth/ProgramsAndServices/ProvincialYouthConcurrentDisordersProgram/default.htm
Thanks again for your inquiry, and please do not hesitate to ask any further questions and/or provide further suggestions.
Carol-Ann Saari
Good reminder to ASK questions about “recreational” drug use. Also a good reminder for me that a teens brain is still developing and thus even more vulnerable to the effects of toxins.
I hope this change in practice will lead to decreased mortality
Your findings appear to be lacking in scientific evidence, or really any evidence beyond your personal experience with a limited sample of individuals. Not to mention that these individuals were likely of the similar circumstance and demographic.
I would not be so quick to create a dogmatic approach without empirical evidence. I find it particularly naive of you to be making assumptions on issues that are out of your field of expertise (eg. the potency of the Cannabis plant). You may be incorrect in your assumptions and it may cause you to end up making incorrect decisions.
Always remember, the scientific method is your friend.
Dear MrOC,
Thank you for your comments. I realize my initial post spoke mostly to my 7 years of clinical experience with youth using marijuana. However, my experience is in keeping with the research on marijuana. I urge you to read the collection of research reports from the National Institute on Drug Abuse. It is extremely informative and confirms my observations. I also recommend the “The Downside of High” by The Nature of Things where they review the potency of cannabis.
I definitely agree about the damage that marjiuana is causing to our youth! While I do understand that more investigation needs to be done to support our reasoning with our pts, I do not think that this should stop us from counseling about the clear damage that it causes in those that become addicted to it.