August 27, 2019
By Will Boggs MD
NEW YORK (Reuters Health) - Nearly a quarter of 8th-, 10th-, and 12th-graders have used cannabis concentrate at some point, a survey of Arizona students suggests.
"There is almost no research on cannabis-concentrate use in adolescents, and so it was surprising to find that so many Arizona teens have used cannabis concentrates," Dr. Madeline H. Meier of Arizona State University, in Tempe, told Reuters Health by email.
Higher tetrahydrocannabinol (THC) concentrations are thought to increase the risk for cannabis use disorder, cognitive impairment, psychosis, and other adverse consequences. THC concentrations in cannabis concentrates range from an estimated 39% to 69%, compared with average THC content in marijuana ranging from 12% to 20%, Dr. Meier and her colleagues note in Pediatrics, online August 26.
Among more than 47,000 adolescents who participated in the 2018 Arizona Youth Survey, 33% reported lifetime cannabis use, 24% reported lifetime cannabis-concentrate use, 18% reported cannabis use in the past month and 13% reported cannabis-concentrate use in the past month.
Nearly half of 12th-graders (46%) reported lifetime cannabis use, and a third (33%) reported lifetime cannabis-concentrate use.
Cannabis concentrate users had the highest lifetime risk of other substance use. For example, the odds of using e-cigarettes were 3.24 times higher for concentrate users than for cannabis users who had not used concentrates and were 24.50 times higher for concentrate users than for cannabis nonusers.
Concentrate users were also significantly more likely to initiate substance use before age 17, with 75% higher odds of using alcohol before age 17 compared with cannabis users who had not used concentrates and 13.86-fold higher odds of using alcohol before age 17 compared with cannabis nonusers.
Adolescents who used cannabis concentrate had the highest level of risk and the lowest level of protection on every substance use factor, including perceived risk of harm from marijuana, peer substance use, parental attitudes toward drug use, commitment to school, and perceived availability of drugs in the community.
"Pediatricians should routinely screen for cannabis use and deliver brief interventions to reduce teen cannabis use," Dr. Meier said.
"I think it is important that parents, teachers, and pediatricians educate themselves about cannabis concentrates - what they look like and how they are used," she said. "That way, adults know what to look for when they suspect a teen might be using cannabis."
"We don't yet have a good understanding of the risks associated with the use of high-THC cannabis, such as cannabis concentrates," Dr. Meier said. "We need controlled laboratory studies of cannabis concentrates, but because cannabis is a Schedule 1 drug, laboratory research is very difficult. We also need longitudinal studies to document long-term outcomes of adolescents who use cannabis concentrates and to disentangle effects associated with selection into concentrate use from effects of exposure to higher-THC cannabis."
Dr. Maria Melchior from Institut Pierre Louis d'Epidemiologie et de Sante Publique, in Paris, who recently reported an association between early cannabis initiation and low educational attainment, told Reuters Health by email, "The prevalence of use of cannabis concentrates is astounding."
"Regulation of access to cannabis concentrates, as well as e-cigarettes, which are used to vape cannabis concentrates, should be strengthened," she said.
"The impact of liberalization of cannabis policy on adolescents' patterns of use, as well as the profile of adolescents at highest risk of chronic use (particularly in terms of socioeconomic standing, area of residence, and ethnic background) need to be followed," added Dr. Melchior, who was not involved in the new study. "Also, long-term trajectories of use in a context of partial or full legalization need to be ascertained."
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