Earlier this week, the American Academy of Pediatrics (AAP) issued an updated policy statement about the legalization of marijuana for both recreational and medical use in the United States. Since its last statement about the matter in 2004, many states have passed laws legalizing marijuana for medical use, and a small number, as well as the District of Columbia, have legalized it for recreational use also. The AAP has policy positions about all manner of issues related to the health and well-being of children and adolescents, and an update to its stance on marijuana policy taking into account the changes in legal status around the country was clearly due.
As a proud AAP member myself, I tend to agree with its policy statements almost all of the time. Indeed, there is a lot in this new policy statement (PDF) that I agree with, too. It calls for the decriminalization of pot, and an end to the life-altering ill effects for youth that can follow felony convictions for possession and use. It urges limitations on medical-marijuana use to those that have been evaluated by the Food and Drug Administration, and encourages investigation of means for delivering the active ingredients that bypass the ill effects of smoking weed. The technical report that accompanies the policy statement (PDF) contains further information debunking the notion that marijuana is a benign substance, particularly for those whose brains are still developing.
I am down with all of that. However, there is one significant area where my opinion and the AAP’s part ways: It opposes outright legalization of marijuana use, and I do not.
In opposing legalization, the AAP makes reference to potential harms to children and adolescents that may come from allowing recreational use. However, at this time there are insufficient data about the effects of legalization on rates of adolescent marijuana use. According to the AAP’s articles, there has been little change in teen pot use in states where it has been decriminalized, but it’s too soon to tell what will happen when it’s legal to buy and sell it outright. It may be that more teenagers will smoke it, perhaps related to advertising subtly aimed at them or the implied message that weed can’t be all that harmful if it’s legal.
But what seems impossible to deny is that making recreational marijuana use illegal for everyone has been a failure when it comes to stopping it.
Among the many very personal questions I ask when I do annual checkups for my adolescent patients are questions about substance use. I’ve found that frank, non-judgmental, one-on-one queries often elicit honest responses. For others, their guiltily elusive denials are such obvious tells that, with a little gentle prompting, I get the truth. And the truth is that a lot of them smoke weed.
I make reference to many of the same ill effects that the AAP includes in its report when I discourage my patients from using it. It’s bad for their lungs, and can have a lot of negative cognitive or psychological effects, as well. But the fact that it’s illegal barely registers as more than an inconvenience to most of them. With one of the databases the AAP uses in its report showing that about 20 percent of high-school seniors are current users, it’s hard to view keeping marijuana illegal as an effective disincentive.
Is it plausible that removing this disincentive will lead more teens to smoke pot? I grant it may have some effect. But we just don’t know how many kids there are out there who are more concerned about the legal status of marijuana than about the ill physical and psychological effects. I suspect the latter are much more salient factors for most than the former.
As an advocacy group for children’s health, it is entirely understandable that the AAP would focus solely on the potential for harm to them as a justification for policy positions. But we tolerate adult access to many things that are harmful to children, the most ready examples being alcohol and tobacco. In order to justify even non-criminal penalties for grown-up use of something, the harm must be sufficiently great and the penalties effective as a disincentive. With even laundry pods causing more documented deaths than marijuana toxicity, current marijuana policy across most of the country fails on both counts.
Illegal drug use among adolescents has waned even as attitudes about marijuana use have grown more tolerant nationwide. While it is possible that legalization will reverse this trend, I am skeptical on that front. But an unspecified and currently unknown number of potential teenage users for whom illegality is the decisive factor is simply insufficient as a basis for keeping it restricted for adult use.
I agree with the AAP that marijuana is bad for adolescents, and will continue to counsel my patients against using it. I join them in urging decriminalization, and in supporting further study about how changing marijuana policies affect patterns of teenage use. But I cannot agree that there is enough evidence about potential harm to children and adolescents from a change in policy to justify keeping it illegal for adult use.