CO pediatricians warn against legalization

I’m so pleased that more physicians are taking strong, public stands against marijuana legalization — and I wish more doctors, hospitals and medical associations would join us. My thanks to the Colorado chapter of the American Academy of Pediatrics for sending this letter to Coloradans. May others learn from — and avoid — the mistakes several states, including Colorado, have made.

October 5, 2012

Fellow Coloradans:

Have you heard about Amendment 64? Make sure to think about Colorado’s kids and know the facts before you vote in November. Regardless of your feelings about marijuana, we, as pediatricians, feel it is important to know about how marijuana legalization can affect children and teenagers and the increased risks they could face if Amendment 64 passes.

Here’s what the studies have found.

Marijuana and Young Children

Since medical marijuana dispensaries began operating in 2009, there have beenmore accidental ingestions of marijuana by young children in Colorado (1, 2).

• Between October 2009 and December 2011, there were 14 children (ages8 months-12 years) seen for accidental marijuana ingestions at Children’s Hospital Colorado.
• Of these children, 9 had documented exposure to
  someone else’s medical marijuana, 8 were hospitalized, and 2 required admission to the intensive care unit (2).

There were no children seen at Children’s Hospital Colorado for accidentalmarijuana ingestions from January 2005 to October 2009 (2).

Marijuana and Teenagers

Chronic use of marijuana before age of 15 leads to worse neurocognitive functioning (i.e. ability to think, to reason, and to work) later in life (3).

Use of marijuana before age 18 increases risk of other illicit drug use (4).

Using marijuana as a young teenager puts vulnerable individuals at increasedrisk of developing of psychosis (5).

In Colorado, 49-74% of teenagers in drug rehabilitation programs report buying or receiving marijuana from a person with a medical marijuana card (6, 7).

Easy access to marijuana in the community and having friends and family whouse marijuana makes teenagers much more likely to use marijuana (8-11).

Marijuana use is generally higher in countries where nonusers associate fewer risks with it and where marijuana availability is high (12).

• In the Netherlands where there is acceptance of marijuana, 28% of boyshad used marijuana and 4.3% had frequent use.
• In contrast, Sweden where marijuana tolerance is zero, only 7.6% of boyshad used marijuana and 0.7% had frequent use.

Other Potential Costs

Marijuana can lead to more reckless driving (13).

Compared to 2007-2008, there have been 15 more fatal car crashes involving a driver under the influence of marijuana in 2009-2010 (14).

For every $1 received in taxes from alcohol, more than $10 are spent on alcohol-associated conditions (15). It is unknown how much will be spent in the future for marijuana-related illnesses such as lung disease, cognitive impairments, andmental illness (3, 5, 16).

Sincerely,
Colorado Chapter, American Academy of Pediatrics
Dr. Cathryn Wells, MD, FAAPDr.
Claudia Kunrath, MD, FAAPDr.
Kristine Knuti Rodrigues, MD, FAAPDr.
George Wang, MD

References
1. Wang GS, Narang SK, Wells K, Chuang R. A case series of marijuana exposures in pediatricpatients less than 5 years of age. Child Abuse Negl. 2011;35(7):563-5.

2. Wang GS, Heard K, editors. Pediatric marijuana exposures in a medical marijuana legal state.North American Conference of Clinical Toxicology; 2012 October 4, 2012; Las Vegas, NV.

3. Fontes MA, Bolla KI, Cunha PJ, Almeida PP, Jungerman F, Laranjeira RR, et al. Cannabis usebefore age 15 and subsequent executive functioning. Br J Psychiatry. 2011;198(6):442-7.

4. Lynskey MT, Vink JM, Boomsma DI. Early onset cannabis use and progression to other drug usein a sample of Dutch twins. Behav Genet. 2006;36(2):195-200.

5. Dragt S, Nieman DH, Schultze-Lutter F, van der Meer F, Becker H, de Haan L, et al. Cannabisuse and age at onset of symptoms in subjects at clinical high risk for psychosis. Acta Psychiatr Scand.2012;125(1):45-53.

6. Salomonsen-Sautel S, Sakai JT, Thurstone C, Corley R, Hopfer C. Medical marijuana use among adolescents in substance abuse treatment. J Am Acad Child Adolesc Psychiatry. 2012;51(7):694-702.PMCID: 3381870.

7. Thurstone C, Lieberman SA, Schmiege SJ. Medical marijuana diversion and associated problemsin adolescent substance treatment. Drug Alcohol Depend. 2011;118(2-3):489-92. PMCID: 3178678.

8. Hofler M, Lieb R, Perkonigg A, Schuster P, Sonntag H, Wittchen HU. Covariates of cannabis useprogression in a representative population sample of adolescents: a prospective examination of vulnerability and risk factors. Addiction. 1999;94(11):1679-94.

9. von Sydow K, Lieb R, Pfister H, Hofler M, Sonntag H, Wittchen HU. The natural course of cannabis use, abuse and dependence over four years: a longitudinal community study of adolescents andyoung adults. Drug Alcohol Depend. 2001;64(3):347-61.

10. von Sydow K, Lieb R, Pfister H, Hofler M, Wittchen HU. What predicts incident use of cannabisand progression to abuse and dependence? A 4-year prospective examination of risk factors in acommunity sample of adolescents and young adults. Drug Alcohol Depend. 2002;68(1):49-64.

11. Amos A, Wiltshire S, Bostock Y, Haw S, McNeill A. ‘You can’t go without a fag…you need it for your hash’–a qualitative exploration of smoking, cannabis and young people. Addiction. 2004;99(1):77-81.

12. ter Bogt T, Schmid H, Gabhainn SN, Fotiou A, Vollebergh W. Economic and cultural correlates of cannabis use among mid-adolescents in 31 countries. Addiction. 2006;101(2):241-51.

13. Richer I, Bergeron J. Driving under the influence of cannabis: links with dangerous driving,psychological predictors, and accident involvement. Accid Anal Prev. 2009;41(2):299-307.

14. Halpape H. Colorado Drugged Driving Fact Sheet. 2011 [updated 2011; cited]; Available from:http://www.coloradodot.info/programs/alcohol-and-impaired-driving/druggeddriving/assets/DruggedDrivingFactSheet082011.pdf

15. Naimi TS. The cost of alcohol and its corresponding taxes in the U.S.: a massive public subsidyof excessive drinking and alcohol industries. Am J Prev Med. 2011;41(5):546-7.

16. Van Hoozen BE, Cross CE. Marijuana. Respiratory tract effects. Clin Rev Allergy Immunol.1997;15(3):243-69.