WASHINGTON -- If you're a teenager or a pregnant woman, the federal government has a message for you: don't use marijuana.
"Recent increases in access to marijuana and in its potency, along with misperceptions of its safety, endanger our most precious resource: our nation's youth," said Surgeon General Jerome Adams, MD, MPH, at a Thursday morning press conference -- alongside other administration officials -- to unveil a on the topic. "Over and over again, I hear a great and rising concern about the rapid normalization of marijuana use and the impact that a false perception of its safety is having on our young people and on pregnant women."
Adams also had a message for healthcare providers. "If you're a health provider, please, please get educated about the prevalence of marijuana in your community and the harms, so that you can appropriately answer patients' questions," he said.
"As of today, 33 states have legalized marijuana in some way," for medicinal use, recreational use, or both, according to Adams. "Even in [those states] that have only approved marijuana for purported medicinal use, high school students report a decline in their perceived harmfulness of the drug.... In 2017, new marijuana users between the ages of 18 and 25 rose by almost 30%, and more than 9 million 12- to 25-year-olds reported marijuana use in the prior month."
"In pregnant women, marijuana is now actually the most commonly used illicit drug," Adams said. "Between 2002 and 2017, marijuana use in pregnant women doubled. And while the perceived harm of marijuana use is decreasing, the scary truth is that the actual potential for harm is increasing; not enough people know today's marijuana is far more potent than in days past. The amount of THC [tetrahydrocannabinol], the component responsible for euphoria and intoxication but also for most of marijuana's documented harms, has increased three- to five-fold over the last few decades, and that's before you take into account concentrated forms such as edibles, oils, and waxes that can increase THC even further, by an additional three-fold. Or, as I like to say, this ain't your mother's marijuana."
In addition, "we've seen an increase in [emergency department] visits for psychosis, overdose, and accidental ingestion," he continued. "Nearly one in five people who begin marijuana use during adolescence become addicted -- you can become addicted to marijuana. The earlier and more often you use marijuana, especially at higher THC levels, the higher the risk.... Science tells us young people who regularly use marijuana are more likely to show a decline in IQ and school performance, are more apt to miss classes and ultimately to drop out, and they are even more likely to attempt suicide."
The surgeon general also noted that "marijuana use during pregnancy can affect the baby's brain and also result in lower birthweight.... THC is transmitted by breast milk, which is why ACOG [the American College of Obstetricians and Gynecologists] recommends against marijuana even after delivery. And marijuana and tobacco smoke share harmful components, so no one should smoke either product around a baby. We must take action now to protect our young people during a particularly vulnerable period in life."
Elinore McCance-Katz, MD, PhD, assistant secretary for mental health and substance use in the Department of Health and Human Services (HHS), agreed. "In our most recent national survey on drug use and health, we saw a significant increase in marijuana use by Americans 12 and older ... [a] continuing trend for increase in marijuana use in addition to an increasing potency of the drug," she said.
"The other thing we're seeing are very increased rates of major depression in adolescents; we are also seeing that in young adults and adults at large ... [and] we're seeing higher rates of serious mental illness," she said. "While we cannot say marijuana is causal of those things, when you look at the increasing trend for marijuana use and you see the association of increases in serious mental illness and major depression with suicidality in people that are marijuana users versus those who are not, it's quite concerning."
President Trump is participating personally in an HHS educational campaign on this issue: he is donating one-fourth of his annual $400,000 salary to fund the new advisory's digital outreach. "President Trump recognizes substance abuse for what it is -- a health issue, with serious and tragic effects on far too many American lives," said HHS Secretary Alex Azar, who also spoke at the event.
The marijuana-growing industry appeared to be supportive of the administration's message. "Minors, pregnant women, and people with a history of mental illness should avoid cannabis consumption unless directed by a physician," a spokesperson for the National Cannabis Industry Association wrote in an email in response to a request for comment. "We support honest, fact-based education programs to help decrease potentially problematic cannabis consumption, in those groups and in general. We do not support punitive or criminal methods of addressing health issues that may be associated with cannabis."
When asked to define under what circumstances a physician might direct an adolescent or a pregnant patient to use marijuana, the spokesperson responded that it would be "for any serious condition whose symptoms or negative impacts outweigh the potential negative impacts of cannabis.... I recommend speaking with a physician who is familiar with medical cannabis applications."