Clinician perspectives on adolescent cannabis-related beliefs and behaviors following recreational cannabis legalization

Kelly C Young-Wolff; Monique B Does; Maha N Mian; Stacy A Sterling; Derek D Satre; Cynthia I Campbell; Lynn D Silver; Stacey E Alexeeff; Sarah F Cunningham; Asma Asyyed; Andrea Altschuler

doi:10.1016/j.addbeh.2024.108046

Clinician perspectives on adolescent cannabis-related beliefs and behaviors following recreational cannabis legalization

Addict Behav. 2024 Apr 27:156:108046. doi: 10.1016/j.addbeh.2024.108046. Online ahead of print.

Affiliations

¹ Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States. Electronic address: Kelly.c.young-wolff@kp.org.
² Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.
³ Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States.
⁴ Public Health Institute, Oakland, CA, United States.
⁵ Regional Offices, Kaiser Permanente Northern California, Oakland, CA, United States.

PMID: 38744214
DOI: 10.1016/j.addbeh.2024.108046

Abstract

Background: As more states legalize cannabis, studies are needed to understand the potential impacts of recreational cannabis legalization (RCL) on adolescents from the perspective of clinicians who care for them.

Methods: This qualitative study characterized clinician perspectives on whether cannabis legalization is associated with changes in adolescents' cannabis use beliefs, behaviors, and consequences. Semi-structured qualitative interviews were conducted with 32 clinicians in a large healthcare organization from 9/6/2022-12/21/2022. Video-recorded interviews were transcribed and analyzed using thematic analysis.

Results: The 32 participants (56.3 % female, mean [SD] age, 45.9 [7.6] years; 65.3 % non-Hispanic White) were from Addiction Medicine (n = 13), Psychiatry/Mental Health (n = 7), Pediatrics (n = 5), and the Emergency Department (n = 7). Clinicians described post-RCL increases in adolescent cannabis use, use of non-combustible modes and high-potency products, and younger age of first use. Clinicians reported social, physical, and policy changes, including changes in social norms, appealing advertisements, marketing, and easier access. Many noted fewer perceived harms among adolescents and greater self-medication post-RCL. They described how RCL contributed to increased parental cannabis use and permissiveness around adolescent use. Finally, many described post-RCL increases in cannabis hyperemesis syndrome, and several noted increased cannabis-related psychosis and acute intoxication, and decreased court-mandated treatment.

Conclusions: Clinicians from diverse specialties described post-RCL increases in adolescent cannabis use and cannabis-related consequences, alongside changes in social norms, access, marketing and advertisements, and decreased perceptions of harms. Findings can inform strategies to support adolescents in the context of increased cannabis availability and acceptability post-legalization and support the development of hypotheses for broader-scale quantitative work.

Keywords: Adolescents; Cannabis; Legalization; Marijuana; Policy.