Marijuana: What Health Care Professionals Should Know and Do

Regardless of your specialty, it’s important to understand the many ways in which youth marijuana use can compromise health and exacerbate existing physical and mental health conditions. Knowing a patient’s family medical and social history, whether they have co-occurring mental health disorders, and how marijuana is used and talked about in the home can help you protect youth who may be more susceptible. You’re in a position to keep families informed of risk and how best to intervene if marijuana use occurs.

Staying up to date is critical. New research on cannabinoid hyperemesis syndrome (CHS) shows it can occur among youth who use marijuana frequently or intensely. Most adolescents who develop CHS report daily or greater than daily use; more than 95% use at least weekly. Symptoms include severe, uncontrolled nausea, vomiting and abdominal pain, which occur in phases and can last weeks after cannabis cessation. CHS is on the differential diagnosis list for adolescents presenting with acute bouts of nausea and vomiting. The most effective remedy is cessation of cannabis use; standard antiemetic medications generally are ineffective.^[1]

Health professionals can advocate for appropriate media modeling of marijuana consumption and its consequences. First, you can lend your voice in support of policies and regulations that protect youth from access to and use of the drug. This includes reducing youth exposure to marijuana advertising and marketing and expanding youth-focused treatment services. Second, support funding for quality research into the prevention, intervention and treatment of youth marijuana use. Finally, advocate for family involvement in all aspects of care to ensure optimum outcomes for young patients.

Screening young patients for marijuana use is one of the most important measures a health care provider can take to help mitigate its harms, including the development of a marijuana use disorder. The American Academy of Pediatrics recommends the Screening, Brief Intervention and Referral to Treatment (SBIRT) approach. This should be a routine practice. In doing so, you can help prevent use and offer opportunities to intervene if a young person has already begun to use or is experiencing marijuana-related problems.

Try to determine why the patient uses marijuana – to get high with friends (social reasons) or to get through the day (coping motives). The answer can help guide a clinician’s intervention toward psychoeducation interventions or mental interventions.

Assess patients whose screening results are positive for frequency and intensity of marijuana use to determine the appropriate level of intervention. Use brief intervention techniques in the clinical setting. Finally, be familiar with motivational interviewing techniques for patients who do not need immediate referral to treatment.

Below is a list of approved screeners for marijuana and other substances aimed at young patients:

• CRAFFT is a validated, in-depth screening tool that identifies problem marijuana use. It has recently been updated to include marijuana edibles and vaping.
• S2BI (Screening to Brief Intervention) categorizes adolescent substance use into different risk categories.
• BSTAD (Brief Screener for Tobacco, Alcohol and other Drugs) screens adolescents through frequency-of-use questions.
• A single screening question such as, How often have you used marijuana over the past year? can be as effective as a full battery of questions, if time is limited.

Be aware that young people might perceive pen and paper or interview screenings as less confidential than computer-administrated screenings.

Marijuana screening tools generally include questions on personal use, friends’ use and family use, as well as a risk assessment. Given the high co-occurrence of mental health and substance use disorders in adolescents, health professionals need to assess and ask questions related to their patients’ psychological health. Even if a patient does not use marijuana, it is helpful to positively reinforce this choice and provide assistance should the patient face pressure to use marijuana.

Providers can intervene and refer patients to treatment as necessary. Performing a risk assessment (e.g., considering how often the patient uses marijuana and how much) helps professionals provide the most appropriate intervention. For example, brief advice alone may be sufficient for some, while full treatment might be right for others. In all cases involving youth substances, family-based interventions should be incorporated when possible. Treatment typically involves age-appropriate psychosocial therapies, such as cognitive-behavioral therapy, motivational enhancement therapy and family interventions. There currently is no Food and Drug Administration-approved medication to treat marijuana use disorder.