Thanks, Marc. As you indicated, I started in medical practice in 1972. Soon after that, I got involved in addictions because nobody else was doing it and I felt a great need.
Over the years, countless people have passed through my hands, and with great success. I've developed certain keys, certain techniques, and perhaps sharing these with you will help you to understand the dilemma we have with youthful use of cannabis. I have a certification in addiction medicine, and I hope that these practical comments will help to feed the creation of a public education program, which even has to precede the legalization.
Cannabis use in this presentation is predominantly about high-THC products. It does not include medical cannabis, which is predominantly cannabidiol or CBD. It's very important to make that distinction.
Teens often begin by using cannabis to relieve the anxiety of adolescence, naturally, and as a result of peer pressure, but beyond the recreational use, for some youngsters cannabis is a form of self-medication for an underlying disorder, either mental or emotional. The most common is attention deficit disorder, with or without hyperactivity. This provokes an anxiety and a feeling of inadequacy in youth. When they take cannabis, it calms this anxiety, but unfortunately it also diminishes their capacity for attention, compounding the problem.
ADHD and addiction are coexistent in at least 50% of cases. I can say that many of the youth I treat had an underlying ADHD problem that was not being treated. When I treat it, we get success.
Other coexistent psychiatric disorders include generalized anxiety, latent psychosis, post-traumatic stress, and bipolar disorder. All of these conditions exist in adolescence and are all too frequently missed by their treating physicians. They need to be diagnosed and treated, or otherwise the teenager will continue to self-medicate.
The parents of a habitual cannabis-using teenager and the physicians who treat them are well aware of the characteristic cognitive impairments affecting memory processing, reasoning and judgment, execution of tasks, insight, and time perception. These impairments become more pronounced with the duration and intensity of use and they require many months to resolve after stopping. A retardation of the emotional maturation process ensues, which is normally not completed, as you know, until the age of 25, in normal circumstances.
If addiction develops, as it will in a minimum of 17% to 25% of adolescent users, one also sees the features of addiction: a loss of control of the quantity of use, with the failure to recognize adverse consequences of use and craving leading to obsessional use. The withdrawal syndrome after cannabis cessation, which includes irritability, insomnia, and disorganization, lasts about two weeks. That plays a role in the difficulty of cessation.
Beyond that, the months required for the resolution of the cognitive impairment caused by the cannabis use contribute to a second phase of withdrawal as the person awakens to a reality that is entirely foreign and frightening, causing them to experience panic and anxiety, which often requires enormous support, including medication. The sort of behaviour we'll see is the 18-year-old who stops using, has not gone through his normal evolutionary growth from 13 to 18, and reverts to 13-year-old behaviour.
There are not many longitudinal studies to prove what is regularly observed and what I'm talking to you about. They are appearing, however. The National Institute on Drug Abuse in Washington, D.C. has produced considerable work—by Nora Volkow amongst others—and they've been cited elsewhere. A new study undertaken by NIDA in 2016 on the adolescent brain and cognitive development should bring more evidence to light.
A 2016 study in the U.K. looked at the pattern of cannabis use during adolescence and its link to harmful substance use later. In over 5,000 teens followed from the ages of 13 to 18, the study measured the amount of nicotine, alcohol, and illicit drug use. When they reached the age of 21, the study collated all of the data and found that the problematic use of nicotine, alcohol, and illicit drugs occurred 20% of the time in those using cannabis, and it was at an intensity at a rate related to the intensity of their cannabis use.
These are very telling studies that finally are being done. It's the sort of thing that we've perceived for years, but only now are they coming to light. Unfortunately, more money needs to be spent in order to aliment your public education program.
The rising problem of addiction to illicit substances and diverted prescription drugs in adolescents and adults directly correlates with the high level of regular cannabis use as well. Regardless of age, the vast majority of the people we treat for substance use disorder started with cannabis use in early life. Every single heroin addict, cocaine addict, and speed addict who I treat at 20, 30, 40, or 50 years of age started to use cannabis at the age of 12 or 13. In the case of teens caught up in the opioid crisis, for every teenager I see who is sniffing Hydromorph Contin, an enormous quantity of opiates, every single one of them started with cannabis. That's because of their loss of ability to discern danger.
As has been stated, adolescents will procure and use cannabis regardless of the legal restraints. With that in mind, the creation of an elaborate public education program is primordial.