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Welcome to the Screenagers podcast. I'm Delaney Rustin, physician and the filmmaker of the Screenagers movies. Today, we're talking about cannabis, teenagers and our tech revolution. We delve into messages teens are getting about weed on social media. What do we know about teen use and mental health problems, including addiction, and what's going on with the lack of regulation when it comes to the cannabis industry. In addition, we'll explore helpful approaches for talking about cannabis with youth in our lives. And let's start by hearing from some teens about what's happening in their digital spaces regarding weed.

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On Instagram, you can follow accounts that will teach you literally anything about anything. If you want to learn how to roll joints, I guarantee there's an Instagram page that teaches you every single way you can roll a joint from every different country and how it's different. And because of that, when you have access to this stuff and you're seeing so many people do it all the time, you don't pick up on how bad it may be for you. You just pick up on, oh, there's a lot of people doing this, and they do it in really cool ways. That's awesome. Let me try it.

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One YouTuber that I really like, I

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watched a video of him and he got sent a huge sum of weed to try.

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Yeah, you can get sponsored by all those companies, any, any weed brand company.

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And it's not just influencers.

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Online.

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Adolescents are seeing their peers use. This is a level of exposure to use that we adults never had growing up.

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My friends, they would post themselves just getting absolutely drunk, high, whatever, and doing hilarious things. So there's a comedy aspect that you buy into as well, where you're like, oh, this is just hilarious. Nothing else, nothing more. It's funny and there's nothing else to it.

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Let's hear now from a college student who talks about the intersection of their weed use and their screen time.

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Whenever I was high, I was always on screens, scrolling Instagram, TikTok movies, YouTube shorts. Just random, random distractions that would not even register as a waste of time because the dopamine from the weed would make it so satisfying. But later I would realize how much of time passed fast and passed pointlessly.

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Messages about weed are being fed to adolescents in all sorts of ways. One of the messages out there is the idea that, well, weed is natural and it can be used to treat all sorts of things.

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We are certainly seeing kids who are using cannabis instrumentally, meaning that they're using it to treat some symptom. They're using it sometimes to treat pain or discomfort or whatever symptom they're having.

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That's Dr. Sharon Levy, Director of the Adolescents Substance Use and Addiction Program at Bob Austin Children's Hospital and professor of pediatrics at Harvard Medical School.

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A lot of kids tell me that they use cannabis at bedtime, that that's how they go to sleep. They're using it to treat their own anxiety.

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I think that there are a lot of misconceptions about Cannabis.

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This is Dr. Pam Ling, director of the UCSF center for Tobacco Control Research.

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People think because we had medical cannabis for so many years that cannabis is a medicine and it does have some therapeutic uses. So it can be used for pa. Be used for nausea and vomiting. It can be used for appetite.

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It's important to note that Dr. Ling didn't mention using cannabis to treat mental health problems. That's because as doctors, we don't use it for treating such problems. But still, some teenagers go to it thinking it will help them deal with these kind of problems. This is a good time to hear from Jo, who is now in college and who shared some of her journey with depression and weed use during high school. In my latest film, Screenagers under the

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Influence, the depression started the beginning of 10th grade.

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I felt bleak.

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I thought marijuana is getting legalized as legalized as medicine. So I'm just taking it into my own hands with social media. I kind of got to create the normal. I surround myself with people who were using the way that I was or worse, and then I didn't really have to look at myself.

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More and more research is revealing that ongoing use of cannabis is often worsening anxiety and depression symptoms for many users.

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We know that there are strong associations with cannabis use and poor mental health.

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That's Dr. Levy once again.

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Particularly people who start using during their adolescence and young adulthood have more anxiety, they have more depression.

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I know this firsthand as a doctor in my clinic. Teens often tell me they think cannabis is helping treat their anxiety or depression symptoms. But then when we talk further, they start to realize that it might be making certain symptoms worse. For instance, some of them talk about how weed makes them feel unproductive, which then in turn makes them feel worse about themselves. Adolescents who use cannabis for mental health problems face other risks as well. As explained here by Dr. Levy.

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What's really interesting is they tend to start using cannabis younger, they use a lot more cannabis, they're more likely to use daily, and they're more likely to tell us that they're planning on continuing to use. So it's a much riskier pattern among kids who say they're using it for a medical purpose.

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As Dr. Levy just said, these teenagers are more likely to use regularly and more likely to continue to use throughout their lives. This brings us to the next big point, the confusion that's out there about whether a person can become actually addicted to cannabis. I've talked to a lot of teenagers who are not sure what to think about this. For example, I asked this teenager, and he responded in the following way.

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Like medically addicted or like mentally addicted? Cause I don't think there's no addictive stimulant in it. Medically, I don't think so. At least that's what I hear a lot amongst us kids in our age.

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Let's listen again to Joe, who we heard from earlier.

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I was smoking pot almost every single day. I would hide it all around the house. I sort of worked it into my head like, cannot manage without being high.

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Indeed, Jo shared in our latest film, Screenagers under the Influence, that she realized she had become addicted to weed. After all, it's releasing dopamine in the reward center, and that creates the addiction cycle. People can become both psychologically and physically addicted. Dr. Levy explains some of the physical withdrawal symptoms from cannabis.

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People have started because they had problems sleeping, but now they've gotten in a position where they really are going to have trouble stopping. A lot of kids tell us that they're using cannabis because they need it for their appetite. One of the reasons that they can't eat without cannabis is because they've become physiologically dependent on it. And when they stop using it, they withdraw. And one of the withdrawal symptoms is that they have trouble eating. And with cannabis, withdrawal can go on for weeks, so they can be very uncomfortable.

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Apart from these risks that we've just discussed, there's also another issue.

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We're seeing a lot of kids who are reporting psychotic symptoms while they're using cannabis. In other words, they tell us that they hallucinate when they use cannabis. We're seeing a lot of kids develop psychotic disorders, which we know is associated with cannabis use.

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To understand how common psychotic type symptoms are being experienced by young people, Dr. Levy and her team devised a study. Dr. Levy, can you tell me about your research that looks at teenagers reporting adverse reactions to weed?

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We did a study number of years ago where we recruited kids who are coming in for regular checkups at high school, age 14 to 18, and we asked them if they had used cannabis in the past year. About a third of Them said they had so about 160, 170 kids. And then we asked that group, have you ever experienced an hallucination while you were using cannabis? Or have ever had paranoia or extreme anxiety while using cannabis? Those are psychotic symptoms. And more than 40% of kids who had used cannabis in the past year had one or both of those symptoms. About a quarter hallucinations and about a third paranoia. And when you put them together, one or the other 42% was the actual number. When I saw those numbers come out of the analyses, I thought, wow, nobody knows this. We really need to publish this.

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Here's a college student that I spoke with about their experience with this exact issue.

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Yeah, I just started using a lot during high school. I had an episode of psychosis. Basically, I ingested so much THC that I was out of my mind and body for, like, three days. So after that happened, I was like, yeah, I can't be using anymore.

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What's happening is cannabis is really poisoning the neurons. That's what's giving people these hallucinations or making them feel anxious. It's a signal of how toxic this stuff really can be to the developing brain.

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At this point, you may be asking yourself, hallucinations. These aren't the effects that were talked about when we were teenagers. So why the change?

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The THC content has risen so high, essentially, you're seeing side effects, but you're seeing them more commonly now that the products are more potent.

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THC is tetrahydrocannabinol, which is the psychoactive component of cannabis.

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These oils that are highly concentrated thc, or active ingredient, nobody would have called that marijuana back in the 1970s. We've actually expanded the meaning of the word, and that's the industry acting.

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The original plant had about 2 to 4% THC, and now it's around 25% when people buy cannabis in the dispensaries. But it can be as high as 90%, depending on the delivery method, such as oils being used in vapes. People talk about both vape and dab pens when it comes to smoking weed. Dab is a thick oil extracted from cannabis and then heated to very high temperatures, creating an extremely potent concentration of THC per hit. Similar to a discussion that was brought up in our recent podcast episode on vaping. The cannabis industry is creating products with so little regulation that it's creating products that are really worrisome.

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Well, what we're seeing is that in more and more states, it's legal to sell cannabis either for medical and or for recreational Purposes. The industry always wants to make a better selling product. That's what industries do, that's what they're really supposed to do. But in the case of addictive substances, it gets really tricky because to make addictive substances more attractive, what you do is you raise the concentration of the active ingredient and you try and find ways of getting that into the body much faster. That's always a product that's going to be more rewarding.

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And more rewarding means an increased chance of addiction. The industry has found ways to make delivery faster of this high concentration of thc. And one of these ways is, you guessed it, vapes. Here Dr. Pam Ling explains how many of the concerns around vapes extend beyond tobacco products to cannabis products as well.

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Vaping also can mean vaping weed. There's a lot of crossover that's now happening between nicotine products and cannabis products because you can use the same device or very similar looking devices to use nicotine or to use cannabis. There is a substantial proportion of teens who are actually using nicotine vapes to vape marijuana.

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Vaping is a way of using cannabis that gets it into the bloodstream and up to the brain very quickly.

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Here's Jo again.

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I would smoke sometimes in the classroom because you can have like the vape pens. Now, I would do that while in the back of the classroom.

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What's really important to note is that when a person is vaping thc, the smell of cannabis is minimal. So be it at home or at school, smoking cannabis can be really kept undercover. It's a brand new reality. I wanted to understand more about today's cannabis industry and So I asked Dr. Levy more questions. So, Dr. Levy, I know cannabis is legal in a lot of states, 24 at the present time. Can you explain to me a bit about how these highly concentrated THC products are being able to get into the market?

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The industry, it's in their interest to have any product with THC in it be considered cannabis. Right? So therefore it's legal. This is why I think concentration is really important. We need the FDA to say you can go up to this level and not only can you have a certain level of concentration, but you have to limit the deliverable dose.

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The point being, regulation would create a maximum concentration by which a product could be referred to as cannabis. After that, the product would need to be called something else, clearly stating that it's related to cannabis, but it's just so much more potent. There's a lot of parallels here to the ways in which the tobacco industry historically has Worked to make their products much more potent.

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We know that this tobacco industry was famous for spraying acids on the tobacco leaves so that they would deliver more nicotine. They changed the ph of the smoke. They did all kinds of things to change the pharmacokinetics of nicotine to make those peaks faster and higher. And you can do that in a smoke device. You can do it even better in a vaping device, which has all kinds of different components that you can fiddle with. Those devices are a real danger. Here's the problem. The FDA doesn't regulate cannabis because it's illegal by federal law. So each state has to come up with their own policies.

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The food and Drug Administration is the national entity responsible for protecting public health by ensuring the safety of drugs, of which cannabis is a drug. Yet since this drug is not legalized at the federal level, each state is tasked with coming up with their own policies. The states, in many cases, are less well equipped to tackle this job. Dr. Levy talks about how federal policy is so important in helping prevent use among young users and relates it to what we know from the history of cigarette use.

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I take as an analogy what we've done with cigarettes. Cigarette use among high school kids in the 1970s was huge. Something like 65% of high school seniors were regularly using cigarettes. Now that number's less than 5%. So we've made tremendous progress, and there have been a lot of factors that have contributed to it. But I think we've learned a lot about policy. Right? One of the things that we've learned is that we really have to limit marketing and sales pitches. And so we should not have billboards. We don't have tobacco billboards anymore because they were too harmful. They were getting too many kids to smoke. We certainly have cannabis billboards. Recently, we've advocated with the Massachusetts medical Society to promote Massachusetts adopting some of the laws that are already in place for tobacco and applying them to cannabis. We don't see why we should have to stop, start that all over again. Nor do we see why every single state should have to have its own board of experts to figure out how to regulate cannabis. If cannabis is going to be legal, we actually need federal regulation.

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I couldn't agree more. And let's hope things really start to change and smart regulation really starts to take off. And that regulation wouldn't just be with billboards, but, of course, lots of other areas as well. And meanwhile, and this is really important, what can we be doing in our homes to make youth more savvy about the myths and realities of cannabis and help work to decrease and prevent use. One approach that can be really helpful is talking with teens about why it is that some teenagers choose to use in the first place. Perhaps saying, I've heard that some teenagers believe cannabis can help with sleep and mood problems and anxious feelings. And obviously some of them, you know, want to get a high feeling that can come from the drug. You know, what do you think about that? What things have you been hearing? So just keeping the tone, really matter of fact, and then after talking about that, then find another day to bring up some of the science around the realities of regular use as well as the risks that come with just periodic use. You know, I also like to talk with adolescents and I've done this a lot with my own kids by raising questions with them. So you might ask the question, how many states do you think have legalized cannabis for recreational use? And then from there you would say, and in how many of these states does a person need to be 21 years or older? And what's great about that is that you're not just saying, did you know weed is illegal for Anyone under age 21? But more as a quiz. And it can really be an effective way to have a conversation. Another key discussion point has to do with talking about what young people are seeing regarding cannabis online. What are they seeing with peers, with ads, with shows, influencers, TikTok talking about on video games, you know, when they're on their headsets and talking about different things and you know, just all sorts of media, what are they seeing? And it's important not to get anxious if they bring up things, but to really just stay calm and curious, even if you literally have to bite your lower lip. And in terms of kind of the messaging that we want to give our young people about using, here's Dr. Levy again.

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Firm limits are what help shape teenagers behavior. So it's really important to say, look, we need ground rules here. My house rules are that there's just no substance use in the house. You're not allowed to bring drugs or paraphernalia into the house. You're not allowed to use substances in this house. That's really helpful.

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Besides just being clear about house rules, research shows that as parents, when we are clear that we hope our young people steer away from cannabis, it increases the odds that they make healthier choices. It really does.

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Some teens have lost control, then they're going to need a lot of help. Some teens haven't really lost control, but still they're using substances regularly and they're starting to create problems. I think all of those teens can benefit from working with a behavioral health counselor.

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Health counselors are trained, as I am as a physician, to use interviewing techniques that allow people, adolescents in this situation, to feel comfortable in exploring the various motivations for their use and how it may be actually impacting certain goals in their lives in negative ways. Joe, who we heard from earlier in the show, who confronted weed addiction, started to go to community support groups.

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I found other people who were in recovery or seeking recovery, and I really liked it and I connected to the emotions that people were talking about. It gotten me through so much.

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And here is Jo's mother identifying the addiction. Owning the addiction has been really empowering to her. While she was in treatment, I started discovering other parents going through the same things. There's a lot of networks, particularly on the Internet, where parents can support each other.

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It's been almost two years since the last time I smoked.

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It's been great knowing that Joe has found help and so has her family. It's not easy knowing where to turn when a parent is concerned about their child's weed use. Doing a visit with a primary care provider can be a good starting point. Talking to a school counselor and sometimes schools have designated people who are just focused on substance use. Finding support groups online is another key resource. And also another major resource is finding other families nearby who have gone through similar things. If you don't know friends who face this, it means having to open up and ask around. It means being vulnerable and creating a vulnerable village. And that's something that can be really hard to do, but it is just critical. Another really important thing is talking to young people themselves. They have a wealth of information. Here's the college student that we heard from earlier on in the show who talked about how she often would just smoke weed and be on social media and how the weed took away her thoughts of needing to get off of it.

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One solution that helped me decrease my weed use was thinking about my habits projected onto a third person, someone that I loved, cared about. What if their actions were the same as mine? And what would I want for them to change and how could I get them support? And then going about this process as if it's not you dealing with it, but instead a third party. Like to depersonalize and de shame your own journey.

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Here she shares another insight on what helped her decrease her use.

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Whenever I sat down to smoke, I would not have a full plan on what to do for the rest of the day. It would just be like cool. This is my activity. One way to stop was be like, what am I trying to accomplish? And if it really was just distractions, what are other cool ways to do that? To do art, to do something I'm proud of. To do something with an aftermath that I can look back on and be like, cool. Today I did a workout. Today I did an interesting new course on duolingo. There's so many simple ways you can spend your time to look back on productively or excitingly without being high.

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We have covered so much today and so many young people and experts contributed their knowledge to the show and we are just deeply grateful. Be sure to check out the show notes@screenagersmovie.com and learn more about the topics and and how to find some resources on this topic and a lot of resources on parenting screen time as well. Thank you for listening to the show and if you can rate it and share it, it really helps others find the show. It would be a wonderful gift. And remember, it can be really impactful to listen to this and other episodes with young people in your life. It's a great way to start fruitful discussions. Also, check out screenagersmovie.com where you can learn about our three Screenagers movies and you can sign up for my weekly blog and much more. The Screenagers podcast is produced by me, your host, Delaney Rustin, Lisa Tabb, and Alan Gofinski, and Alan also does our sound editing.