Surgeon general's marijuana advisory to pregnant women, youths sparks debate

WASHINGTON (Sinclair Broadcast Group) — The surgeon general’s advisory Thursday warning adolescents and pregnant women against using marijuana has sparked a backlash from supporters of decriminalizing the drug who accused him of using “scare tactics” to overstate its dangers, although they agree children should not be exposed to it.

“Recent increases in access to marijuana and its potency along with misperceptions of its safety endanger our most precious resource, our nation’s youth,” Surgeon General Jerome Adams said at a news conference Thursday.

Federal data shows marijuana is the third most commonly used addictive substance by adolescents, and use by pregnant women has doubled since 2002. Blaming these trends in part on state laws allowing marijuana use for medical or recreational purposes, officials warned young people and unborn babies whose brains are still developing are believed to be at greatest risk to suffer adverse effects.

“We know now that no amount of marijuana use during pregnancy and adolescence is safe,” said Health and Human Services Secretary Alex Azar.

This was Adams’ third advisory as surgeon general, and the first issued by the government about marijuana since 1982. His last advisory in December warned about the dangers of e-cigarette use, a point he reiterated Thursday amid reports of pulmonary illnesses possibly linked to vaping.

“No young person should be vaping,” he said. “No young person should be using marijuana. The risks that we know of for both of those products are too high and there are many risks we don’t know about.”

Officials said the threat of youth and pregnant marijuana use is growing increasingly urgent because the drug is getting stronger. They emphasized that the marijuana products available legally in some states now are sometimes three to five times more potent than in past decades.

“This ain’t your mother’s marijuana,” Adams said.

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Recreational use of marijuana is now legal to some degree in ten states and the District of Columbia, and sales are set to begin in an 11th, Illinois, in January. More than 20 others have legalized use of the drug for medical purposes.

“High school students’ perception of the harm from regular marijuana use has been steadily declining over the last decade. During this same period, a number of states have legalized adult use of marijuana for medicinal or recreational purposes, while it remains legal under federal law. The legalization movement may be impacting youth perception of harm from marijuana,” the surgeon general’s advisory stated.

Anti-marijuana groups welcomed the advisory Thursday as a step back from the brink of normalization of a drug they argue is much more dangerous than users think.

“Big Marijuana and its promoters have consistently pushed blatant falsehoods and misinformation to suggest marijuana is safe, despite the large and growing of evidence to the contrary” said Kevin Sabet, president of Smart Approaches to Marijuana, in a statement. “Administration officials should be applauded for finally shining a light on the harms of today’s highly potent marijuana.”

Marijuana legalization advocates agree with the surgeon general that teenagers should not be using the drug and pregnant women should consult medical professionals to educate themselves about the risks. However, they questioned some of the data he presented and the general perception his press conference left about marijuana use.

“We share the surgeon general’s concerns about keeping adolescents and pregnant women safe and healthy,” said Sheila Vakharia, deputy director of research and academic engagement at the Drug Policy Alliance. “However, we are concerned his presentation didn’t accurately present the trends in use among these groups.”

According to the Substance Abuse and Mental Health Administration, marijuana use by 12-to-25-year-olds was relatively stable from 2017 to 2018 and use by pregnant women fell substantially in 2018. The biggest increases in use were among non-pregnant adults 26 and older.

“If the Surgeon General is truly concerned about youth consumption, then he should rely on honest education rather than misleading claims and fear-mongering," said Violet Cavendish, spokesperson for the Marijuana Policy Project.

Eric Altieri, executive director of NORML, used the same term: fear-mongering. His organization pointed to research suggesting there is no correlation between legalization of marijuana in a state and increased youth consumption.

“Our current model of prohibition represents the utter lack of control over any aspect of marijuana or the marijuana market...,” Altieri said. “The Surgeon General's time would be better spent advocating for a structure for regulation under which we can educate Americans about the actual harms and benefits of cannabis through public education campaigns and product-labeling,” he said.”

Azar said Thursday President Trump has donated his $100,000 salary for the second quarter of 2019 to fund a digital awareness campaign spreading the word about the surgeon general’s advisory and the risks of marijuana use for pregnant women and adolescents. The plan has so far drawn a tentative response from the cannabis industry.

“We fully support fact-based educational efforts to discourage cannabis consumption in minors and other groups for whom consumption could be potentially problematic,” said Morgan Fox, media relations director for the National Cannabis Industry Association. “We absolutely do not support efforts that rely on scare tactics and insufficient science, or that promote punitive responses to problematic consumption and continue to punish adults for using a substance that is objectively safer than alcohol.”

Even if usage of marijuana by these vulnerable demographics is not currently on the rise, the data still shows millions of teens and pregnant women are using the drug every year. Legalization groups maintain a blanket prohibition is not the best way to approach reducing those numbers.

"Prohibition has failed miserably at stopping youth from accessing marijuana,” Cavendish said. “Despite what the U.S. surgeon general claims, regulating marijuana in fact makes it more difficult for youth to access the drug due to age-restrictions that are enforced by licensed businesses.”

Advocates maintain it would be safer for adolescents if the drug was legal and sales were strictly controlled by the government.

“The bottom line is that cannabis has always been readily available, and regulating it simply pulls the commodity out of the illicit market where dealers have no incentive to guarantee a safe and reliable product and certainly don't check IDs to ensure their customers are not minors,” Fox said.

However, Sabet warned ease of legal access to marijuana does not eliminate risks, especially for pregnant women. He cited research showing 70% of dispensaries in Colorado have recommended potent marijuana products to treat morning sickness.

“Marijuana can have incredibly deleterious effects on young minds and it is absolutely shameful, though not surprising, that the industry would push its wares and pseudo-science on young mothers,” he said.

Although Trump administration officials focused on the potential dangers presented by legalization of marijuana, Vakharia stressed treating possession of the drug as a crime and locking up users carries financial and public health costs too.

“Federal and state-level prohibition and criminalization come with their own harms,” she said.

Data on the effects of marijuana on youths is inconsistent, and advocates say part of the problem is that researchers must navigate federal laws against the sale and use of the drug. Azar acknowledged that concern Thursday and said he has had discussions with the Department of Justice and the Drug Enforcement Agency about how to facilitate more research.

“We don’t know everything we might want to know about this drug,” Azar said.

HHS officials highlighted studies indicating a relationship between youth marijuana use and increased instances of schizophrenia, depression, psychosis, and suicide attempts. Some research also shows frequent marijuana use is associated with impairments to learning, memory, and decision-making.

Researchers at Johns Hopkins University found marijuana exposure in adolescent rats causes inflammation of a specific type of brain cell that can cause major psychiatric disorders. However, they cautioned that far more research is necessary to determine if the same thing happens in humans.

Other recent studies have called these findings into doubt. Research published in the September 2019 issue of Drug and Alcohol Dependence concluded adolescent cannabis use caused no lasting structural changes to the brain. The authors of that study did also warn it is “prudent” to encourage young people to stop using the drug.

Another study released last year suggested the cognitive detriments of youth cannabis use have been overestimated in the past. Though researchers identified small reductions in cognitive functioning associated with marijuana use, they also found abstaining from the drug for a few days can diminish those effects.

The risk for pregnant women is somewhat clearer. Studies have shown marijuana use during pregnancy can result in low birth weight, and tetrahydrocannabinol can enter the fetal brain from the mother’s bloodstream, disrupting development. THC can also be passed on through breast milk, potentially causing hyperactivity or poor cognitive functioning in the baby.

A paper published earlier this year by researchers at Washington University in St. Louis indicated prenatal marijuana exposure is related to a small increase in a child’s risk of developing psychosis later in childhood. They were unable to prove a causal link, though.

The National Institute on Drug Abuse is currently funding four studies of the impact of maternal marijuana use on infants’ brains, trying to establish more definitive answers.

“There has not been any science that shows marijuana is safe,” said Nora Volkow, the institute’s director, at the surgeon general’s news conference Thursday.

Given the inconclusive nature of the existing body of research, Lynn Paltrow, executive director of National Advocates for Pregnant Women, called Adams’ advisory “misleading and irresponsible.” Very few things are proven to be safe for pregnant women, and claims of potential harm have been used to restrict their rights in the past.

“There’s an enormous difference between things that have risk—which is virtually everything a woman does, ingests, or is exposed to during the course of pregnancy—and actual harm,” Paltrow said.