Not long ago when Joseph Garbely, chief medical officer for the Caron Foundation, reviewed younger patients starting drug or alcohol treatment on his unit, he usually saw people shaking, sick, and seizing from alcohol or opioid withdrawal. Marijuana was seldom what put them in those medical beds.
“A few years ago, it was rare to see a young person enter Caron with marijuana-induced psychosis,” said Garbely. “Now we see it on a regular basis. Older teens and young adults — approximately ages 18 to 26 — are the most impacted. We see a significant misperception about the safety and efficacy of marijuana among our teen and young-adult patient population.”
Marijuana, legal for medical uses in well over half the states in the country and as a recreational substance in ever more states, is generating increasing concern as a dependency-causing drug capable of serious impairment and harm, particularly among its youngest users. New Jersey voters will get to decide in 2020 whether to legalize marijuana for recreational use for people age 21 and over.
While it was once doubted as an addictive substance, treatment professionals now say they are seeing more adolescents and young adults with cannabis use disorder. Often starting in their early teens, many graduate to daily use.
“The majority of cases we see of substance use disorder are marijuana,” said Ned Campbell, medical director of Rehab After School, an intensive out-patient program for adolescents in Southeastern Pennsylvania, including the Philadelphia area.
In-patient admissions have increased, as well.
At Caron, the number of patients who were admitted with a primary diagnosis of cannabis use disorder increased more than 22% from 2014 to 2019. In those five years, people admitted to treatment for marijuana addiction rose from more than 27% of Caron’s total admissions to nearly 40%.
Independence Blue Cross, the region’s largest health insurer, has seen claims for cannabis use disorder treatment rise substantially. Between 2012 and 2018, there was a 180% increase in marijuana treatment claims. That included a 100% claim rise for patients ages 19 to 25. Claims for adolescents requiring treatment went up 25% during the same period.
Terri L. Randall, medical director of Children’s Hospital of Philadelphia’s Substance Use Disorder Clinic, said it has become more common for young patients to experience such bad reactions as extreme anxiety and even detachment from reality from cannabis use — and continue using.
“The fact that kids continue to use, even despite an adverse experience or unpleasant experience with marijuana, is really concerning to me,” Randall said. “Not only are they having difficult consequences of their use, but they also are finding themselves using more and are unable to control their use. That really is at the heart of the diagnosis of addiction.”
The extremes aren’t only showing up in treatment offices.
“We’re certainly seeing a lot more emergency department visits due to marijuana,” said Kevin Osterhoudt, medical director of Children’s Hospital of Philadelphia’s poison control center. ”We’re seeing more people with paranoid delusions. We’re seeing a lot more people with signs of acute psychosis.”
Today’s marijuana is not the reefer of the Woodstock generation or even the weed of the Grunge era. Over the decades, the amount of THC — the psychoactive compound in cannabis — has soared.
“The nature of what’s being consumed has changed dramatically,” said Itai Danovitch, an American Society of Addiction Medicine fellow and psychiatry chairman at Cedars-Sinai Medical Center in Los Angeles.
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