We caught up with Dolly Klock, MD who is is a Board Certified Family Physician and Founder of ADOLESSONS. Dr. Klock has over fifteen years of clinical experience in the Los Angeles area, and she served as a medical advisor for the entire run of the hit TV sitcom Scrubs. In this Podcast, Dr. Klock shares her best tips parents can use to talk to their kids about teen marijuana use.

Key takeaways parents should know about teen marijuana use

• Use teachable moments to start conversations
• Even in states where marijuana has been legalized, recreational use under the age of 21 is illegal
• Just because something is legal does not make it safe

What do parents need to know about today’s marijuana?

Many teens are under the impression that marijuana is safe and it's not harmful in any way. Oftentimes adults in their lives may be reinforcing that message. Many parents I talk to used when they were teens and they don't see it as a big deal. From a health and a medical standpoint, I do feel it's a big deal, given what we know today about teenage brain development. This is a conversation worth having. There is research that suggests that parents who talk openly and directly with their kids about substance use have teens that are less likely to experiment with drugs.

How it’s different from marijuana of the past?

The marijuana that is grown today has a higher concentration of THC. THC is the mind-altering substance that is in marijuana. Marijuana comes from the cannabis plant but the way it is being grown today is different. There are also more formulations now that did not exist in the past. Marijuana can be inhaled, smoked, vaped and there are now edible forms. The pot brownies from the past still exist, but now there are gummy bear forms, Jolly Rancher type candies, and candy bars. There are marijuana-infused beverages -- and it can be brewed as a tea. One thing that we've seen even with adults, who were former users now are turning to different formulations, is that the marijuana is not affecting their bodies the way that they were used to. It is not quite the same drug that was out there in the past.

How does teen marijuana use affect their bodies and brains?

Whether they are inhaling marijuana or ingesting it as edibles, the drug can affect their lungs, hearts and brain. Once the THC is in the bloodstream, it affects the brain in different ways.

• One is by acting on areas of the brain called the basal ganglia and the cerebellum. These are parts of the brain that control our movements, balance and coordination. It's as if the marijuana causes a delay in messaging between the brain and the rest of our bodies. Why is this important for kids to know? It puts them at increased risk of falls and accidents. What we worry about a lot is what happens if they get behind the wheel and drive while they're impaired. They are at risk of car accidents, or accidents while operating other heavy machinery.
• Another effect on the brain has to do with their judgment. The THC affects their frontal cortex and this is where our decision-making happens. If teens are under the influence they may choose to participate in risky activities; that could mean engaging in physical or sexual activities that they would normally avoid if they were sober.
• THC also affects the hippocampus in our brains. The hippocampus is the part of our brain that's responsible for learning and for memory. Concentration, problem-solving, memory (both short-term and long-term) are affected. Studies show that when regular marijuana use begins in the teen years, there are greater declines long-term in terms of memory, learning, and IQ. We have seen higher rates of both mood disorders and schizophrenia among people who were chronic teen users of marijuana. That is something worth thinking about.

How common is teen marijuana use?

The National Institute of Health has an arm called the National Institute on Drug Abuse. They put forth an annual survey of middle and high schoolers that is done through the University of Michigan, called Monitoring the Future. They look at 8th, 10th, and 12th graders every year. In terms of marijuana, they asked them have you ever tried marijuana? Have you used it in the last year? In the last month? Are you a daily user?

• 13.5 % of eighth graders said that they had ever tried marijuana. Less than 1% of 8th graders said that they use it daily.
• By the time they are seniors in high school, the numbers are higher. 45% of seniors said that they had ever used marijuana. 37% had used it in the past year, 22% in the past month, and about 6% were using it daily.
• This reflects a trend we see in teens with most substances. Once teens start using a substance, their usage tends to increase as time goes on. There is a real benefit to delaying the first use because it allows time for some extra brain development and it puts teens at lower risk for developing addiction and problematic use.

How should parents talk to teens about marijuana?

There are a couple basic things that parents sometimes forget to talk about. The first is that even in states where marijuana has been legalized, it is still illegal to be under the age of 21 and use marijuana recreationally. Kids don't necessarily know that. Another point to make is that just because something is legal doesn’t mean that it is safe. This is a great way to capture the attention and start a conversation with teens, who are primed to question authority. They don't like to feel manipulated. Get them to think through what other behaviors are legal but unsafe, like using tanning beds and cigarettes.It is so important not to lecture teens. They don't want to hear the lecture. When talking about facts, parents should emphasize health and safety. We have to figure out how to guide them through their own thought processes, because ultimately these are decisions that they will have to make themselves. Starting this conversation early helps. Teen marijuana use is not a one-time conversation; this is an ongoing talk. It is important for parents to communicate their expectations and to set limits. Whenever you set limits, it is their job as teens to push against those limits. If you start very liberally, it is going to be harder to reign things in. Set the limits, let them know what the consequences are and let them understand that this is all about your desire for them to grow into healthy adults.

• Use teachable moments to start conversations. The news is a great way to start conversations, because talking about the news can provide a more neutral starting point than talking about your child or their friends.
• Know where your kids are. Are they going to a party? Pick up the phone, call the parents, find out if they will be home and what are their rules about drugs and alcohol.
• Role playing is important with kids. Present them with some scenarios and let them think through what they would do in various situations, because in the heat of the moment when your teens are faced with tricky situations in the presence of peers, it may be hard for them to know what to do.
• Have an exit plan. If all else fails, and teens are feeling unsafe in a situation, they need to know that you have their back, that you will come and help them. You want to be the person that they will reach out to.
• While it is never too late to start these conversations, the earlier you begin, the better. If you think that your teen has problematic substance use, get them professional help immediately. Talk to their pediatrician or family physician, mental health professionals, school counselor.

What should parents say if their teen asks them if they used marijuana when they were in high school?

Parents sometimes get defensive and feel like that information is personal, but your kid is giving you a great gift by asking that question. They are asking to engage in a conversation about this very tricky topic.

• If the answer is yes that you did, you have two choices. You can tell the truth or you can not tell the truth. If your reality is that “Yes I used it back in the day and it was great and everything worked out well.” that might not be the healthiest message to share.
• Instead you can say something like “Yeah, I did but we didn't know as much about the teenage brain and how it’s affected by marijuana back then”, or “the marijuana then was different than what's out there today.”
• Or “I did and you know I was lucky that I didn't run into trouble, but let me tell you these other stories about my friends who used and what happened to them.” This discussion needs to be honest and authentic for it to be successful. It is possible to be honest while still making your expectations and limits very clear to your teens.

Where can parents get resources to present to kids about marijuana?

Information that can be found at National Institute on Drub Abuse for Teens and NIH are useful. Also, don’t forget to connect with your teens over their interests. When teens are part of a trusting, mutually respectful relationship with their parents they are less likely to engage in risky behaviors.

Final words for parents who think that they have a great kid and don't need this help?

They do have a great kid, but even great kids make bad choices. Part of this has to do with their brain development. They are wired in a way that can cause them to make emotional, feel-good, impulsive choices. They are not trying to be difficult, it's just the stage of development that they are in. I encourage parents to get in there, dig in deep and get to know your kid. Enjoy your kid for who they are. Teens are amazing, energetic, passionate and insightful people.