Prevention leaders: Teen pot use tricky to predict as legalization approaches
Pick a side of the marijuana legalization debate, and studies abound to back it up.
One example: Reports from legal-use states show conflicting data on whether teen use increases, decreases or stays flat after adult use is legalized.
A 2018 research letter in the JAMA Pediatrics journal found "marijuana use among youth may actually decline after legalization for recreational purposes," in part, because "it is more difficult for teenagers to obtain marijuana, as drug dealers are replaced by licensed dispensaries that require proof of age."
The study, which analyzed national Youth Risk Behavior surveys from 1993 to 2017, found an 8 percent decrease in the odds of youth marijuana use in states where it is recreationally legal for adults, and a 9 percent decrease in the odds of frequent use.
Conversely, a 2019 analysis of National Survey on Drug Use and Health data by the anti-legalization group Smart Approaches to Marijuana found 7.7% of 12- to 17-year-olds use marijuana in states where it is recreationally legal, while 6.2% use in states where it is not.
And these are just two studies.
"There really is a lot of bias," said Carson Ezell, a Stevenson High School junior from Buffalo Grove who leads an anti-marijuana arm of the Catalyst prevention club.
The conflicting information makes it hard to know what to believe, said Vrushali Thakkar, a Stevenson senior and Catalyst club president from Vernon Hills.
"That harms particularly youth," she said. "Because ... they don't think it's addictive, they think you can drive."
What's clear is Illinois officials will have their eye on teen substance abuse surveys given here, as prevention organizations increase education to try to ensure more underage use does not become a side effect of legal adult use.
Whether teen use would increase with adult-use legalization was part of the debate over the Cannabis Regulation and Tax Act before it was passed May 31 and signed by Gov. J.B. Pritzker on June 25.
On one side is the theory that once recreational marijuana is legal for adults, using it while underage no longer will seem quite so rebellious.
That's paired with the belief that prevention education -- set to receive 20% of the additional money the state brings in from marijuana licensing and taxation -- has been proven over time to decrease use.
In pushing for legalization, state Sen. Heather Steans and state Rep. Kelly Cassidy, both Chicago Democrats, cited a Colorado health department report called Monitoring Health Concerns Related to Marijuana in Colorado: 2016, which found "past-month marijuana use has not changed since legalization either in terms of the number of people using or the frequency of use among users."
However, the consensus in the drug prevention field is that making a substance legal causes teens to believe it is safe, which makes them more apt to use it.
This decreased perception of risk has not yet played out in data from the Illinois Youth Survey since medical marijuana use gained approval in 2013 and began in 2015. Given every two years to students across the state, the survey has tracked drug use trends since 1993.
Among high school seniors across the nine-county suburban region, excluding Chicago, 25% -- both in 2012 and in 2018 -- said there is no risk of physical harm from smoking marijuana once or twice a week.
But that quarter of the population is wrong, doctors and mental health experts say.
"There's a general perception that there is no harm with marijuana," said Sara Moscato Howe, CEO of the Illinois Association for Behavioral Health. "We're concerned, based on what we've seen around the country, that we're going to have an uphill battle with that."
Marijuana is not harmless, as it can cause higher rates of depression, increased anxiety, irritability, family and school conflict, motivation issues and the inability to pass a drug test to find employment, said Margaret Polovchak, manager of prevention services at OMNI Youth Services in Buffalo Grove.
And for 17% of people who begin using in their teens, marijuana becomes addictive, according to studies cited by the National Institute on Drug Abuse and the National Institutes of Health. That's compared with an addiction rate of 9% among people who begin using marijuana as adults.
Worse teen use?
That's why prevention advocates say they're worried as the days tick by toward the start of adult recreational use.
"Why are we doing this? We're supposed to protect our children," said 55th District state Rep. Marty Moylan, a Des Plaines Democrat who opposed legalization. "Even though they say it's for over 21, it's going to be used highly by teens."
Legalization and retail sales will increase access to marijuana and advertising for it, prevention experts say. And the more widely available any substance is, the less risky teens may believe it is.
This, prevention experts say, could cause teens who already use marijuana to use more -- and at higher potencies -- leading to higher risks of addiction and harm. That's what a 2017 study from the Oregon Research Institute found, saying "legalization of recreational marijuana did not increase marijuana use for youth who did not use marijuana but did increase use in youth who were already using."
"I don't think we're going to see an increase in the number of users, per se, but in the amount of use and the development of dependency disorders," OMNI's Polovchak said. "The kids that have other risk factors -- whether it's mental illness or myriad situations -- it's those kids, once it becomes more available, we are seeing the increase in frequency."
Despite a tricky factual landscape about youth marijuana use in other states, prevention experts in Illinois trust they'll be able to know the truth of what occurs here in the years after legal adult use begins Jan. 1.
The Illinois Youth Survey for 26 years has been asking teens about their use of harmful or illegal substances, including marijuana. Prevention experts say they have faith in the anonymous survey to accurately reflect how use trends change once recreational marijuana sales begin. Stevenson students Ezell and Thakkar, too, say they and their peers are honest on the questionnaire.
"We do have a great tool" in the Illinois Youth Survey, said Karen Jarczyk, prevention director for 360 Youth Services in Naperville.
The survey is administered by the Illinois Center for Prevention Research & Development in the University of Illinois' School of Social Work. Researchers analyze responses for inconsistencies to weed out overreporting of drug use, and they discourage schools from requiring parental consent before students take the survey to help avoid underreporting.
"There's a level of expertise there we can feel pretty confident in," Jarczyk said.
The survey, in the recent past, has shown decreasing reported marijuana use among 12th-graders across the region. The amount of high school seniors reporting they'd used the drug within the past year fell from 40% in 2012 to 35% in 2018.
"We've worked really hard the last couple of decades in talking to teens and parents about substance use and the risks of it," said Jamie Epstein, co-founder of the Stand Strong prevention coalition in the Stevenson area. "Prevention does work."
Education ramps up
In passing the law allowing adult recreational use, Epstein said, legislators put too much faith in prevention leaders to stop teen use from increasing. She and other experts say they plan to step up their outreach.
The Ela Coalition Against Youth Substance Use, for example, plans to send postcards to families in Lake Zurich Unit District 95 on the risks of using marijuana, prescription drugs, alcohol, tobacco and social media.
"What makes me nervous is that kids will use because they see it as being OK," said Susan Fackler, director of community and family services for Ela Township. "We have to watch out for kids' brain development."
Students next will take the Illinois Youth Survey in 2020, after legal adult use is set to begin Jan. 1. While it likely will take several years to see any trends in youth use caused by -- or correlated with -- adult-use legalization, prevention experts say now is the time to start campaigning to keep teens away from the drug.
"There's just not a lot of education for the common person on marijuana. People aren't as educated as they think," said Katie Gallagher, director of education at Robert Crown Health Center in Hinsdale. "The accessibility means there will need to be a lot more education."
Will declining teen pot use continue?The Illinois Youth Survey asks students about marijuana use every two years. Since 2012 -- despite the approval of medical marijuana in 2013 and sales beginning in November 2015 -- rates of high school seniors who report using the drug have been declining.
Amount of teens who said they have used marijuana within the past year
Amount of teens who said they have used marijuana within the past 30 days
Source: Illinois Youth Survey Suburban Chicago Weighted Sample