Clinicians should routinely ask adolescents about their cannabis use to help identify patterns of misuse that can lead to depression, anxiety, problems at school and other mental and physical health issues, according to Canada’s national association representing pediatricians.

In a new paper published Thursday, the Canadian Paediatric Society (CPS) urges clinicians to normalize discussions about cannabis with their young patients, given how common its consumption is and the fact that one in six adolescents who use it will go on to develop mental or physical problems as a result. According to a Health Canada survey published last year, 44 per cent of 16- to 19-year-olds in Canada have tried cannabis in the past year. The new paper states that many parents and youth are concerned about the potential health effects of cannabis and are looking to their doctors for answers.

Christina Grant, co-chair of the CPS cannabis project advisory group, said many young people may be going to their health provider with symptoms they don’t even realize are related to cannabis use, such as loss of concentration, difficulty sleeping and mood changes, but that clinicians may feel ill-equipped to raise the discussion. The new paper published by the CPS provides clinicians with resources and tool kits with evidence-based advice on how to start the conversation in a non-judgmental way and spot signs of potential cannabis misuse.

“We really want to help practitioners have an approach that is very respectful for the individual teenager in front of you in your office,” Dr. Grant said.

Karen Leslie, an adolescent-medicine physician and lead for the substance abuse program at Toronto’s Hospital for Sick Children, said that conversations about cannabis, as well as alcohol and vaping, should take place at every adolescent health care visit.

“You want to be opportunistic,” Dr. Leslie said. “Any connection with a health care provider is an opportunity for some kind of anticipatory guidance.”

The new guidance document emphasizes the importance of maintaining patient confidentiality and answering questions honestly. Clinicians should also ask teens how cannabis use may be affecting all facets of their life, including family, school, work and personal relationships. The document also provides resources clinicians can use to help screen for problematic cannabis use.

Cannabis, which was legalized in Canada in 2018, can lead to a host of health problems, particularly if people start to use it early on in life. Youth are particularly vulnerable to changes in brain development that can result from frequent use.

Dr. Leslie said there’s a spectrum of health problems that young people can develop as a result of cannabis use, such as anxiety and sleep disorders. In some young people, particularly those in high-risk groups, such as those with a family history of schizophrenia, cannabis use can also lead to an increased risk of psychosis.

But there’s no clear understanding yet of exactly who may be at risk for cannabis-related health problems, which is why it’s a good idea for clinicians to talk to all of their young patients about it. For instance, many young people believe that cannabis can help relieve anxiety, but Dr. Leslie said that over time, it can actually make the problem worse.

“A lot of it is looking at risk factors for a young person,” she said. “I think it’s a balance of giving them information [and] making sure they have the information they need.”

The Globe and Mail, June 4, 2020