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Stanford Medicine

Addiction, Pediatrics, Public Health

To reduce use, educate teens on the risks of marijuana and prescription drugs

According to a study published this week in the Journal of Adolescent Health, non-medical use of prescription medications like Vicodin and Adderall is rising among teens. Marijuana is also on the rise among adolescents, with the National Institute on Drug Abuse reporting 22 percent of 12th graders using it in the past month. Otherwise illicit drug use among teenagers has not increased in the last decade, and teen cigarette smokers have actually decreased, with fewer teens now smoking cigarettes than marijuana.

One potential explanation for the rise in prescription medication and marijuana misuse and abuse among teens, in contrast to other substances of abuse like tobacco, is the fact that prescription drugs and marijuana are viewed in contemporary medical and lay culture as having “medicinal” properties. Both Vicodin and Adderall have FDA-approved indications, the former for pain and the latter for attention deficit disorder. Although marijuana is a Schedule I drug at the federal level, meaning it has not been approved for any medical use, marijuana is readily available for chronic pain, anorexia, intractable nausea, and other ailments in many states through dispensaries.

Teens may be using… because they have embraced the idea that these substances are good for them, or at least not necessarily bad for them

Teens may be using Vicodin, Adderall, and marijuana in increasing numbers and with increasing frequency because they have embraced the idea that these substances are good for them, or at least not necessarily bad for them. For teens who have received a diagnosis of chronic pain or attention deficit disorder, they may justify ongoing abuse as necessary to “treat” their disorder, even in the face of obvious addiction. Furthermore, withdrawal from substances of abuse is almost universally characterized by anxiety, depression, insomnia, and attention problems. Adolescents as well as adults may misconstrue symptoms of withdrawal as indicative of an underlying physical or psychiatric disorder, which in turn perpetuates use.

What is needed to combat this alarming trend in illicit drug use among teens is to launch state and national campaigns alerting adolescents to the true dangers inherent in misuse and abuse of prescription medications and marijuana, as perceptions among teens of potential harmfulness correlates with decreased use. Such a campaign would also seek to re-stigmatize use of these substances, just as national anti-smoking campaigns stigmatized cigarette smoking to the point where prevalence rates decreased by 20-30 percent in just a couple of generations, and smoking cigarettes has been banned from almost all public venues.

Cultural narratives, in other words, around specific substances of abuse, are central to influencing behavior, especially among teens who may be more susceptible than adults to the stories we tell.

Previously: How to prevent prescription-drug misuse among teens, Do people really get addicted to marijuana? and NIH podcast reveals prescription drug abuse more prevalent in teenage girls than boys

Anna Lembke, MD, is an assistant professor of psychiatry and behavioral sciences at Stanford.

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