BHIPP Bulletin

Volume 10, Issue 3

September 2024

This month's BHIPP Bulletin is a contribution from

Rheanna Platt, MD, Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine and BHIPP Consultant.

According to the 2021 Youth Risk Behavior Survey, 27.8% of high school students reported lifetime cannabis use, and 6.3% of 12^th graders reported daily cannabis use.¹ As of April 2024, recreational cannabis is legal in 24 states (including Maryland), and an additional 13 states (and all states where recreational cannabis is legal) have legalized medicinal cannabis.² At the same time, there has been a substantial increase in potency (increase in the psychoactive tetrahydrocannabinol (THC) content in cannabis products) over the past 2 decades,³ as well as an increase in alternative forms of cannabis (e.g. edibles, vapor device use, dabs, and blunts, which contain both cannabis and tobacco), some of which are highly potent compared to the concentration of THC in the marijuana plant. In this context, surveys assessing adolescent perception of cannabis risks suggest a trend of decreased perception of risks of cannabis use over time.⁴

Despite declining perception of risks, there is accumulating evidence about the adverse effects of cannabis on youth. Because the areas of the brain responsible for impulse control and executive functions remain actively developing and are not fully mature until the mid-twenties, adolescents are especially vulnerable to adverse effects from substance use.⁵ This is particularly the case for those with younger age of onset of cannabis use (e.g. age < 15 years), with high-potency use, and with daily use, which increases the risk of developing substance use disorders (including opioid use disorders), neurocognitive decline, and psychosis, compared to those with later-onset use, lower-potency use, and less frequent use. Additionally, exposure to cannabis during adolescence appears to be associated (in a dose-dependent fashion) with increased prevalence of mood, psychotic, and substance use disorders.⁶ Moreover, while many youth report use of cannabis acutely as ‘self-medication’ for mood and/or anxiety symptoms, longitudinal studies suggest that onset of cannabis use during adolescence is associated with increased likelihood of developing mood and anxiety disorders during adolescence and adulthood (and with increased severity of these disorders).⁶ The above risks may be magnified with use of synthetic cannabinoids (e.g. Spice and K2), which have also increased in popularity over time.  

Role of the Primary Care Provider:

Given this background, what is the role of a pediatric primary care provider? Below are some suggested tips and resources.

1)  Start with prevention – primary care providers have the opportunity to work with families early to promote protective factors. Encouraging parental monitoring of youth and supporting parenting more broadly can have significant long-term preventive effects.⁷

2) Consider asking about caregiver use of cannabis; if a caregiver uses cannabis, it is important to discuss whether youth in the household may have access (e.g., where and how products are stored), how use of cannabis is discussed with youth, risks of accidental ingestion, etc.

3) Provide educational resources to caregivers about the risks of cannabis use in youth. Resources include infographics and patient information websites (e.g., guides for parents about how to talk with youth about marijuana).

4) BHIPP’s September 2020 Bulletin reviews evidence-based screening tools for substance use such as the CRAFFT as well as evidence-based brief interventions appropriate for primary care, including SBIRT and Screening to Brief Intervention (S2BI), along with links to resources for implementing these tools in pediatric primary care.

5) When discussing cannabis use with youth, debunk myths about methods of use. For example, there is the perception among many youth that vaping is less harmful than smoking.⁸

6) In addition to BHIPP, the Maryland Addiction Consultation Service (MACS) is available to support providers caring for patients with substance use disorders and concerns. The MACS warmline (1-855-337-MACS) provides consultation and resource/referral assistance. Watch the co-hosted MACS and BHIPP webinar on Youth and Cannabis in an Era of Increased Access: What’s all the Fuss?

As always, if you have questions about the behavioral health needs of your patients, we encourage you to call the BHIPP consultation line at 

855-MD-BHIPP (632-4477), open 9am-5pm Monday-Friday, for resource/referral networking or consultation support.

We will keep you informed about all our services and training events through our website (www.mdbhipp.org) and monthly e-newsletters. Additionally, BHIPP is on LinkedIn, X, and Facebook. We invite you to follow us there to stay up-to-date on upcoming training events, pediatric mental health research, and resources for providers, families and children.

BHIPP Announcements

Register for the new BHIPP ECHO Beyond the Basics Series!

Register for the BHIPP ECHO Beyond the Basics series! The first session will be held on October 10th from 12:00-1:00pm. Join our multidisciplinary team of child behavioral health experts on the second Thursday of every month between October 2024 and May 2025 for virtual case-based learning and didactic presentations. This series is great for providers who have already participated in BHIPP ECHO, or who feel like they are experienced in treating behavioral health in their practice and are looking to explore advanced topics. Free CME and CEU credit is available for participation.

Join the BHIPP ECHO Core Foundations Series Learning Collaborative!

Register for the BHIPP ECHO Core Foundations series! The first session will be held on October 24th from 12:00-1:00pm. Join our multidisciplinary team of child behavioral health experts every month between October 2024 and May 2025 for virtual case-based learning and didactic presentations. This series is great for providers who want to improve their knowledge of child mental health and develop foundational skills. Free CME and CEU credit is available for participation.

Sign up for the upcoming BHIPP Webinar!

Register for an upcoming BHIPP Webinar on October 29th at 12:00pm! BHIPP Webinars are a series of interactive, web-based learning sessions that are a virtual space for pediatric primary care, emergency medicine, and behavioral health providers to connect, learn and share about strategies, practices and resources to promote mental health and resilience among children and families as well as providers. Free CME and CEU credit is available for participation.

New BHIPP ECHO: Enhanced Behavioral Health Training for PMHNPs

Register for the new BHIPP PMHNP ECHO series! The first session will be held on November 12th from 11:00am-12:00pm. Join our multidisciplinary team of child behavioral health experts every month between November 2024 and April 2025 for virtual case-based learning and didactic presentations. This series is designed for Maryland Psychiatric-Mental Health Nurse Practitioners (PMHNPs) who want to deepen their knowledge of child and adolescent mental health. Free CEU credit is available for participation.

Complete this survey on Tourette Syndrome to receive a

$50 e-gift card!

The Tourette Syndrome Center of Excellence at Johns Hopkins Medicine and Kennedy Krieger Institute in collaboration with Maryland Behavioral Health Integration in Pediatric Primary Care (BHIPP) is conducting a brief survey to better understand pediatric primary care providers (PCPs) knowledge about Tourette Syndrome and related tic disorders (collectively TS) and to identify current practices of PCPs when encountering children and adolescents with TS. We will use this information to inform development of clinical tools to assist PCPs when encountering youth with TS in their everyday practice. PCPs will receive a $50 e-gift card upon completion of this 20-minute survey.