Who Knew?2023-06-01T22:29:36-04:00

Thank you to the Montgomery County Office of Drug & Alcohol for funding the Youth Marijuana Prevention Project (YMPP)

Conversations about Cannabis

In 2023, we sat down with a behavioral health clinician, a person who previously used cannabis, a high school student, and a high school parent to have an honest and informed conversation about cannabis, substance use disorder, mental health, and ways to support teens.

Topics are based on questions asked anonymously by Montgomery County high school students.

This activity is made possible by funding from the Pennsylvania Department of Drug and Alcohol Programs, the Human Services Block Grant and the Montgomery County Commissioners. The County of Montgomery makes no representations or warranties as to the suitability of this information for your particular purpose, and that to the extent you use or implement this information in your own setting, you do so at your own risk. The information provided herewith is solely for your own use and cannot be sold. In no event will the County of Montgomery be liable for any damages whatsoever, whether direct, consequential, incidental, special, or claim for attorney fees, arising out of the use of or inability to use the information provided herewith.

View the full conversation:

Learn more about our moderator, Jill Adams, SFW

Jill Adams, SFW is the Executive Director with Onward Behavioral Health. Beginning her career in the juvenile justice field as a graduate from Bloomsburg University, Jill has worked with at-risk youth for more than ten years in multiple facets from juvenile detention, victim services, and juvenile probation, to treating adolescents with substance use disorders and creating programs to serve adolescents with substance use and mental health diagnoses.  Jill is the Director of Adolescent Services for Rehab After School and The Light Program which operate under the Onward Behavioral Health organization.

Jill is also a state-wide trainer for the Victim Awareness Curriculum through the National Center for Juvenile Justice and is a certified strengths-based family worker through her work with Temple University, Harrisburg.  She enjoys presenting to parents, youth, and other professionals on topics of prevention and intervention.  Jill believes that a combination of traditional and progressive treatment modalities work best to achieve healing in a treatment setting in addition to strong family and community connections.

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In 2022, we sat down with a physician, a mental health clinician, a person who previously used cannabis, and a high school student to have an honest and informed conversation about cannabis, substance use disorder, mental health, and ways to connect teens with the best support systems.

Topics are based on questions asked anonymously by Montgomery County high school students.

View the full 50-minute conversation.

View video segments by topic.

Learn more about our special guests:

Lizzy Lopez, MA, LPC, NCC

Laura Offutt, MD, FACP

Bob Lamb, MPH

Visit our “Clearing the Air About Vaping” page.

Visit our “Cannabis (it’s complicated)” page.

Answers to students’ questions.

In 2021, Montgomery County high school students anonymously submitted 280 questions they have about cannabis use to four Subject Matter Experts (SME’s). Below are their video responses to many of the most common questions, which were asked by young volunteers on behalf of Montgomery County students.

View videos by Subject Matter Expert.

More answers to students’ questions.

We found that many of the questions asked by Montgomery County students were asked repeatedly, so we have created FAQ’s to address those questions.

Is it possible to become addicted to medical marijuana?2021-05-18T15:04:46-04:00

“Medical marijuana” and cannabis purchased illegally contain the same cannabinoids.

See “Cannabis Can Be Addictive” for more information.

Recent data suggest that 30% of those who use marijuana may have some degree of marijuana use disorder.

People who begin using marijuana before the age of 18 are four to seven times more likely to develop a marijuana use disorder than adults.


What treatments are available for teens who are addicted to substances?2021-05-18T09:20:41-04:00

There are many levels of care available for teens who are struggling with a substance dependence, including in-patient, partial hospitalization programming (PHP), intensive outpatient programming (IOP), and individual outpatient therapy. If you think you need help, please talk to your primary care physician or caretaker.

Find Treatment:  https://findtreatment.gov/results


Does cannabis make you unmotivated?2021-05-18T09:23:11-04:00

Amotivational syndrome is associated with frequent cannabis use.


Is cannabis addiction linked to depression?2021-05-18T15:03:05-04:00

Some research suggests that cannabis smokers are diagnosed with depression more often than nonsmokers are — particularly regular or heavy cannabis users. However, it doesn’t appear that cannabis directly causes depression. Heavy users may appear depressed as a result of the dulling effects of the drug on feelings and emotions.

There also are links between marijuana and other mental health conditions. Marijuana use may trigger schizophrenia or detachment from reality (psychosis) in people who are at higher risk of psychosis. The symptoms of diagnosed psychotic illness may be aggravated if marijuana use continues.

There also is some evidence that teenagers who attempt suicide may be more likely to have used marijuana than those who have not made an attempt. As with marijuana use and depression, more research is needed to better understand these associations.

Also, see “Cannabis use and mental health” for more information on the association between cannabis use and depression.


How common is it for teens to use cannabis?2021-05-18T15:11:31-04:00
How does cannabis use affect brain development?2021-05-18T15:13:37-04:00

Adolescence is a time of critical brain and neural reorganization, which makes it sensitive and highly vulnerable to exogenous substances, such as cannabis and other drugs.


What are risks associated with cannabis use?2021-05-18T15:17:03-04:00

Risks include, but are not limited to, addiction, negative effects on mental health, impeding on brain development and functioning. See the facts below for more information on each of these risks.


Can cannabis use impact intelligence?2021-05-18T15:21:06-04:00

Frequent use starting as a teen can lead to an irreversible loss of 6-8 IQ points


Is it illegal to eat edibles?2021-05-24T21:22:32-04:00

Current Pennsylvania law prohibits the manufacturing and selling of edible cannabis. It is also illegal to bring edible cannabis into Pennsylvania from other states that allow the sale of edible cannabis.

Edibles (as well as all cannabis products) for non-medical purposes cannot be consumed by those under 21 in any of state that has legalized adult-use cannabis.


What percentage of cannabis users become addicted?2021-05-18T15:52:56-04:00

Approximately 9% of cannabis users are at risk of developing a cannabis use disorder. People who begin using marijuana before age 18 are four to seven times more likely than adults to develop a marijuana use disorder.


Learn the Facts About Cannabis & Kids


The Cannabis Industry is Targeting Youth


Big Tobacco companies like Altria, Phillip Morris and British American Tobacco are gearing up to lead the cannabis industry. The unethical choices the tobacco industry made decades ago marketing its addictive and harmful products to kids and the lax government oversight that allowed it to happen are playing out again in the legal cannabis industry in states like California and Colorado. Tobacco companies have leant their support to pro-cannabis groups lobbying for legalization.1

The first legal cannabis dispensaries for adult use in California opened in January 2018. Three cannabis industry behaviors—extensive increases in potency (percentage of THC in products), manufacturing of products to attract youths, and aggressive marketing—that were directly adopted from tobacco industry practices became immediately evident across the state.2

In states where cannabis was legalized, many lessons from tobacco control to prevent youth use were not adopted, potentially creating greater risk of harm.2

Despite restrictions that prohibit cannabis advertising on social media, adolescents are exposed to cannabis marketing via social media, and this exposure is associated with recent cannabis use.3

One study found that young people who are exposed to cannabis marketing on social media are five times more likely to use cannabis, and youth who thought it was likely that they would own or wear cannabis-branded merchandise or who had a favorite cannabis brand had nearly eight times greater odds of past-year cannabis use.4

(References are listed at the very bottom of this page.)


Cannabis Use & Mental Health


Cannabis use leads to acute cognitive impairments that may continue beyond the period of intoxication.5a The study found that cannabis intoxication leads to small to moderate cognitive impairments in areas including:

  • making decisions,
  • suppressing inappropriate responses,
  • learning through reading and listening,
  • the ability to remember what one reads or hears, and
  • the time needed to complete a mental task.

Cannabis users who began regular use in their teens had poorer later life outcomes than non-using peers. The larger group who began regular cannabis use after leaving high school accounted for most cannabis-related harms in adulthood.5

Frequent using starting as a teen can lead to an irreversible loss of 6-8 IQ points.6

The brain continues to develop into your mid-20s, so using weed in your teens creates structural changes in your brain that impact your ability to learn. Individuals who start using substances during adolescence often experience more chronic and intensive use, and they are at greater risk of developing a substance use disorder compared with those who begin use at an older age. In other words, the earlier the exposure, the greater the risk.7

Teens in Montgomery County who use weed and other drugs are much more likely to struggle with depression.8

Chronic use beginning in your teen years is linked to serious psychiatric illnesses.9

Negative health outcomes is amplified when the frequent use begins in your teen years.9

“Self-medicating” with weed actually makes anxiety and depression worse in the long run.9

Daily cannabis use was associated with increased odds of psychotic disorder compared with never users, increasing to nearly five-times increased odds for daily use of high-potency types of cannabis.10

Adolescents who reported using high-potency cannabis were more likely use cannabis more frequently, experience problems with cannabis, and are at a higher risk of developing an anxiety disorder.11

A meta-analysis of 11 studies, including longitudinal and prospective studies, shows that cannabis consumption in adolescence is associated with increased risk of developing major depression in young adulthood and suicidality, especially suicidal ideation.12

Weed smoke contains levels of dangerous chemicals and tar that are similar to tobacco smoke.13

Because of how it is smoked, weed leads to 4 times of the deposition of tar in the lungs compared to cigarette smoking.13

Studies have shown a clear link between weed use during adolescence and an increased risk for an aggressive form of testicular cancer that predominantly strikes young adult males.13

(References are listed at the very bottom of this page.)


Concentrates & the New Cannabis


Today’s marijuana bears little resemblance to the natural cannabis plant. The use of marijuana concentrates has escalated in recent years with butane extracts appearing particularly popular. The administration of butane hash oil, referred to as “dabbing,” is distinct from traditional flower cannabis usage due to the THC content of samples and the presence of impurities such as unpurged butane.14

Today’s extracts are often created using a process that involves butane, hence the term “butane hash oil” (BHO), but regardless of the solvent, the result is a product potentially far more potent than flower cannabis.14

BHO is only one of several cannabis and cannabis-type products that have recently increased in availability in medical, retail, and illicit markets. The flowers of the female cannabis plant and other parts of the plant contain phytocannabinoids, including THC. These compounds act on the cannabinoid receptors in the brain and alter neurotransmitter release. Synthetic cannabinoids, which have also gained in popularity despite legal regulations, differ from these natural products derived from the cannabis plant but also act on cannabinoid receptors.14

Cannabis is also the most widely used illicit drug in the world and its use has been associated with various mental health problems, particularly in the young.15

Cannabis is a complex plant with over 400 chemical entities of which more than 60 of them are cannabinoid compounds, some of them with opposing effects.16

This is not your parents’ – or even your older sibling’s weed. Concentration of THC in the bud has increased from ~4% in 1994 to 12% in 2014 and dabs and waxes range between 23.7 and 76.8% (U.S. Surgeon General’s Advisory: Marijuana Use and the Developing Brain, 2019).17

THC potency is strikingly high for flower (mean 20.6%) and extracts for inhalation (mean 68.7%)18

The flower or leaves that are generally smoked or vaped are only one formulation. We now have concentrated THC products such as oil, shatter, dab, and edibles that have been able to get the THC concentration upwards of 95%. There is absolutely no research that indicates this level of THC is beneficial for any medical condition. The purpose of these products is to produce a high, and the increased potency makes them potentially more dangerous and more likely to result in addiction.19

(References are listed at the very bottom of this page.)


Life Hacks for Feeling Stressed, Anxious or Depressed


Many young people have difficulty dealing with and processing stress and are not always taught how to address stress in structures outside the family. When teens look to their future, they experience lots of anxiety and lack the tools for dealing with this angst. They have learned to deal with conflicting feelings through electronic distractions (social media, texting, video games). Cannabis is another means of escaping from this pressure without looking within.

Even a single mindfulness meditation session can reduce anxiety:  People with anxiety show reduced stress on the arteries after a one-hour introductory session.20

When you have depression or anxiety, exercise often seems like the last thing you want to do. But once you get motivated, exercise can make a big difference.21

A study found that euphoria was significantly increased after running and supports the “opioid theory” of the runner’s high, specifically in areas of the brain that are involved in the processing of affective states and mood.22

Physical inactivity is an established risk factor for the development of many of health disorders, including psychiatric illnesses. Regular physical activity has been repeatedly shown to be associated with improved emotional wellbeing and inactivity with poorer emotional wellbeing.23

Research suggests that mood disorders can be lifted by spending more time outdoors.24

How to use meditation for teen stress and anxiety.25

(References are listed at the very bottom of this page.)


Only 14.7% of U.S. High School Students got high in the past 30 days.


Adolescents who reported that their friends used marijuana had a 27% greater odds of using marijuana themselves. However, their perception of their friends’ use of marijuana was double that of their self-reported use.26

Among U.S. high school students in 202027:
30.6% used marijuana in their lifetime
24.9% used marijuana in the past year
14.7% used marijuana in the past 30 days
4.1% used marijuana daily

Among Montgomery County, PA high school students in 201928:
16.6% used marijuana in their lifetime (17.3% statewide)
9.7% used marijuana in the past 30 days (9.6% statewide)

Who you surround yourself with impacts your perception of how many people smoke and further impact what decisions you will make in your life. Teens who reported that their friends smoke had a 27% increased likelihood of also smoking.26

The messaging on social media that you are exposed to impacts your perception of how many people smoke and further impact what decisions you make in your life. Teens exposed to pro-weed messaging had a 6% increased chance of smoking themselves.26

Teens whose parents approve of moderate drinking (even under supervision) significantly increases the likelihood of underage drinking and other drug use in adolescence.28

In Montgomery County, nearly 40% of seniors and 70% of teens in total disapprove of using weed.28

Perceived rate of use of peers is higher than self-reported use rates and national average rates of teen use.26

Parental cannabis use was consistently associated with an increase in cannabis, nicotine, alcohol, and opioid use among adolescent and young adult offspring, even when models adjusted for potential confounding variables.29

The normalization of cannabis use and increased access and exposure may be explained by parents (caretakers) using cannabis.29

(References are listed at the very bottom of this page.)


Cannabis Can Be Addictive


People who begin using marijuana before age 18 are four to seven times more likely than adults to develop a marijuana use disorder.30

Marijuana use can lead to the development of a substance use disorder, a medical illness in which the person is unable to stop using even though it’s causing health and social problems in their life. Severe substance use disorders are also known as addiction. Research suggests that nearly 3 of every 10 marijuana users has had a diagnosis of a marijuana use disorder (approximately 6,846,000 Americans).31

In a 20-year study, participants who started using cannabis in young adulthood or adolescence were more likely than non-users to experience increased likelihood to use other illicit substances, become a high-risk alcohol drinker, smoke daily, and were less likely to be in a relationship.32

A study finds that Cannabis is almost as addictive as opioids among teens. A year after first trying cannabis, almost 10.7% of adolescents age 12 to 17 met the criteria of addiction. Those in the same age group who tried prescription opioids had a similar addiction rate of 11.2%, according to the study.33

(References are listed at the very bottom of this page.)

The “Who Knew?” campaign is part of a five-year initiative called the Youth Marijuana Prevention Project (YMPP), which launched in July 2019 in Montgomery County, Pennsylvania.

Thanks to funding from the Montgomery County Office of Drug & Alcohol, Be a Part of the Conversation is presenting facts about the impact of cannabis use on the developing adolescent brain.

Thank you!

The Youth Marijuana Prevention Project (YMPP) is funded by the Montgomery County Office of Drug & Alcohol.


1Forbes:  How Tobacco Giant Altria Is Becoming A Cannabis Company.  >>Learn more.
2Silver LD, Naprawa AZ, Padon AA. Assessment of Incorporation of Lessons From Tobacco Control in City and County Laws Regulating Legal Marijuana in California. JAMA Netw Open. 2020;3(6):e208393. doi:10.1001/jamanetworkopen.2020.8393  >>Learn more.
3Jennifer M. Whitehill, Pamela J. Trangenstein, Marina C. Jenkins, David H. Jernigan, Megan A. Moreno, Exposure to Cannabis Marketing in Social and Traditional Media and Past-Year Use Among Adolescents in States With Legal Retail Cannabis, Journal of Adolescent Health, Volume 66, Issue 2, 2020, Pages 247-254, ISSN 1054-139X.  >>Learn more.
4Pamela J. Trangenstein, Jennifer M. Whitehill, Marina C. Jenkins, David H. Jernigan, Megan A. Moreno, Active cannabis marketing and adolescent past-year cannabis use, Drug and Alcohol Dependence, Volume 204, 2019, 107548, ISSN 0376-8716.  >>Learn more.


5aChan GCK, Becker D, Butterworth P, Hines L, Coffey C, Hall W, Patton G. Young-adult compared to adolescent onset of regular cannabis use: A 20-year prospective cohort study of later consequences. Drug Alcohol Rev. 2021 Jan 26. doi: 10.1111/dar.13239. Epub ahead of print. PMID: 33497516. >>Learn more.
5Chan GCK, Becker D, Butterworth P, Hines L, Coffey C, Hall W, Patton G. Young-adult compared to adolescent onset of regular cannabis use: A 20-year prospective cohort study of later consequences. Drug Alcohol Rev. 2021 Jan 26. doi: 10.1111/dar.13239. Epub ahead of print. PMID: 33497516. >>Learn more.
6NIDA. (2013, August 13). Early-Onset, Regular Cannabis Use Is Linked to IQ Decline. Retrieved from https://archives.drugabuse.gov/news-events/nida-notes/2013/08/early-onset-regular-cannabis-use-linked-to-iq-decline on 2021, March 26.  >>Learn more.
7Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet]. Washington (DC): US Department of Health and Human Services; 2016 Nov. CHAPTER 2, THE NEUROBIOLOGY OF SUBSTANCE USE, MISUSE, AND ADDICTION. >>Learn more.
8Pennsylvania Youth Survey (PAYS), Montgomery County 2019 >>Learn more.
9Hammond, C. J., Chaney, A., Hendrickson, B., & Sharma, P. (2020). Cannabis use among U.S. adolescents in the era of marijuana legalization: A review of changing use patterns, comorbidity, and health correlates. International Review of Psychiatry, 3, 221-234.  >>Learn more.
10Marta Di Forti, Diego Quattrone, Tom P Freeman, Giada Tripoli, Charlotte Gayer-Anderson, Harriet Quigley, and others. The Lancet Psychiatry, Vol. 6, No. 5, p427–436. Published: March 19, 2019  >>Learn more.
11Hines LA, Freeman TP, Gage SH, et al. Association of High-Potency Cannabis Use With Mental Health and Substance Use in Adolescence. JAMA Psychiatry. 2020;77(10):1044–1051. doi:10.1001/jamapsychiatry.2020.1035  >>Learn more.
12Gobbi G, Atkin T, Zytynski T, et al. Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young AdulthoodA Systematic Review and Meta-analysisJAMA Psychiatry. 2019;76(4):426–434. doi:10.1001/jamapsychiatry.2018.4500 >>Learn more.
13NIDA. 2020, April 8. What are marijuana’s effects on lung health?. Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/what-are-marijuanas-effects-lung-health on 2021, March 26  >>Learn more.


14Butane hash oil and dabbing: insights into use, amateur production techniques, and potential harm mitigation. Al-Zouabi, Stogner, Miller, Lane. Subst Abuse Rehabil. 2018; 9: 91–101. Published online 2018 Nov 2. doi: 10.2147/SAR.S135252 PMCID: PMC6220730 PMID: 30464676 >>Learn more.
15NIDA. 2019, December 24. Marijuana DrugFacts. Retrieved from https://www.drugabuse.gov/publications/drugfacts/marijuana on 2021, March 26. >>Learn more.
16Cannabis, a complex plant:
different compounds and different effects on individuals. Zerrin Atakan, MD. DOI: 10.1177/2045125312457586 >>Learn more.
17U.S. Surgeon General’s Advisory: Marijuana Use and the Developing Brain  >>Learn more.
18Addiction. Smart, Caulkins, Kilmer, Davenport, and Midgette. 2017 December ; 112(12): 2167–2177. doi:10.1111/add.13886.  >>Learn more.
19The Problem with the Current High Potency THC Marijuana from the Perspective of an Addiction Psychiatrist. Elizabeth Stuyt, MD. Mo Med. 2018 Nov-Dec; 115(6): 482–486. PMCID: PMC6312155
PMID: 30643324  >>Learn more.


20Experimental Biology 2018. (2018, April 23) Even a single mindfulness meditation can reduce anxiety. Science Daily. >>Learn more.
21Depression and anxiety: Exercise eases symptoms. >>Learn more.
22Henning Boecker, Till Sprenger, Mary E. Spilker, Gjermund Henriksen, Marcus Koppenhoefer, Klaus J. Wagner, Michael Valet, Achim Berthele, Thomas R. Tolle, The Runner’s High: Opioidergic Mechanisms in the Human Brain, Cerebral Cortex, Volume 18, Issue 11, November 2008, Pages 2523–2531. >>Learn more.
23J. Sarris, S. Moylan, D. A. Camfield, M. P. Pase, D. Mischoulon, M. Berk, F. N. Jacka, I. Schweitzer, “Complementary Medicine, Exercise, Meditation, Diet, and Lifestyle Modification for Anxiety Disorders: A Review of Current Evidence“, Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 809653, 20 pages, 2012. >>Learn more.
24Stanford researchers find mental health prescription: Nature. Study finds that walking in nature yields measurable mental benefits and may reduce risk of depression.  >>Learn more.
25How to use meditation for teen stress and anxiety.  >>Learn more.


26Roditis, M. L., Delucchi, K., Chang, A., & Halpern-Felsher, B. (2016). Perceptions of social norms and exposure to pro-marijuana messages are associated with adolescent marijuana use. Preventive Medicine: An International Journal Devoted to Practice and Theory, 93, 171-176.  >>Learn more.
27Monitoring the Future National Survey results on drug use; 1975-2020. Sponsored by The National Institute on Drug Abuse at The National Institutes of Health  >>Learn more.
28Pennsylvania Youth Survey (PAYS), Montgomery County 2019 >>Learn more.
29The Influence of Parental Marijuana Use on Children. Madras, B. K. (2021, January 14). The Influence of Parental Marijuana Use on Children. Retrieved February 02, 2021, from https://www.physiciansweekly.com/the-influence-of-parental-marijuana-use-on-children-9/   >>Learn more.


30Winters KC, Lee C-YS. Likelihood of developing an alcohol and cannabis use disorder during youth: association with recent use and age. Drug Alcohol Depend. 2008;92(1-3):239-247. doi:10.1016/j.drugalcdep.2007.08.005. >>Learn more.
31Hasin DS, Saha TD, Kerridge BT, et al. Prevalence of Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013. JAMA Psychiatry. 2015;72(12):1235-1242. doi:10.1001/jamapsychiatry.2015.1858. >>Learn more.
32Chan GCK, Becker D, Butterworth P, Hines L, Coffey C, Hall W, Patton G. Young-adult compared to adolescent onset of regular cannabis use: A 20-year prospective cohort study of later consequences. Drug Alcohol Rev. 2021 Jan 26. doi: 10.1111/dar.13239. Epub ahead of print. PMID: 33497516. >>Learn more.
33Volkow ND, Han B, Einstein EB, Compton WM. Prevalence of Substance Use Disorders by Time Since First Substance Use Among Young People in the US. JAMA Pediatr. Published online March 29, 2021. >>Learn more.
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