1. harms associated with early and frequent marijuana use among BC youth
blunt talk:
harms associated with early and frequent marijuana use among BC youth
Thanks for the Ministry of Health who funded the study and to all the experts who reviewed the report and provided feedback.

2. Blunt Talk - Context It is currently illegal to possess marijuana.
Growing pressure to legalize marijuana use.
Prior research has demonstrated the risks of
starting using marijuana at a young age
regular marijuana use
This report seeks to identify:
At what levels of use there is an increase in health related harms
Who is at risk for problematic use
What protective factors are linked to less harmful use
What are the baseline levels of use for comparison with future surveys.
At the time of this report, it is against Canadian law to possess, sell, give away, or grow marijuana unless legal permission has been obtained from Health Canada.
Because it is illegal, there have been relatively few studies looking at the potential harms of use among young people.
[CLICK] Prime Minister Trudeau made an election promise to legalize access to marijuana, and there has been growing pressure to move towards legalization from health professionals, law enforcement and others.
Through survey responses, focus groups and workshop McCreary has done with young people, we know that many support the legalisation, and speak to what they see as the positive aspects of marijuana use.
[CLICK] It has been less common to hear young people comment on the negative aspects of substance use, such as dependence and addiction. This is despite research on the links between early or frequent marijuana use and poorer mental health and impaired brain development.
[CLICK] This report seeks to identify:
At what levels of use there is an increase in health related harms
Who is at risk for problematic use
What protective factors are linked to less harmful use
What are the baseline levels of use for comparison with the next survey in 2018 after changes in the law are scheduled to happen.

3. Administration of the BC Adolescent Health Survey
29,832 surveys were completed
1,645 classrooms
56 school districts
325 PHN’s and nursing students
The data for this report came from the 2013 BC Adolescent Health Survey.
This is the fifth BC AHS McCreary has conducted. McCreary started the survey in 1992, and have repeated the process every five years with youth in Grades 7-12 in mainstream public schools.
For AHS V, we collected:
[CLICK] 29, 832 usable surveys,
[CLICK] in 1, 645 classrooms,
[CLICK] in 56 of the 59 BC school districts,
[CLICK] with the help of over 325 public health nurses, and nursing students.
[CLICK] The black areas of the map are school districts that chose not to participate. 98.5% of the province was covered by this survey.
With a survey like this you can’t always get at the why’s behind the behaviours, and this report can only describe correlations not causations. For example, in these results very early marijuana use was associated with poorer mental health. We can’t say for certain which way that relationship goes, or if there is a third variable involved, such as abuse

4. Youth who had tried marijuana
The trends for marijuana use were encouraging. In the space of a decade, the percentage of young people who had ever tried marijuana decreased from over a third to around a quarter.
In 2003 and 2008, there was no gender difference in marijuana use, but in 2013 females were less likely than males to have tried it.

5. Youth attending schools in urban areas of BC were less likely to have tried marijuana than those in rural areas (24% vs. 35%).
Among the 16 Health Service Delivery Areas (HSDAs), the percentages of youth who had tried marijuana ranged from 17% in Richmond and Vancouver to 42% of youth living in the Northwest.
There were also some cultural differences. Youth who identified as East Asian, South Asian, and Southeast Asian were less likely than other youth to have tried marijuana, and students born in Canada were twice as likely as those born abroad to have tried marijuana.

6. Youth who had not tried marijuana
Although this report is focussed on those who have used marijuana, it is important to note that almost three-quarters of youth who completed the survey had never tried it.
[CLICK] Youth who had never tried it were more likely to rate their mental health as good or excellent, and reported better school attendance.
There was a link between marijuana use and their friends’ attitudes, as youth who had never used marijuana were nearly five times more likely to report that their friends would be upset with them if they used it

7. Note: Among youth who had tried marijuana
Age of first use
The most common age for males and females to try marijuana was 14 years, but it is becoming more common for youth, especially females, to wait until they were at least 15 years old to first try marijuana.
As well as being less likely to have tried marijuana, youth in urban areas who had tried it were also more likely to wait until they were at least 15 years old to first do so.
Note: Among youth who had tried marijuana

8. Note: Among youth aged 16-18 who had tried marijuana
Is early use harmful?
To explore any harms associated with the age that youth first tried marijuana, the following analyses were limited to youth who were 16 to 18 years old, and compared the experiences of those who first tried marijuana at age 12 or younger, at 13 or 14, and at 15 or older.
[CLICK] Youth who were 12 or younger when they first tried marijuana, were less likely to report positive overall health, or mental health. They also less frequently slept for eight or more hours the night before taking the survey, and had fewer positive plans for the future.
Note: Among youth aged who had tried marijuana

9. Note: Among youth aged 16-18 who had tried marijuana
Is early use harmful?
Youth who tried marijuana at an earlier age were also more likely to have used cannabis recently and frequently.
As seen in the graph, 6% of those who waited until age 15 to try marijuana had used it on 20 or more days in the past month, compared to 23% of those who first tried it at 13, and 43%* who first used it at age 11.
There was also links to other substance use. The earlier youth used marijuana, the more likely they were to have tried cocaine, hallucinogens and mushrooms, as well as to have an alcohol or drug addiction.
Note: Among youth aged who had tried marijuana
* The percentage should be interpreted with caution as the standard error was relatively high but still within a releasable range

10. Youth aged 12 or younger Had not used marijuana Used marijuana
Good/excellent overall health
80%
93%
Health condition or disability
40%*
19%
Suffered a serious injury in past year
45%*
23%
Attempted suicide
17%* 3%
The previous section compared the health picture of older students who started using marijuana earlier, with those who first used later. However, there are also health disparities already being experienced among younger youth between those who had tried marijuana already and those who had not.
Among those aged 12 or younger who had already used marijuana, their overall health and mental health ratings were lower than those had not used marijuana.
[CLICK] They were more likely to have a health condition or disability, or to have suffered a serious injury or concussion in the past year.
[CLICK] They had more frequently considered or attempted suicide.
[CLICK] They more frequently had been abused and were lacking adult support.
[CLICK] And, three quarters had also tried alcohol, compared to only 5% who had not used marijuana.
Sexually abused
28% 2%
Had supportive adult in family
53%*
85%
Tried alcohol
76% 5%
* The percentage should be interpreted with caution as the standard error was relatively high but still within a releasable range

11. Predictors of early use
Used marijuana before age 13
Refugees
37%*
Went to bed hungry
39%*
Lesbian, gay or bisexual
18%
Having identified that using marijuana at an early age was associated with poorer outcomes, the next step is to identify the experiences and challenges that might make youth more vulnerable to using marijuana at that point.
[CLICK] For example, 37%* of refugees had used marijuana before age 13. This is compared to 11% of Canadian-born youth.
Other groups at risk of early use were [CLICK] those who went to bed hungry often or always (compared to 10% of youth who did not experience this level of poverty).
[CLICK] LGB youth (9% of their straight peers used this early).
[CLICK] Those with a physical disability. Certain mental health conditions were also associated with using marijuana at 12 or younger, including depression, anxiety disorder, ADHD, FASD and autism or Asperger’s.
[CLICK] And those who used other substances by this age, including alcohol and tobacco, were also more likely to have used marijuana by then.
Physical disability
35%*
Before the age of 13
used alcohol
41%
used tobacco
48%
Note: Among year olds who had tried marijuana
* The percentage should be interpreted with caution as the standard error was relatively high but still within a releasable range

12. Note: Among youth who had tried marijuana
Recent use
This presentation has so far covered when youth started using marijuana, and the risks of starting at 12 years old or younger.
The next section shares the findings on marijuana use in the past month, and if frequency of use is also linked to poorer health outcomes.
First, despite the decrease from past survey years in the percentage of students who had ever used marijuana, there has been no change in past month use over the past decade.
When asked about their substance use on the Saturday before taking the survey, almost one in three youth (32%) who had tried marijuana reported using it that day, more males than females.
Note: Among youth who had tried marijuana

13. What are harmful levels of recent use?
Any use in the past month
Three or more days
Consistent risk associated with 20 or more days
These youth appear to have been driving the outcomes at a lower threshold
Matches other research
Using marijuana at all in the past month was linked to a greater risk of reporting poor or fair health. However, there was no consistent pattern for what level of use was associated with harmful use.
For some outcomes (such as attempting suicide or self-harm), [CLICK] using on three or more days in the past month was a greater risk. But using on six or more days was associated with a greater likelihood of experiencing a concussion, and using on 10 or more days in the past month was linked to eating disordered behaviours.
[CLICK] With every risk included in the analyses, youth who used marijuana on most days were more likely to report harms.
These youth also appear to be driving the outcomes. When harms were noted among youth using on 6 or more days, for example, these were not always seen when youth who used on 20 or more days were removed from the analyses.
[CLICK] For these reasons, and to reflect findings from other studies, this report focused on harms associated with using marijuana on 20 or more days in the past month.

14. Harms associated with frequent use
Sleep
Nutrition
Injuries
School
Other substance use
Using marijuana on 20 or more days was associated with not getting enough sleep.
[CLICK] Youth who used marijuana on most days reported among the highest rates of unhealthy eating.
[CLICK] Although there were few differences in the actual rate of injuries, those who used marijuana 20 or more days were doing different things when they were injured. They were more likely to have been skateboarding, or fighting with others when they were injured, and less likely to have been playing sports.
[CLICK] The more youth used marijuana in the past month, the greater the likelihood that they skipped class during that time. These youth were also more likely to feel disconnected from their school.
[CLICK] There was also a link between recent marijuana use and the use of other substances. [CLICK] A greater number of days using marijuana was associated with a higher likelihood of engaging in heavy sessional drinking over the same time period, [CLICK] to have smoked cigarettes in that time, [CLICK] as well as ever using other substances, like hallucinogens or cocaine.
Note: Among youth who had tried marijuana

15. Predictors of frequent use
Stressful life events
Risk taking
Tobacco use
Future plans
Mental health
Having identified that using marijuana on 20 or more days in the past month was associated with poorer outcomes, the next step is to identify the experiences and challenges that might make youth more vulnerable to using marijuana that often.
Many of the same predictors of early use were associated with frequent use.
[CLICK] Youth who lived in challenging circumstances or had experienced stressful life events were more likely to have been using marijuana frequently. This included youth who came to Canada as refugees, those who went to bed hungry because there wasn’t enough food at home, those who were discriminated against or bullied, as well as those who had been abused.
[CLICK] Participation in extreme sports, gambling, breaking seatbelt and helmet laws, and risky sexual behaviour were all associated with frequent marijuana use.
[CLICK] 25% of youth who first smoked tobacco at age 12 or younger used marijuana on 20 or more days in the past month.
[CLICK] Youth who saw themselves in negative circumstances in five years’ time, such as being in prison, homeless, or dead, were more likely to have used marijuana on 20 or more days.
[CLICK] Youth with mental health challenges were also more likely to have used marijuana on most days. 19% of students with ADHD/ADD used it this frequently, compared to 10% of those without this condition.
Youth with other conditions were also more likely than their peers without these conditions to have used marijuana frequently, [CLICK] including youth with autism or Asperger’s, a learning disability, FASD, and a behavioural condition.
Note: Among youth who had tried marijuana
* The percentage should be interpreted with caution as the standard error was relatively high but still within a releasable range

16. Youth who first used marijuana recently
Those who had been using for more than a year were more likely to have…
Used in the past month
Used frequently
Ever used other substances
This report also compared the health of youth who had first tried marijuana within the past year, with those who had first tried it over a year ago.
[CLICK] The 51% who had been using for more than a year were more likely to have used in the past month, and to have used frequently. For example, youth who first tried it more than a year ago were almost seven times as likely to have used marijuana on 20 or more days in the past month.
[CLICK] These students more frequently had used on the Saturday before the survey, and had tried other substances as well, such as cocaine, hallucinogens and mushrooms.

17. Progression to regular use
Other research has found that the progression from first trying marijuana, to regular using it can be as rapid as tobacco progression, and more rapid than that of alcohol. This appeared to be the case for students in BC.
[CLICK] Among students who first tried alcohol within the past year, 4% drank on 6 or more days in the past month. In contrast, 11% who had first tried marijuana and 12% who had first tried tobacco within the past year used these substances that often – a more rapid progression to regular use.
Note: Among youth who had first tried it within the past year

18. Note: Among youth who had used marijuana exclusively
Reasons for using
More common among frequent and at-risk users.
To identify the reasons some youth used marijuana, these analyses were restricted to the youth who had tried marijuana exclusively, and not used any other substance.
The most common reasons to use marijuana were to experiment, have fun, because their friends were doing it, and because of stress.
[CLICK] Stress was more commonly reported among those who were using three or more days a month, those who had a health condition, and those who had been victimized.
[CLICK] Those who had a mental health condition or had been bullied in the past year were also more likely to report they used marijuana because they were sad.
Note: Among youth who had used marijuana exclusively

19. Consequences of use
The most common consequences of marijuana use were:
Being told I did something I couldn’t remember
Passing out
Losing friends, boyfriends or girlfriends
Changes in grades or school work
Arguing with family members
Again, among those who had only used marijuana, the more common consequences youth reported were:
[CLICK] Being told I did something I couldn’t remember
[CLICK] Passing out
[CLICK] Losing friends, boyfriends or girlfriends
[CLICK] Changes in grades or school work
[CLICK] Arguing with family members
Females, those who used on three or more days, and those with a mental health condition were all more likely to have experienced consequences of their marijuana use.
Although the risks associated with using on 20 or more days were emphasized earlier, those who used marijuana on just three or more days in the past month were twice as likely as those who used it on fewer days to report negative consequences of their use (54%* vs. 27%).

20. Driving after using marijuana
Ever drove after using marijuana
19% of males and 11% of females
Drove after using marijuana in the past month
11% of males and 6% of females
More frequent among:
Older youth
Those who had used marijuana for more than a year
Those who used frequently
Fifteen percent of youth who had tried marijuana had driven after using marijuana, which was a decrease from 20% in Nine percent of youth had done so in the past month. Males more frequently reported driving after using marijuana.
These youth were twice as likely to have had their most recent serious injury occur in a motor vehicle.
[CLICK] Older youth were more likely to have driven after using marijuana, and similarly, so were youth who were further through their graduated licencing process.
The longer it had been since youth tried marijuana, and the greater number of days youth used marijuana in the past month, were both linked to impaired driving.
[CLICK] Using on a greater number of days was also associated with being a passenger in a vehicle driven by someone who had been drinking or using marijuana.
Note: Among youth who had tried marijuana

21. Youth who needed help
Seven percent of youth who used marijuana exclusively felt they needed help for their use in the past year.
Groups at risk include:
Younger users
Those who started at a younger age
Frequent users
Those who experienced a negative consequence of use
Those who had a negative vision of their future
Those who skipped class 3+ times a month
Those who missed out on necessary mental health services
Seven percent of youth who used marijuana exclusively felt they needed help for their use in the past year. This was similar to the rate for youth who had used other substances along with marijuana.
There was no gender difference, [CLICK] but younger students who had tried marijuana were more likely than older ones to feel they need help for their marijuana use, as were [CLICK] those who started at a younger age and [CLICK] those who were using frequently.
Other at risk groups included youth who:
[CLICK] Had a negative experience as a result of their marijuana use
[CLICK] Anticipated a bleak future for themselves
[CLICK] Skipped class three or more times in the past month
[CLICK] Missed out on needed mental health services

22. Note: Among youth who used marijuana
Sources of marijuana
“Source of marijuana” refers to who youth got their marijuana from most recently, most commonly a youth outside their family.
Males and older youth were more likely to get their marijuana from the second most common source, an adult outside the family.
Youth who started using marijuana more than a year ago were more likely to go outside the norm, and we saw that different vulnerable groups more frequently got their marijuana from an adult.
Regionally, youth in the North more frequently got their marijuana from a youth inside their family.
Note: Among youth who used marijuana

23. Protective factors - Family
Connection to family
Their family understood them
Had fun with their family
Family paid attention to them
Had an adult in their family they could talk to
Parental monitoring
To end the presentation, the following slides explore what might be present in the lives of young people who had used marijuana, but delayed their first use and reduced the likelihood that they would use it on a daily or almost daily basis.
The four domains discussed are family influences, then school, peers and community.
[CLICK] Youth who felt connected to their family, (through feeling understood, having fun with their family, and being paid attention to) were more likely to delay their marijuana use and less likely to be frequent recent users.
[CLICK] Similarly, youth were less likely to use at the risky levels if they felt they had an adult in their family they could go to with problems.
[CLICK] When students thought that their parents knew what they were doing with their free time, or regularly ate supper with their parents, that was also associated with waiting longer to try marijuana and not using most days in the past month.

24. Protective factors - School
School connectedness
School safety
Helpful school staff
Those who reported the highest levels of school connectedness were more likely to [CLICK] have waited until they were at least 15 years old before first trying marijuana, and were less likely to have both used marijuana in the past month, and to have used it frequently.
[CLICK] Feeling safe at school was also linked to delayed and less frequent marijuana use.
[CLICK] Youth sought help from a variety of school staff members during the past year. When youth who had used marijuana found that support to be helpful, it was linked to lower levels of recent marijuana use. For example, those who asked a teacher for help and found their teacher helpful were less likely to have used marijuana in the past month or to have used it on most days.
Note: Among youth aged who had used marijuana

25. Protective factors – Peers
Having at least one close friend
Friends who would discourage marijuana use
Friends can play an important role in supporting young people’s healthy choices. Youth who reported having at least one close friend in their school or neighbourhood were less likely to have used marijuana on 20 or more days in the past month.
[CLICK] Regardless of the number of friends they had, youth who had friends who would be upset if they used marijuana were less likely than those whose friends would not be upset to report having first tried it at an early age, to have used it in the past month, and to have used it on 20 or more days.
Note: Among youth aged who had used marijuana

26. Protective factors - Community
Community connection
Safe in community
Extracurricular activities
Sports
Meaningful engagement in activities
Youth who felt they were a part of their community were less likely to have first tried marijuana at an early age or to use marijuana frequently.
[CLICK] Also, youth who always felt safe in their neighbourhood were less likely to have used marijuana on most days in the past month.
[CLICK] Participation in at least one extracurricular activity on a weekly basis, such as sports, dance, volunteering, or music was associated with less frequent marijuana use. Playing weekly organised sports was linked to fewer youth reporting frequent marijuana use, and for males, so was playing weekly informal sports.
[CLICK] It was also important that youth felt engaged and valued within their extracurricular activities. These youth were more likely to have waited until they were at least 15 years old to first try marijuana, and there were similar links to frequency of use.
Note: Among youth who had tried marijuana

27. Final word
Early use and frequent use are associated with health challenges.
There are certain groups at risk for early and frequent use, but also protective factors in the lives of young people that are linked to safer behaviour.
Future surveys will continue to provide information on marijuana use, and will be useful in the event of legalization legislation.
McCreary completed this report because other research suggests that there is little research out there about youth marijuana use, but we do know from some studies that using in adolescence has been linked to challenges in adulthood.
[CLICK] This report has shown that early and frequent use is associated with a number of health challenges (including less positive physical and mental health, poor sleep, and lower hopefulness for the future).
[CLICK] This report identified some clear risk factors for early and frequent use, and protective factors that may support youth who do use marijuana to wait longer, and to use at less harmful levels.
[CLICK] McCreary is also looking forward to the 2018 BC Adolescent Health Survey, which will inform the debate about marijuana use and respond to any changes in legislation.

28. For more information
Copies of the report are available at:
Follow us on
Facebook: McCreary Centre Society
For enquiries about this report, presentation requests, or information about accessing data from the BC Adolescent Health Survey, please
For more information:
[CLICK] Copies of the report are available at: Hard copies are also available to order.
[CLICK] Follow McCreary on
[CLICK] or on Facebook: McCreary Centre Society
[CLICK] For enquiries about this report, presentation requests, or information about accessing data from the BC Adolescent Health Survey, please

29. It’s a great time to have conversations about cannabis -
and we can help
The Centre for Addictions Research of BC already have some useful resources for parents, teachers and young people around cannabis use.

30. iMinds - A real-world approach to drug education & tools for inquiry
Focus on building competencies
Students explore social and environmental factors that influence their personal attitudes and behaviours related to alcohol and other drugs
Based on a constructivist approach, iMinds engages students
Includes all required materials
Cross-curricular
These resources focused on grades 4-12, and are all online at
CARBC are currently developing some learning activities that related to this report. As available, they will also be posted to website.

31. How else can CARBC help ... www.helping schools.ca
Cycles -a film-based resource that encourages teens to talk openly and honestly about why some young people use cannabis
– an online cross-curricular resource
The Art of Motivation – online support for using a motivational interviewing approach
Take Care with Cannabis –
– for parents
Consultation, workshops and support
CARBC has been working to build on their learning related resources.
These learning activities fit with the drug literacy related learning objectives and fit with a variety of curriculum areas such as English, Social Studies as well as the Physical and Health Education curriculum.

32. Supporting parents
These guides for parents can also be very useful, including Cannabis Use and Youth: A parent's guide.
The Safe Use series is online at

33. For more info on CARBC’s work
For more information, contact Cindy Andrew

34. annie@mcs.bc.ca duncan@mcs.bc.ca
Thank You
Copies of the report are available at:
For enquiries about this report, presentation requests, or information about accessing data from the BC Adolescent Health Survey, please