Youth cannabis use between ages 9 and 17 years is associated with slower cognitive development during a time of key brain development, according to a study published online April 20 in Neuropsychopharmacology.
Natasha E. Wade, from the University of California, San Diego, and colleagues used data from the Adolescent Brain Cognitive Development Study to assess the influence of adolescent cannabis use onset on neurocognitive trajectories. The analysis included self-reported substance use as well as objective toxicological tests (hair, urine, breath, and oral fluid) for 11,036 youths aged 9 to 17 years.
The researchers found that within the cannabis group, there were age interactions showing altered neurocognitive trajectories across domains (immediate recall and delayed memory, processing speed, inhibitory control, visuospatial processing, language, and working memory; βs = −0.11 to −0.52). Hair-identified delta-9-tetrahydrocannabinol exposure by age predicted worse episodic memory versus controls (β = −0.60), but with no differences for cannabidiol-exposed individuals versus controls. In late childhood, those who used cannabis likely had preexisting better cognitive performance, but experienced reduced improvement or flattened trajectories over time. These neurocognitive trajectories in youth with cannabis use persisted when accounting for within-person change and numerous known confounders.
“Delaying cannabis use supports healthy brain development,” Wade said in a statement. “As cannabis becomes more widely available, it’s important for families and teens to understand how it may affect the developing brain.”
Black teens may face disproportionate exposure to stressors associated with higher substance use vulnerability, including community violence, chronic stress, and untreated mental health problems. Additionally, the growing legalization and normalization of cannabis may lower perceived risk among adolescents.
These issues compound the historical inequities Black youth have faced in accessing behavioral healthcare and early intervention services. Research shows Black adolescents were less likely to access mental health services during the pandemic.
To address these disparities, clinicians must avoid stigmatizing conversations about substance use and instead focus on education, prevention, and trust-building. They should also understand the broader social and structural contexts that can influence Black teens to use cannabis.
Research suggests adolescent cannabis use is associated with an increased risk of mental health disorders later in adolescence and young adulthood, including psychotic, bipolar, depressive, and anxiety disorders.
In addition, Black adolescents are less likely to receive adequate mental health treatment despite comparable or higher exposure to traumatic stressors, including community violence, systemic racism, and loss of a loved one. In fact, nearly 65 percent of Black adolescents report exposure to at least one traumatic event.
By screening teens for cannabis use, clinicians may find opportunities to assess their mood, sleep habits, trauma exposure, and school functioning. Delivering culturally responsive, compassionate care may also strengthen the trust with a population that remains significantly underserved in mental healthcare.
To prevent delayed cognitive development in pediatric patients using cannabis, clinicians should approach psychoeducation and counseling without relying on fear-based messaging.
Practical approaches that can avoid fear-based messaging include:
Discussing substance use may be uncomfortable for adolescent patients, so providers must approach the conversation in a respectful, culturally sensitive manner.
Cannabis has become increasingly normalized for adolescents amid changing policies and social media influence. Clinicians should incorporate cannabis screening into adolescent visits to help prevent delayed cognitive development. They can also screen for co-occurring mental health symptoms, counsel families on delayed initiation, and pay attention to school performance and memory complaints.
Providers must also use culturally sensitive, nonjudgmental communication strategies to support effective psychoeducation and earlier intervention.
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