Report on Adolescent Cannabis Use and its Implications for Sustainable Development Goal 3

Introduction: A Public Health Challenge to Mental Well-being

The increasing normalization and accessibility of cannabis in the United States present a significant challenge to the achievement of Sustainable Development Goal 3 (Good Health and Well-being). While legislative changes have decriminalized cannabis in many states, the lack of rigorous, FDA-equivalent testing has led to its widespread availability without a full understanding of its public health impact. This report analyzes the growing body of evidence linking adolescent cannabis use to adverse mental health outcomes, directly undermining SDG Target 3.4, which aims to promote mental health and well-being, and SDG Target 3.5, focused on strengthening the prevention and treatment of substance abuse.

Increased Access and Adolescent Vulnerability

Despite legal age restrictions, adolescent access to cannabis and its primary intoxicant, THC, has risen. This heightened accessibility corresponds with alarming rates of dependency and mental health complications, posing a direct threat to the well-being of young populations.

Key Risk Factors for Adolescents

• Cannabis Use Disorder (CUD): Nearly 30% of all cannabis users develop CUD.
• Elevated Adolescent Risk: The risk for addiction among adolescent users is double that of adults.
• Problematic Use Trajectory: Within four years of initiation, one in five adolescents develops problematic cannabis use.

Cannabis Use, Depression, and Suicidality: A Threat to SDG 3

Recent research highlights a disturbing correlation between adolescent cannabis use and severe mental health crises, including depression and suicidality. These findings underscore the urgency of addressing youth substance use as a critical component of the global mental health agenda outlined in SDG 3.

Motivations for Use: A Pattern of Self-Medication

A CDC study involving 16,000 adolescents identified the primary reasons for cannabis use, revealing a trend of self-medication for mental health issues:

1. To feel calm or relaxed (73%)
2. To have fun or experiment (50%)
3. To improve sleep (44%)
4. To forget problems or memories (44%)
5. To alleviate anxiety or depression (40%)

This pattern of use, intended to manage stress and mental distress, paradoxically increases the risk for the very conditions users seek to alleviate.

Statistical Link to Suicidality

A study published in Drug and Alcohol Dependence established a direct statistical link between adolescent cannabis use and suicidal behaviors, even after controlling for pre-existing depression. The findings indicate that cannabis use itself is an independent risk factor.

• Adolescent cannabis use was associated with a significantly increased risk for suicidal ideation.
• The risk for suicide attempts more than doubled among adolescent users.
• Specifically, cannabis use was linked to a 1.85 times higher likelihood of a suicide attempt among adolescents.

Regulatory and Research Deficiencies

The current landscape of cannabis availability starkly contrasts with the stringent protocols for FDA-approved medications, particularly for pediatric populations. This regulatory gap fails to protect young people and hinders progress toward SDG 3 by allowing a largely unvetted substance to proliferate.

Lack of Pediatric Safeguards

Standard pediatric drug trials involve enhanced safety protocols that are absent in the context of legalized cannabis:

• Enhanced Monitoring: Close monitoring for suicidality is standard in pediatric trials, leading to black box warnings on antidepressants for individuals under 25. Cannabis has undergone no such trials for depression.
• Developmental Assessment: Rigorous studies monitor a drug’s potential effects on physical growth and neurodevelopment. This research has not been performed for cannabis.
• Informed Consent: Complex consent processes involving parents and age-appropriate assent from minors are required, ensuring ethical oversight.

The failure to apply these established public health safeguards to cannabis represents a significant institutional failing that compromises youth health and well-being.

Corroborating Evidence from Longitudinal Studies

Multiple high-quality, long-term studies reinforce the causal link between adolescent cannabis use and the later development of depression and suicidality, further emphasizing the threat to SDG 3.

Key Study Findings:

• JAMA Psychiatry: A meta-analysis by Gobbi et al. found that adolescent cannabis use was associated with a 1.5 times greater risk for developing major depression and a 3.4 times greater risk for suicide attempts in young adulthood.
• Norwegian Longitudinal Study: Frequent adolescent cannabis use (≥11 times/year) correlated with a nearly three times greater risk for suicide attempts in adulthood.
• New Zealand 21-Year Study: Frequent adolescent use (weekly or more) was a significant predictor of later suicidal ideation and attempts, even after adjusting for other factors.
• PNAS Hospital Study: Hospitalized adolescents with CUD had substantially increased odds of suicide attempts and self-harm. The presence of comorbid depression more than doubled these risks.

Conclusion and Recommendations for Achieving SDG 3

The evidence overwhelmingly indicates that adolescent cannabis use is a significant risk factor for depression and suicidality, presenting a direct impediment to achieving the health and well-being targets of SDG 3. The perception of cannabis as a harmless substance or a form of self-medication is dangerously misleading and contributes to a growing public health crisis among youth.

Recommendations for Public Health Action:

1. Clinical Screening: Healthcare providers should assess depressed patients for cannabis use as a potential risk factor for suicide and, conversely, screen cannabis users for depression and suicidality.
2. Public Education: In line with SDG 4 (Quality Education), public health campaigns must be initiated to educate adolescents, parents, and policymakers about the specific neurodevelopmental and mental health risks of youth cannabis use.
3. Strengthened Regulation: Aligning with SDG 16 (Peace, Justice and Strong Institutions), regulatory bodies must address the research and safety gaps, treating cannabis with the same scientific rigor as other substances affecting public health.
4. Future Research: Future cohort studies must track the precise timing and onset of cannabis use in relation to depressive symptoms and suicidal behaviors to further clarify causal pathways.

Protecting the mental health of adolescents from the risks associated with cannabis use is not merely a drug policy issue; it is a fundamental component of the global commitment to ensure healthy lives and promote well-being for all at all ages.

Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article extensively discusses the negative impacts of cannabis use on mental health, which is a core component of SDG 3. It focuses on issues such as depression, suicidal thoughts, and substance use disorders, all of which are critical public health concerns that this goal aims to address. The text highlights the increased risks for adolescents, a vulnerable population group whose health and well-being are paramount to achieving SDG 3. Specific phrases like “impact on mental health is mostly unknown,” “elevated cannabis risks for depression and suicidal thoughts,” and “nearly 30% of users develop cannabis use disorder (CUD)” directly link the article’s content to the promotion of health and well-being.

What specific targets under those SDGs can be identified based on the article’s content?

Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

• This target is directly relevant as the article links cannabis use to increased risks of depression and suicide, which contributes to premature mortality. The article states, “adolescent cannabis use was significantly associated with increased risks for thinking about suicide and more than double the risk for suicide attempts.” It also notes that cannabis use in adolescence was associated with a “3.4X greater” risk for suicide attempts in young adulthood. These findings underscore the need for prevention and mental health promotion as outlined in Target 3.4.

Target 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.

• The article’s central theme is the problematic use of cannabis, a narcotic drug. It explicitly mentions the development of “cannabis use disorder (CUD),” stating that “nearly 30% of users develop” it and that for adolescents, “risks for addiction are twice that of adults.” The discussion around the reasons for use, such as self-medication for anxiety or depression, points to the need for strengthening prevention and treatment services, which is the core objective of Target 3.5.

Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Indicator for Target 3.4: Suicide mortality rate (Indicator 3.4.2)

• While the article does not provide a direct suicide mortality rate, it provides significant data on suicide attempts and ideation, which are direct precursors. Progress can be measured by tracking the prevalence of these behaviors. The article provides several quantifiable risk factors, such as: “Among adolescents, cannabis use was linked to a 1.85 times higher likelihood of attempting suicide,” and “frequent adolescent cannabis use… correlated with nearly a three times greater risk for suicide attempts in adulthood.” Monitoring these associations in public health studies would serve as a measure of progress.

Indicator for Target 3.4: Prevalence of mental health disorders (Implied)

• The target aims to “promote mental health and well-being.” The article provides data on the prevalence and risk of depression linked to cannabis use. An implied indicator is the rate of depression in adolescent and young adult cannabis users. The article notes that “cannabis use in adolescence was associated with an increased risk for major depression and suicidal ideation (about 1.5 times greater).” Tracking the incidence of depression in this demographic is a key measure of mental health outcomes.

Indicator for Target 3.5: Prevalence of substance use disorders (Related to Indicator 3.5.1)

• Indicator 3.5.1 focuses on treatment coverage, but to measure this, one must first know the prevalence of the disorder. The article provides baseline data for this, stating that “nearly 30% of users develop cannabis use disorder (CUD)” and “after four years, 1 in 5 adolescents develop problematic use.” Tracking the prevalence of CUD, especially among adolescents, is a direct way to measure the scale of the substance abuse problem that Target 3.5 aims to address.

SDGs, Targets, and Indicators Analysis

Source: psychologytoday.com