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Cannabis and the Impact on the Pediatric and Adolescent Population

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References

Cannabis and Young Pediatric Exposures

  1. Wang GS. Pediatric concerns due to expanded cannabis use: unintended consequences of legalization. J Med Toxicol. 2017;13(1):88–105. PMID: 27139708.

    Google Scholar 

  2. Johnston LD, Miech RA, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME. Monitoring the future national survey results on drug use 1975–2018: overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, University of Michigan; 2019.

    Google Scholar 

  3. Wong SS, Wilens TE. Medical cannabinoids in children and adolescents: a systematic review. Pediatrics. 2017;140(5):e20171818.

    PubMed  Google Scholar 

  4. https://www.leafly.com/news/health/qualifying-conditions-for-medical-marijuana-by-state. Last accessed 1 Apr 2019.

  5. Committee on Substance Abuse, Committee on Adolescence, Committee on Substance Abuse Committee on Adolescence. The impact of marijuana policies on youth: clinical, research, and legal update. Pediatrics. 2015;135(3):584–7.

    Google Scholar 

  6. Appelboam A, Oades PJ. Coma due to cannabis toxicity in an infant. Eur J Emerg Med. 2006;13(3):177–9.

    PubMed  Google Scholar 

  7. Bonkowsky JL, Sarco D, Pomeroy SL. Ataxia and shaking in a 2-year-old girl: acute marijuana intoxication presenting as seizure. Pediatr Emerg Care. 2005;21(8):527–8.

    PubMed  Google Scholar 

  8. Carstairs SD, Fujinaka MK, Keeney GE, Ly BT. Prolonged coma in a child due to hashish ingestion with quantitation of THC metabolites in urine. J Emerg Med. 2011;41(3):e69–71.

    PubMed  Google Scholar 

  9. Macnab A, Anderson E, Susak L. Ingestion of cannabis: a cause of coma in children. Pediatr Emerg Care. 1989;5(4):238–9.

    CAS  PubMed  Google Scholar 

  10. Weinberg D, Lande A, Hilton N, Kerns DL. Intoxication from accidental marijuana ingestion. Pediatrics. 1983;71(5):848–50.

    CAS  PubMed  Google Scholar 

  11. http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx. Last accessed 1 Apr 2019.

  12. https://www.justice.gov/archives/opa/blog/memorandum-selected-united-state-attorneys-investigations-and-prosecutions-states. Last accessed 2 Apr 2019.

  13. Wang GS, Roosevelt G, Heard K. Pediatric marijuana exposures in a medical marijuana state. JAMA Pediatr. 2013;167(7):630–3.

    PubMed  Google Scholar 

  14. Wang GS, Hoyte C, Roosevelt G, Heard K. The continued impact of marijuana legalization on unintentional pediatric exposures in Colorado. Clin Pediatr. 2018;5:114. https://doi.org/10.1177/0009922818805206.

    Article  Google Scholar 

  15. Wang GS, Roosevelt G, Bucher-Bartelson B, Le Lait MC, Bronstein A, Heard K. Impact of decriminalizing marijuana on unintentional pediatric exposures in the US. Ann Emerg Med. 2014;63(6):684–9.

    PubMed  Google Scholar 

  16. Thomas AA, Dickerson-Young T, Mazor S. Unintentional pediatric marijuana exposures at a tertiary care children’s hospital in Washington state: a retrospective review. J Emerg Med. 2017;53(6):e119–23.

    PubMed  Google Scholar 

  17. Bashqoy F, Heizer J, Reiter P, Wang GS, Borgelt L. Increased testing and health care costs for pediatric cannabis exposures. Pediatr Emerg Care. 2019. Epub ahead of print.

    Google Scholar 

  18. Richards JR, Smith NE, Moulin AK. Unintentional cannabis ingestion in children: a systematic review. J Pediatr. 2017;190:142–52.

    PubMed  Google Scholar 

  19. Wang GS, Lelait MC, Deakyne S, Bronstein A, Bajaj L, Roosevelt G. Increase in unintentional pediatric exposures in a recreational marijuana state. JAMA Peds. 2016;170(9):e160971.

    Google Scholar 

  20. Noble MJ, Hedberg K, Hendrickson RG. Acute cannabis toxicity. Clin Toxicol (Phila). 2019;57(8):735–42.

    CAS  Google Scholar 

  21. Vo KT, Horng H, Li K, Ho RY, Wu AHB, Lynch KL, Smollin CG. Cannabis intoxication case series: the dangers of edibles containing tetrahydrocannabinol. Ann Emerg Med. 2018;71(3):306–13.

    PubMed  Google Scholar 

  22. Nappe TM, Hoyte CO. Pediatric death due to myocarditis after exposure to cannabis. Clin Pract Cases Emerg Med. 2017;1(3):166–70.

    PubMed  PubMed Central  Google Scholar 

  23. Wang GS, Bourne DWA, Klawitter J, Sempio C, Chapman K, Knupp K, Wempe MF, Borgelt L, Christians U, Heard K, Bajaj L. Disposition of oral delta-9 tetrahydrocannabinol (THC) in children receiving cannabis extracts for epilepsy. Clin Toxicol (Phila). 2019;58:1–5.

    CAS  Google Scholar 

  24. Heizer J, Borgelt L, Bashqoy F, Wang GS, Reiter PD. Marijuana misadventures in children: exploration of a dose-response relationship and summary of clinical effects and outcomes. Pediatr Emerg Care. 2018;34(7):457–62.

    Google Scholar 

  25. https://marijuanapackaginglaws.com/. Last accessed 1 Apr 2019.

  26. https://www.colorado.gov/pacific/marijuana/news/med-bulletin-new-packaging-and-labeling-rules-and-effective-dates. Last accessed 2 Apr 2019.

  27. https://www.colorado.gov/marijuana/. Last accessed 2 Apr 2019.

  28. https://lcb.wa.gov/laws/labeling-resources. Last accessed 1 Apr 2019.

  29. https://www.oregon.gov/olcc/marijuana/pages/packaginglabelingpreapproval.aspx. Last accessed 1 Apr 2019.

  30. Breault HJ. Five years with 5 million child-resistant containers. Clin Toxicol. 1974;7(1):91–5.

    CAS  PubMed  Google Scholar 

  31. Sibert JR, Craft AW, Jackson RH. Child-resistant packaging and accidental child poisoning. Lancet. 1977;2(8032):289–90.

    CAS  PubMed  Google Scholar 

  32. Walton WW. An evaluation of the poison prevention packaging act. Pediatrics. 1982;69(3):363–70.

    CAS  PubMed  Google Scholar 

  33. https://www.colorado.gov/pacific/marijuanahealthinfo/summary. Last accessed 24 Jun 2019.

  34. Moir D, Rickert WS, Levasseur G, Larose Y, Maertens R, White P, Desjardins S. A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions. Chem Res Toxicol. 2008;21(2):494–502.

    CAS  PubMed  Google Scholar 

  35. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/index.htm. Last accessed 2 Apr 2019.

  36. Wilson KM, Torok MR, Wei B, Wang L, Robinson M, Sosnoff CS, Blount BC. Detecting biomarkers of secondhand marijuana smoke in young children. Pediatr Res. 2017;81(4):589–92.

    CAS  PubMed  Google Scholar 

  37. Wilson KM, Torok MR, Wei B, Wang L, Lowary M, Blount BC. Marijuana and tobacco coexposure in hospitalized children. Pediatrics. 2018;142(6):e20180820.

    PubMed  Google Scholar 

  38. Johnson AB, Wilson KM, Wang GS, Mistry RD. Prevalence and impact of second hand marijuana smoke exposure on Emergency Department visitation in children. Pediatric Academic Societies Annual Meeting. San Francisco. May 9, 2017.

    Google Scholar 

  39. El Marroun H, Tiemeier H, Jaddoe VW, Hofman A, Verhulst FC, van den Brink W, et al. Agreement between maternal cannabis use during pregnancy according to self-report and urinalysis in a population-based cohort: the generation R study. Eur Addict Res. 2011;17:37–43.

    PubMed  Google Scholar 

  40. van Gelder MM, Reefhuis J, Caton AR, Werler MM, Druschel CM, Roeleveld N. Characteristics of pregnant illicit drug users and associations between cannabis use and perinatal outcome in a population-based study. National Birth Defects Prevention Study. Drug Alcohol Depend. 2010;109:243–7.

    PubMed  Google Scholar 

  41. Passey ME, Sanson-Fisher RW, D’Este CA, Stirling JM. Tobacco, alcohol and cannabis use during pregnancy: clustering of risks. Drug Alcohol Depend. 2014;134:44–50.

    PubMed  Google Scholar 

  42. Beatty JR, Svikis DS, Ondersma SJ. Prevalence and perceived financial costs of marijuana versus tobacco use among urban low-income pregnant women. J Addict Res Ther. 2012;3:1000135.

    PubMed  PubMed Central  Google Scholar 

  43. Schempf AH, Strobino DM. Illicit drug use and adverse birth outcomes: is it drugs or context? J Urban Health. 2008;85:858–73.

    PubMed  PubMed Central  Google Scholar 

  44. Volkow ND, Han B, Compton WM, McCance-Katz EF. Self-reported medical and nonmedical cannabis use among pregnant women in the United States. JAMA. 2019;322(2):167–69.

    Google Scholar 

  45. Dickson B, Mansfield C, Maryam G, Allshouse A, Borgelt L, Sheeder J, Silver R, Metz T. Recommendations from cannabis dispensaries about first-trimester cannabis use. Obstet Gynecol. 2018;6(131):1031–8.

    Google Scholar 

  46. Crume TL, Juhl AL, Brooks-Russell A, Hall KE, Wymore E, Borgelt LM. Cannabis use during the perinatal period in a state with legalized recreational and medical marijuana: the association between maternal characteristics, breastfeeding patterns, and neonatal outcomes. J Pediatr. 2018;197:90–6.

    PubMed  Google Scholar 

  47. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Marijuana-Use-During-Pregnancy-and-Lactation?IsMobileSet=false. Last accessed 2 Apr 2019.

  48. Bertrand KA, Hanan NJ, Honerkamp-Smith G, Best BM, Chambers CD. Marijuana use by breastfeeding mothers and cannabinoid concentrations in breast milk. Pediatrics. 2018;142(3).

    Google Scholar 

  49. Baker T, Datta P, Rewers-Felkins K, Thompson H, Kallem RR, Hale TW. Transfer of inhaled cannabis into human breast Milk. Obstet Gynecol. 2018;131(5):783–8.

    CAS  PubMed  Google Scholar 

  50. https://www.colorado.gov/pacific/marijuana/laws-and-youth. Last accessed 1 Apr 2019.

  51. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm611046.htm. Last accessed 2 Apr 2019.

  52. https://www.dea.gov/drug-scheduling. Last accessed 2 Apr 2019.

  53. https://www.fda.gov/newsevents/publichealthfocus/ucm421168.htm. Last accessed 2 Apr 2019.

  54. https://www.fda.gov/newsevents/publichealthfocus/ucm484109.htm. Last accessed 2 Apr 2019.

  55. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm583295.htm. Last accessed 2 Apr 2019.

  56. Barchel D, Stolar O, De-Haan T, Ziv-Baran T, Saban N, Fuchs DO, Koren G, Berkovitch M. Oral cannabidiol use in children with autism spectrum disorder to treat related symptoms and co-morbidities. Front Pharmacol. 2019;9:1521.

    PubMed  PubMed Central  Google Scholar 

  57. Aran A, Cassuto H, Lubotzky A, Wattad N, Hazan E. Brief report: cannabidiol-rich cannabis in children with autism spectrum disorder and severe behavioral problems-a retrospective feasibility study. J Autism Dev Disord. 2019;49(3):1284–8.

    PubMed  Google Scholar 

  58. Karhson DS, Krasinska KM, Dallaire JA, Libove RA, Phillips JM, Chien AS, Garner JP, Hardan AY, Parker KJ. Plasma anandamide concentrations are lower in children with autism spectrum disorder. Mol Autism. 2018;9:18.

    PubMed  PubMed Central  Google Scholar 

  59. Pretzsch CM, Freyberg J, Voinescu B, Lythgoe D, Horder J, Mendez MA, Wichers R, Ajram L, Ivin G, Heasman M, Edden RAE, Williams S, Murphy DGM, Daly E, McAlonan GM. Effects of cannabidiol on brain excitation and inhibition systems; a randomised placebo-controlled single dose trial during magnetic resonance spectroscopy in adults with and without autism spectrum disorder. Neuropsychopharmacology. 2019;44(8):1398–405.

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Wei D, Lee D, Cox CD, Karsten CA, Peñagarikano O, Geschwind DH, Gall CM, Piomelli D. Endocannabinoid signaling mediates oxytocin-driven social reward. Proc Natl Acad Sci U S A. 2015;112:14084.

    CAS  PubMed  PubMed Central  Google Scholar 

Cannabis and the Teen Brain

  1. Greydanus DE, Pratt HD, Patel DR, editors. Behavioral pediatrics. 4th ed. New York: Nova Science Publishers; 2015. p. 550.

    Google Scholar 

  2. Greydanus DE, Patel DR, Feucht C, Merrick J, editors. Adolescent medicine: pharmacotherapeutics in general, mental, and sexual health. Berlin: De Gruyter; 2012. p. 400.

    Google Scholar 

  3. Greydanus DE, Patel DR, Pratt HD, editors. Essential adolescent medicine. New York: McGraw-Hill; 2006. p. 600.

    Google Scholar 

  4. Erikson E. Childhood and Society. New York: WW Norton and Co.; 1950. p. 445.

    Google Scholar 

  5. Piaget J, Inhelder B. The growth of logical thinking from childhood to adolescence. New York: Basic Books; 1958.

    Google Scholar 

  6. Lenroot RK, Giedd JN. Brain development in children and adolescents: insights from anatomical magnetic resonance imaging. Neurosci Biobehav Rev. 2006;30(6):718–29.

    PubMed  Google Scholar 

  7. Sporns O. The human connectome: origins and challenges. NeuroImage. 2013;80:53–61.

    PubMed  Google Scholar 

  8. Glasser MF, Smith SM, Marcus DS, Andersson JL, Auerbach EJ, Behrens TE, et al. The human connectome project’s neuroimaging approach. Nat Neurosci. 2016;19(9):1175–87.

    PubMed  PubMed Central  Google Scholar 

  9. Bookheimer SY, Salat DH, Terpstra M, Ances BM, Barch DM, Buckner RL, et al. The lifespan human connectome project in aging: an overview. NeuroImage. 2019;185:335–48.

    PubMed  Google Scholar 

  10. Ernst M, Korelitz KE. Cerebral maturation in adolescence: behavioral vulnerability. Encéphale. 2009;35(Suppl 6):S182–9.

    PubMed  Google Scholar 

  11. Attridge M, Ghali L. Linking early brain and biological development to psychiatry: introduction and symposia review. J Can Acad Child Adolesc Psychiatry. 2011;20(4):253–64.

    PubMed  PubMed Central  Google Scholar 

  12. Keulers EH, Goulas A, Jolles J, Stiers P. Maturation of task-induced brain activation and long range functional connectivity in adolescence revealed by multivariate pattern classification. NeuroImage. 2012;60(2):1250–65.

    PubMed  Google Scholar 

  13. Raznahan A, Shaw P, Lalonde F, Stockman M, Wallace GL, Greenstein D, et al. How does your cortex grow? J Neuro Sci. 2011;31(19):7174–7.

    CAS  Google Scholar 

  14. Bramen JE, Hranilovich JA, Dahl RE, Forbes EE, Chen J, Toga AW, et al. Puberty influences medial temporal lobe and cortical gray matter maturation differently in boys than girls matched for sexual maturity. Cereb Cortex. 2011;21:636–46.

    PubMed  Google Scholar 

  15. Van Leijenhorst L, Gunther Moor B, Op de Macks ZA, Rombouts SA, Westenberg PM, Crone EA. Adolescent risky decision-making: neurocognitive development of reward and control regions. NeuroImage. 2010;51(1):345–55.

    PubMed  Google Scholar 

  16. Van Duijenvoorde AC, Op de Macks ZA, Overgaauw S, Gunther Moor B, Dahl RE, Crone EA. A cross-sectional and longitudinal analysis of reward-related brain activation: effects of age, pubertal stage, and reward sensitivity. Brain Cogn. 2014;89:3–14.

    Google Scholar 

  17. Qu Y, Galvan A, Fuligni AJ, Lieberman MD, Telzer EH. Longitudinal changes in prefrontal cortex activation underlie declines in adolescent risk taking. J Neurosci. 2015;35(32):11308–14.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Blankenstein NE, Schreuders E, Peper JS, Crone EA, van Duijenvoorde ACK. Individual differences in risk-taking tendencies modulate the neural processing of risky and ambiguous decision-making in adolescence. NeuroImage. 2018;172:663–73.

    CAS  PubMed  Google Scholar 

  19. Shallice T, Cipolotti L. The prefrontal cortex and neurological impairments of active thought. Annu Rev Psychol. 2018;69:157–80.

    PubMed  Google Scholar 

  20. Pine DS, et al. Functional magnetic response imaging and pediatric anxiety. J Am Acad Child Adolesc Psychiatry. 2008;47:1217–21.

    PubMed  PubMed Central  Google Scholar 

  21. Roozendaal B, McEwen BS, Chattarji S. Stress, memory and the amygdala. Nat Rev Neurosci. 2009;10(6):423–33.

    CAS  PubMed  Google Scholar 

  22. Shin LM, Liberzon I. The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology. 2010;35:169–91.

    PubMed  Google Scholar 

  23. Silveri MM, Rohan ML, Pimentel PJ, Gruber SA, Rosso IM, Yurgelun-Todd DA. Sex differences in the relationship between white matter microstructure and impulsivity in adolescents. Magn Reson Imaging. 2006;24(7):833–41.

    PubMed  Google Scholar 

  24. Kambam P, Thompson C. Development of decision-making capacities in children and adolescents. Behav Sci Law. 2009;27(2):173–90.

    PubMed  Google Scholar 

  25. Eslinger PJ, Robinson-Long M, Realmuto J, Moll J, deOliveira-Souza R, Tovar-Moll F, et al. Developmental frontal lobe imaging in moral judgment: Arthur Benton’s enduring influence 60 years later. J Clin Exp Neuropsychol. 2009;31(2):158–69.

    PubMed  Google Scholar 

  26. Dahl RE. Biological, developmental, and neurobehavioral factors relevant to adolescent driving risks. Am J Prev Med. 2008;35(3S):S278–84.

    PubMed  Google Scholar 

  27. Casey BJ, Jones RM, Hare TA. The adolescent brain. Ann N Y Acad Sci. 2008;1124:111–26.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Geier CF. Adolescent cognitive control and reward processing: implications for risk taking and substance use. Horm Behav. 2013;64(2):333–42.

    PubMed  Google Scholar 

  29. Fite JE, Goodnight JA, Bates JE, Dodge KA, Pettit GS. Adolescent aggression and social cognition in the context of personality impulsivity as a moderator of predictions from social information processing. Aggress Behav. 2008;34(5):511–20.

    PubMed  PubMed Central  Google Scholar 

  30. Romer D, Betancourt L, Giannetta JM, Brodsky NL, Farah M, Hurt H. Executive cognitive functions and impulsivity as correlates of risk taking and problem behavior in preadolescents. Neuropsychologia. 2009;47(13):2916–26.

    PubMed  PubMed Central  Google Scholar 

  31. Greydanus DE, Calles JL Jr, Patel DR, Nazeer A, Merrick J, editors. Clinical aspects of psychopharmacology in childhood and adolescence—second edition. New York: Nova Science Publishers; 2017. p. 325.

    Google Scholar 

  32. Greydanus DE, Kaplan G, Patel DR, Merrick J. Substance use disorders in adolescents and young adults: a manual for pediatric and primary care clinicians. New York: Nova Science Publishers; 2019. p. 420.

    Google Scholar 

  33. Romer D. Adolescent risk taking, impulsivity, and brain development: implications for prevention. Dev Psychobiol. 2010;52(3):263–76.

    PubMed  PubMed Central  Google Scholar 

  34. Romer D, Duckworth AL, Sznitman PS. Can adolescents learn self-control? Delay of gratification in the development of control over risk taking. Prev Sci. 2010;11(3):319–30.

    PubMed  PubMed Central  Google Scholar 

  35. Greydanus DE, Kaplan G, Baxter LE Sr, Patel DR, Feucht CL. Cannabis: the never-ending, nefarious nepenthe of the 21st century: what should be clinician know? Dis Mon. 2015;61(4):118–75.

    PubMed  Google Scholar 

  36. Felder C, Dickason-Chesterfield A, Moore S. Cannabinoid biology, the search for new therapeutic targets. Mol Interv. 2006;6(3):149–61.

    CAS  PubMed  Google Scholar 

  37. Malfitano AM, Basu S, Maresz K, Bifulco M, Dittel BN. What we know and do not know about the cannabinoid receptor 2 (CB2). Semin Immunol. 2014;26(5):369–79.

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Fezza F, Bari M, Florio R, Talamonti E, Feole M, Maccarrone M. Endocannabinoids, related compounds and their metabolic routes. Molecules. 2014;19(11):17078–106.

    PubMed  PubMed Central  Google Scholar 

  39. Fattore L, Spano MS, Deiana S, Melis V, Cossu G, Fadda P, et al. An endocannabinoid mechanism in relapse to drug seeking: a review of animal studies and clinical perspectives. Brain Res Rev. 2007;53(1):1–16.

    CAS  PubMed  Google Scholar 

  40. Dinieri JA, Hurd YL. Rat models of prenatal and adolescent cannabis exposure. Methods Mol Biol. 2012;829:231–42.

    CAS  PubMed  Google Scholar 

  41. Schneider M. Puberty as a highly vulnerable developmental period for the consequences of cannabis exposure. Addict Biol. 2008;13(2):253–63.

    PubMed  Google Scholar 

  42. Yücel M, Solowij N, Respondek C, Whittle S, Fornito A, Pantelis C, et al. Regional brain abnormalities associated with long-term heavy cannabis use. Arch Gen Psychiatry. 2008;65(6):694–701.

    PubMed  Google Scholar 

  43. Harvey MA, Sellman JD, Porter RJ, Frampton CM. The relationship between non-acute adolescent cannabis use and cognition. Drug Alcohol Res. 2007;26(3):309–19.

    Google Scholar 

  44. Lichenstein SD, Musselman S, Shaw DS, Sitnick S, Forbes EE. Nucleus accumbens functional connectivity at age 20 is associated with trajectory of adolescent cannabis use and predicts psychosocial functioning in young adulthood. Addiction. 2017;112(11):1961–70.

    PubMed  PubMed Central  Google Scholar 

  45. Pacheco-Colón I, Limia JM, Gonzalez R. Nonacute effects of cannabis use on motivation and reward sensitivity in humans: a systemic review. Psychol Addict Behav. 2018;32(5):497–507.

    PubMed  PubMed Central  Google Scholar 

  46. Fried PA. Marihuana use by pregnant women and effects on offspring: an update. Neurotoxicol Teratol. 1982;4:451–4.

    CAS  Google Scholar 

  47. Goldschmidt L, Day NL, Richardson GA. Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicol Teratol. 2000;22:325–36.

    CAS  PubMed  Google Scholar 

  48. Gray KA, Day NL, Leech S, Richardson GA. Prenatal marijuana exposure: effect on child depressive symptoms at ten years of age. Neurotoxicol Teratol. 2005;27(3):439–48.

    CAS  PubMed  Google Scholar 

  49. Goldschmidt L, Richardson GA, Willford J, Day NL. Prenatal marijuana exposure and intelligence test performance at age 6. J Am Acad Child Adolesc Psychiatry. 2008;47(3):254–63.

    PubMed  Google Scholar 

  50. El Marroun H, Hudziak JJ, Tiemeier H, Creemers H, Steegers EA, Jaddoe VW, et al. Intrauterine cannabis exposure leads to more aggressive behavior and attention problems in 18-month-old girls. Drug Alcohol Depend. 2011;118(2–3):470–4.

    PubMed  Google Scholar 

  51. Fried PA. Cannabis use during pregnancy: its effects on offspring from birth to young adulthood. Clin Dev Med. 2011;188:153–68.

    Google Scholar 

  52. Hayatbakhsh MR, Flenady VJ, Gibbons KS, Kingsbury AM, Hurrion E, Mamun AA, et al. Birth outcomes associated with cannabis use before and during pregnancy. Pediatr Res. 2012;71(2):215–9.

    PubMed  Google Scholar 

  53. Jaques SC, Kingsbury A, Henshcke P, Chomchai C, Clews S, Falconer J, et al. Cannabis, the pregnant woman and her child: weeding out the myths. J Perinatol. 2014;34(6):417–24.

    CAS  PubMed  Google Scholar 

  54. Grant KS, Petroff R, Isoherranen N, Stella N, Burbacher TM. Cannabis use during pregnancy: pharmacokinetics and effects of child development. Pharmacol Ther. 2018;182:133–51.

    CAS  PubMed  Google Scholar 

  55. Henschke P. Cannabis: an ancient friend or foe: what works and doesn’t work. Semin Fetal Neonatal Med. 2019;24(2):149–54.

    PubMed  Google Scholar 

  56. Lamy S, Laqueille X, Thibaut F. Consequences of tobacco, cocaine and cannabis consumption during pregnancy on the pregnancy itself, on the newborn and on child development: a review. Encephale, 2015. 41(Suppl 1):S12–20. [French].

    Google Scholar 

  57. Schreiber S, Pick CG. Cannabis use during pregnancy: are we at the verge of defining a “fetal cannabis spectrum disorder”? Med Hypotheses. 2019;124:53–5.

    CAS  PubMed  Google Scholar 

  58. Luke S, Hutcheon J, Kendall T. Cannabis use in pregnancy in British Columbia and selected birth outcomes. J Obstet Gynaecol Can 2019. pii: S1701-2163(18)30909-5. doi: https://doi.org/10.1016/j.jogc.2018.11.014.

  59. Huizink AC. Prenatal cannabis exposure and infant outcomes: overview of studies. Prog Neuro-Psychopharmacol Biol Psychiatry. 2014;52:45–52.

    CAS  Google Scholar 

  60. Jansson LM, Jordan CJ, Velez JL. Perinatal marijuana use and the developing child. JAMA. 2018;320(6):545–6.

    PubMed  Google Scholar 

  61. Richardson KA, Hester AK, McLemore GL. Prenatal cannabis exposure- the “first hit” to the endocannabinoid system. Neurotoxicol Teratol. 2016;58:5–14.

    CAS  PubMed  Google Scholar 

  62. American College of Obstetricians and Gynecologists. Committee Opinion No. 722. Marijuana use during pregnancy and lactation. Obstet Gynecol. 2017;130:e205–9.

    Google Scholar 

  63. National Academies of Sciences, Engineering, and Medicine. Prenatal, perinatal and neonatal exposure to cannabis. In: The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. Washington, D.C.: National Academies Press; 2017.

    Google Scholar 

  64. Ford TC, Hayley AC, Downey LA, Parrott AC. Cannabis: an overview of its adverse acute and chronic effects and its implications. Curr Drug Abuse Rev. 2017;10(1):6–18.

    CAS  PubMed  Google Scholar 

  65. Chadi N, Levy S. What every pediatric gynecologist should know about marijuana use in adolescents. J Pediatr Adolesc Gynecol 2019. pii: S1083-3188(19)30167-6. doi: https://doi.org/10.1016/j.jpag.2019.03.004.

  66. Caballero A, Tseng KY. Association of cannabis use during adolescence, prefrontal CB1 receptor signaling, and schizophrenia. Front Pharmacol. 2012;3:101–4.

    PubMed  PubMed Central  Google Scholar 

  67. Scott JC, Slomiak ST, Jones JD, Rosen AFG, Moore TM, Gur RC. Association of cannabis with cognitive functioning in adolescents and young adults: a systematic review and meta-analysis. JAMA Psychiatry. 2018;75(6):585–95.

    PubMed  PubMed Central  Google Scholar 

  68. Crippa JA, Lacerda AL, Amaro E, Busatto Filho G, Zuardi AW, Bressan RA. Brain effects of cannabis—neuroimaging findings. Rev Bras Psiquiatr. 2005;27(1):70–8.

    PubMed  Google Scholar 

  69. Sundram S. Cannabis and neurodevelopment: implications for psychiatric disorders. Hum Psychopharmacol. 2006;21(4):245–54.

    CAS  PubMed  Google Scholar 

  70. Martin-Santos F, Fagundo AB, Crippa JA, Atakan Z, Bhattacharyya S, Allen P, et al. Neuroimaging in cannabis use: a systemic review of the literature. Psychol Med. 2010;40(3):383–98.

    CAS  PubMed  Google Scholar 

  71. Marmorstein NR, Iacono WG, McGue M. Associations between substance use disorders and major depression in parents and late adolescent-emerging adult offspring: an adoption study. Addiction. 2012;107(11):1965–73.

    PubMed  PubMed Central  Google Scholar 

  72. Colizzi M, Bhattacharyya S. Cannabis use and the development of tolerance: a systematic review. Neurosci Biobehav Rev. 2018;93:1–25.

    CAS  PubMed  Google Scholar 

  73. Gordon SM, Tulak F, Troncale J. Prevalence and characteristics of adolescent patients with co-occurring ADHD and substance dependence. J Addict Dis. 2004;23:31–40.

    PubMed  Google Scholar 

  74. Dennis M, Godley SH, Diamond G, Tims FM, Babor T, Donaldson J, et al. The cannabis youth treatment (CYT) study: main findings from two randomized trials. J Subst Abuse Treat. 2004;27(3):197–213.

    PubMed  Google Scholar 

  75. Greydanus DE, Apple RA, Merrick J. Cannabis and ADHD: a Pandora’s box of perpetual perplexity. Int J Child Health Hum Dev. 2017;10(2):1–3.

    Google Scholar 

  76. Brandt A, Rehm J, Lev-Ran S. Clinical correlates of cannabis use among individuals with attention deficit hyperactivity disorder. J Nerv Ment Dis. 2018;206(9):726–32.

    PubMed  Google Scholar 

  77. Wallace AL, Wade NE, Hatcher KF, Lisdahl KM. Effects of cannabis use and subclinical ADHD symptomatology on attention based tasks in adolescents and young adults. Arch Clin Neuropsychol. 2018;26:34. https://doi.org/10.1093/arclin/acy080.

    Article  Google Scholar 

  78. Fergusson DM, Boden JM. Cannabis use and adult ADHD symptoms. Drug Alcohol Depend. 2008;95(1–2):90–6.

    PubMed  Google Scholar 

  79. Silva N Jr, Szobot CM, Shih MC, Hoexter MQ, Anselmi CE, Pechansky F. Searching for a neurobiological basis for self-medication theory in ADHD comorbid with substance use disorders: an in vivo study of dopamine transporters using (99m)Tc-TRODAT-1 SPECT. Clin Nucl Med. 2014;39(2):e129–34.

    PubMed  Google Scholar 

  80. Pandolfo P, Vendruscolo LF, Sordi R, Takahkashi RN. Cannabinoid-induced conditional place preference in the spontaneously hypertensive rate-an animal model of attention deficit hyperactivity disorder. Psychopharmacology. 2009;205(2):319–26.

    CAS  PubMed  Google Scholar 

  81. Distel MA, Vink JM, Bartels M, van Beijsterveldt CEM, Neale MC, Boomsma DI. Age moderates non-genetic influences on the initiation of cannabis use: a twin-sibling study in Dutch adolescents and young adults. Addiction. 2011;106(9):1658–66.

    PubMed  PubMed Central  Google Scholar 

  82. Soler Artigas M, Sánchez-Mora C, Rovira P, Richarte V, Garcia-Martínex I, Pagerols M, et al. Attention-deficit/hyperactivity disorder and lifetime cannabis use; genetic overlap and causality. Mol Psychiatry. 2019. https://doi.org/10.1038/s41380-018-0339-3.

  83. Kolla NJ, van der Maas M, Toplak ME, Erickson PB, Mann RE, Seeley J, et al. Adult attention deficit hyperactivity disorder symptoms profiles and current problems with alcohol and cannabis: sex differences in a representative, population survey. BMC Psychiatry. 2016;16:50. https://doi.org/10.1186/s12888-016-0746-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Costentin J. Neuropsychopharmacology of delta-9-tetrahydrocannabinol. Ann Pharm Fr. 2008;66(4):219–31. [French].

    CAS  PubMed  Google Scholar 

  85. Goldstein RZ, Volkow ND. Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nat Rev Neurosci. 2011;12(11):652–69.

    CAS  PubMed  PubMed Central  Google Scholar 

  86. Goldstein RZ, Volkow ND. Drug addiction and its underlying neurobiological basis: neuroimaging evidence for the involvement of the frontal cortex. Am J Psychiatry. 2002;159(10):1642–52.

    PubMed  PubMed Central  Google Scholar 

  87. Feil J, Sheppard D, Fitzgerald PB, Yücel M, Lubman DI, Bradshaw JL. Addiction, compulsive drug seeking, and the role of frontostriatal mechanisms in regulating inhibitory control. Neurosci Biobehav Rev. 2010;35(2):248–75.

    PubMed  Google Scholar 

  88. Bloomfield MA, Ashok AH, Volkow ND, Howes OD. The effects of Δ9-tetrahydrocannabinol on the dopamine system. Nature. 2016;539(7629):369–77.

    CAS  PubMed  PubMed Central  Google Scholar 

  89. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, DSM-5. 5th ed. Washington, D.C.: American Psychiatric Association; 2013.

    Google Scholar 

  90. Brezing CA, Levin FR. The current state of pharmacological treatments for cannabis use disorder and withdrawal. Neuropsychopharmacology. 2018;43(1):173–94.

    CAS  PubMed  Google Scholar 

  91. Patel J, Marwaha R. Cannabis use disorder. StatPearls [Internet]. Treasure Island: StatPearls Publishing; 2019.

    Google Scholar 

  92. Simpson AK, Magid V. Cannabis use disorder in adolescence. Child Adolesc Psychiatr Clin N Am. 2016;25(3):431–43.

    PubMed  Google Scholar 

  93. Stormshak EA, Caruthers AS, Gau JM, Winter C. The impact of recreational marijuana legalization on rates of use and behavior: a 10-year comparison of two cohorts from high school to young adulthood. Psychol Addict Behav. 2019;33:595. https://doi.org/10.1037/adb0000508.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Freeman TP, Winstock AR. Examining the profile of high-potency cannabis and its association with severity of cannabis dependence. Psychol Med. 2015;45(15):3181–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  95. Kmietowicz A. Teens who use cannabis show higher risk of taking other illicit drugs. BMJ. 2017;357:j2791. https://doi.org/10.1136/bmj.j2791.

    Article  Google Scholar 

  96. De Luca MA, Di Chiara G, Cadoni C, Lecca D, Orsolini L, Papanti D, et al. Cannabis; epidemiological, neurobiological and psychopathological issues: an update. CNS Neurol Disord Drug Targets. 2017;16:598. https://doi.org/10.2174/1871527316666170413113246.

    Article  CAS  PubMed  Google Scholar 

  97. Lopez-Quintero C, Granja K, Hawes S, Duperrouzel JC, Pacheco-Colón I, Gonzalez R. Transition to drug co-use among adolescent cannabis users: the role of decision-making and mental health. Addict Behav. 2018;85:43–50.

    PubMed  PubMed Central  Google Scholar 

  98. Christozov C. The Moroccan aspect of cannabis poisoning from studies made in a psychiatric hospital for chronic diseases [article in French]. Maroc Med. 1965;44(483):630–42.

    CAS  PubMed  Google Scholar 

  99. Debray H, Vidal F, Enjoiras M. Cannabis poisoning in a 13-month-old girl. Presse Med. 1987;16(36):1807.

    CAS  PubMed  Google Scholar 

  100. Boros CA, Parsons DW, Zoanetti GD, Ketteridge D, Kennedy D. Cannabis cookies: a cause of coma. J Paediatr Child Health. 1996;32(2):194–5.

    CAS  PubMed  Google Scholar 

  101. Spadari M, Glaizal M, Tichadou L, Blanc I, Drouet G, Aymard I, et al. Accidental cannabis poisoning in children: experience of the Marseille poison center. Presse Med. 2009;38(11):1563–7. [French].

    PubMed  Google Scholar 

  102. Croche Santander B, Alonso Salas MT, Loscertales AM. Accidential cannabis poisoning in children: report of four cases in a tertiary care center from southern Spain. Arch Argent Pediatr. 2011;109(1):4–7. [Spanish].

    PubMed  Google Scholar 

  103. Carstairs SD, Fujinaka MK, Keeney GE, Ly BT. Prolonged coma in a child due to hashish ingestion with quantification of THC metabolites in urine. J Emerg Med. 2011;41(3):e69–71.

    PubMed  Google Scholar 

  104. Zarfin Y, Yefet E, Abozaid S, Nasser WM, Finkelstein Y. Infant with altered consciousness after cannabis passive inhalation. Child Abuse Negl. 2012;36(2):81–3.

    PubMed  Google Scholar 

  105. Molly C, Mory O, Basset T, Patural H. Acute cannabis poisoning in a 10-month-old infant. Arch Pediatr. 2012;19(7):729–32.

    CAS  PubMed  Google Scholar 

  106. Le Garrec S, Dauger S, Sachs P. Cannabis poisoning in children. Intensive Care Med. 2014;40(9):1494–5.

    Google Scholar 

  107. Pélissier F, Claudet I, Pélissier-Alicot AL, Franchitto N. Parental cannabis abuse and accidential intoxications in children: prevention by detecting neglectful situations and at-risk families. Pediatr Emerg Care. 2014;30(12):862–6.

    PubMed  Google Scholar 

  108. Wang GS, Le Lait MC, Deakyne SJ, Bronstein AC, Bajaj L, Roosevelt G. Unintentional pediatric exposures to marijuana in Colorado, 2009-2015. JAMA Pediatr. 2016;170(9):e160971. https://doi.org/10.1001/jamapediatrics.2016.0971.

    Article  PubMed  Google Scholar 

  109. Pinedo-Painous I, Garrido-Romero R, Valls-Lafon A, Muñoz-Santanach D, Martínez-Sánchez L. Cannabis poisoning under the age of 3 years. Emergencias. 2018;30(6):408–11. [English, Spanish].

    PubMed  Google Scholar 

  110. Noble MJ, Hedberg K, Hendrickson RG. Acute cannabis toxicity. Clin Toxicol (Phila). 2019;24:1–8. https://doi.org/10.1080/15563650.2018.1548708.

    Article  CAS  Google Scholar 

  111. Zupan Mežnar A, Brvar M, Kralj G, Kovačič D. Accidental cannabis poisoning in the elderly. Wien Klin Wochenschr. 2016;128(Suppl 7):548–52.

    PubMed  Google Scholar 

  112. Gobbi G, Atkin T, Zytynski T, Wang S, Askara S, Boruff J, et al. Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: a systemic review and meta-analysis. JAMA Psychiatry. 2019;76:426. https://doi.org/10.1001/jamapsychiatry.2018.4500.

    Article  PubMed  PubMed Central  Google Scholar 

  113. Horwood LJ, Fergusson DM, Coffey C, Patton GC, Tait R, Smart D, et al. Cannabis and depression: an integrative data analysis of four Australasian cohorts. Drug Alcohol Depend. 2012;126(3):369–78.

    PubMed  Google Scholar 

  114. Degenhardt L, Chiu WT, Sampson N, Kessler RC, Anthony JC, Angermeyer M, et al. Toward a global view of alcohol, tobacco, cannabis, ad cocaine use. Findings from the WHO World Mental Health Surveys. PLoS Med. 2008;5(7):e141. https://doi.org/10.1371/journal.pmed.0050141.

    Article  PubMed  PubMed Central  Google Scholar 

  115. De Aquino JP, Sherif M, Radhakrishnan R, Cahill JD, Ranganathan M, D’Souza DC. The psychiatric consequences of cannabinoids. Clin Ther. 2018;40(9):1448–56.

    PubMed  Google Scholar 

  116. Leweke FM, Koethe D. Cannabis and psychiatric disorders: it is not only addiction. Addict Biol. 2008;13(2):264–75.

    PubMed  Google Scholar 

  117. Bossong MG, Niesink RJ. Adolescent brain maturation, the endogenous cannabinoid system, and the neurobiology of cannabis-induced schizophrenia. Prog Neurobiol. 2010;92(3):370–85.

    CAS  PubMed  Google Scholar 

  118. Rapp C, Bugra H, Riecher-Rössler A, Borgwardt S. Effects of cannabis use on human brain structure in psychosis: a systematic review combining in vivo structural neuroimaging and post-mortem studies. Curr Pharm Des. 2012;18(32):5070–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  119. Van Dijk D, Koeter MW, Hijman R, Kahn RS, van den Bring W. Effect of cannabis use on the course of schizophrenia in male patients: a prospective cohort study. Scizophr Res. 2012;137(1–3):50–7.

    Google Scholar 

  120. Galvez-Buccollini JA, Proal AC, Tomaselli V, Trachtenberg M, Coconcea C, Chun J, et al. Association between age at onset of psychosis and age at onset of cannabis use in non-affective psychosis. Schizophr Res. 2012;139(1–3):157–60.

    PubMed  PubMed Central  Google Scholar 

  121. Giovanni M, Giuseppe DI, Gianna S, Domenico DB, Luisa DR, Massimo DG. Cannabis use and psychosis: theme introduction. Curr Pharm Des. 2012;18(32):4991–8.

    Google Scholar 

  122. Decoster J, van Os J, Myin-Germeys I, De Hert M, van Winkel R. Genetic variation underlying psychosis-inducing effects of cannabis: critical review and future directions. Curr Pharm Des. 2012;18(32):5015–23.

    CAS  PubMed  Google Scholar 

  123. Nazeer A, Calles JL Jr. Schizophrenia in children and adolescents. In: Greydanus DE, Calles Jr JL, Patel DR, Nazeer A, Merrick J, editors. Clinical aspects of psychopharmacology in childhood and adolescence. 2nd ed. New York: Nova Science Publishers Inc; 2017. p. 191–204.

    Google Scholar 

  124. Bagot KS, Chang A. Marijuana and psychosis: policy implications for treatment providers. J Am Acad Child Adolesc Psychiatry. 2018;57(8):613–4.

    PubMed  Google Scholar 

  125. Zuardi AW, Crippa JA, Bhattacharyya S, Atakan Z, Martin-Santos R, et al. A critical review of the antipsychotic effects of Cannabidiol: 30 years of translational investigation. Curr Phar Des. 2012;18(32):5131–40.

    CAS  Google Scholar 

  126. Murray RM, De Forti M. Cannabis and psychosis: what degree of proof do we require? Biol Psychiatry. 2016;79(7):514–5.

    PubMed  Google Scholar 

  127. Murray RM, Englund A, Abi-Dargham A, Lewis DA, Di Forti M, Davies C, et al. Cannabis-associated psychosis: neural substrate and clinical impact. Neuropharmacology. 2017;124:89–104.

    CAS  PubMed  Google Scholar 

  128. Costentin J. Neurobiology of cannabis—recent data enlightening driving disturbances. Ann Pharm Fr. 2008;64(3):148–59.

    Google Scholar 

  129. Mizrahi R, Watts JJ, Tseng KY. Mechanisms contributing to cognitive deficits in cannabis users. Neuropharmacology. 2017;124:84–8. https://doi.org/10.1016/j.neuropharm.2017.04.018. Epub 14 Apr 2017.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  130. Gomes FV, Rincón-Cortés M, Grace AA. Adolescence as a period of vulnerability and intervention in schizophrenia: insights from the MAM model. Neurosci Biobehav Rev. 2016;70:260–70.

    PubMed  PubMed Central  Google Scholar 

  131. Hamilton I. The need for health warnings about cannabis and psychosis. Lancet Psychiatry. 2016;3(4):322. https://doi.org/10.1016/S2215-0366(16)00086-9.

    Article  PubMed  Google Scholar 

  132. Nestoros JN, Vakonaki E, Tzatzarakis MN, Alegakis A, Skondras MD, Tsatsakis AM. Long lasting effects of chronic heavy cannabis abuse. Am J Addict. 2017;26(4):335–42.

    PubMed  Google Scholar 

  133. D’Souza DC, Radhakrishnan R, Sherif M, Cortes-Briones J, Cahill J, Gupta S, et al. Cannabinoids and psychosis. Curr Pharm Des. 2016;22(42):6380–91.

    PubMed  Google Scholar 

  134. Abush H, Ghose S, Van Enkevort EA, Clementz BA, Pearlson GD, Sweeney JA, et al. Associations between adolescent cannabis use and brain structure in psychosis. Psychiatry Res Neuroimaging. 2018;276:53–64.

    PubMed  PubMed Central  Google Scholar 

  135. Lev-Ran S, Aviram A, Braw Y, Nitzan U, Ratzoni G, Fennig S. Clinical correlates of cannabis use among adolescent psychiatric inpatients. Eur Psychiatry. 2012;27(6):470–5.

    CAS  PubMed  Google Scholar 

  136. Barrowclough C, Emsley R, Eisner E, Beardmore R, Wykes T. Does change in cannabis use in established psychosis affect clinical outcome? Schizophr Bull. 2013;39(2):339–48.

    PubMed  Google Scholar 

  137. Orr C, Spechler P, Cao Z, Albaugh M, Chaarani B, Mackey S, et al. Grey matter volume differences associated with extremely low levels of cannabis use in adolescence. J Neurosci. 2019;39(10):1817–27.

    CAS  PubMed  PubMed Central  Google Scholar 

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  1. Section of Emergency Medicine and Medical Toxicology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    George Sam Wang

  2. Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA

    Donald E. Greydanus & Maria Demma Cabral

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Wang, G.S., Greydanus, D.E., Cabral, M.D. (2020). Cannabis and the Impact on the Pediatric and Adolescent Population. In: Finn, K. (eds) Cannabis in Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-45968-0_5

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