When Naomi's daughter was 14, she had her first encounter with cannabis gummies, purchased with a fake ID at one of several unlicensed smoke shops in their New York City neighborhood. The candy she ate contained at least 50 milligrams of the psychoactive compound THC — well above the typical recreational range of 2.5 to 10 mg — and it prompted severe vomiting and put her, if only briefly, in a near-comatose state.
“But I was really happy she’d had that experience, because I thought it would make her stay away from drugs forever,” Naomi (who asked that her name be changed for privacy reasons) recalls for Yahoo Life.
Instead, the teen switched to smoking weed and vaping THC oil — as frequently as four times a day, her mom discerned through snooping. That led to a scary bout with the chronic vomiting of cannabis hyperemesis syndrome (CHS) and made her “withdrawn and defiant.” Now 17, she was recently caught smoking pot in the bathroom of her private school. It got her suspended, put on probation and made subject to random drug testing which, if she fails, will mean mandatory medical leave for inpatient rehab and possible expulsion before senior year. Meanwhile, her parents have employed a team of pricey experts, including a psychopharmacologist, an addiction-specialist therapist and a family therapist.
“Right now, it's pretty bleak,” admits Naomi, who believes the current situation is due to “a collision of temperament and substance,” all kicked off by that first alluring edible. “I think it seemed less scary to her somehow,” she says. “It looked legit and like a product, as opposed to drugs, and gave her a false sense of security.”
Her daughter is far from alone, including when it comes to why she uses cannabis, which is to calm her anxiety — the reason given by 52.9% of teen users, according to a recent study.
Across the board, teen cannabis abuse has increased dramatically — up 245% over the past 20 years, according to one study — with some experts attributing the rise to the wide availability of edibles. While cannabis is legal only for adults, that study's researchers found that edibles have made the drug more accessible to adolescents and fostered a perception that the drug is totally safe. Edibles are “marketed in ways that are attractive to young people, and they are considered more discreet and convenient,” the study's lead author said. Indeed, a recent survey on youth and cannabis found that teens view edibles as being less risky than smoking joints or blunts or vaping THC.
But compared to the immediate high of smoking weed, the high from edibles can take several hours, leading some impatient teens to take more of them — and causing intense and unpredictable highs.
It's why headlines about teens being rushed to the ER after overindulging in the middle of their school day — something they can easily do without detection — seem to come at a constant clip, with cities including Boston, Chicago, New York City and Los Angeles and suburban schools in Ohio, Indiana, New York and other states reporting kids getting sick, passing out and even having seizures after ingesting high-dose THC edibles.
“If you are using a gummy in school, it's hard to catch you,” Bonnie Halpern-Felsher, youth risk behavior expert and professor of pediatrics at the Stanford School of Medicine, tells Yahoo Life about why kids are being so brazen. “They're super-easy to hide. So they're feeling less vulnerable to getting caught.” In fact, a 2017 focus group study on cannabis edibles and teens revealed that they opted for edibles “primarily to reduce the likelihood of getting caught.”
Plus, with expanding legality, edibles are “ubiquitous,” Halpern-Felsher, creator of the widely used Cannabis Awareness and Prevention Toolkit, says. “They're everywhere right now.” To wit: A national survey of teens from 2014 found that in states that had legalized medical marijuana, 40% of 12th graders who reported using marijuana in the past year said they had consumed edibles, compared with 26% in states without legalized medical marijuana.
Although edibles are still the least common THC delivery method (after smoking and vaping), according to some of Halpern-Felsher's unpublished data, they are preferred by 10 to 30% of users, depending on age, “so it's not nothing,” she says. And she fears it will only increase. “Young people think that to self-medicate [with weed] is the way to reduce their stress. But that is not true. Actually what it often does is make you feel more stressed, because you want more of it — especially if you're addicted.”
What makes ingesting cannabis different from smoking it?
The science behind edibles, says Dr. Travis Fahrenkamp, psychiatrist at the Hazelden Betty Ford Center for Teens, Young Adults and Families, has to do with how the body metabolizes the psychoactive substance THC, or delta-9-tetrahydrocannabinol.
“When cannabis is smoked, that gets delivered into the lungs and right into the bloodstream,” he explains. “When edibles are ingested, they go through the GI tract, they get into the bloodstream, and they go through what is called first-pass metabolism, which means they're metabolized by the liver.”
That process, he says, forms an additional psychoactive metabolite called 11-OH THC, which can be even more potent and appear in the blood at higher quantities. “That's where not only do you get longer duration” of the high, Fahrenkamp says, “sometimes you get more of a psychoactive effect, depending on the dose that you're taking.”
Why it's so easy to take too much
While you may not be able to overdose and die as you could with, say, opioids, there are plenty of risks with ingesting THC, Fahrenkamp warns — the first of which is taking way too much to begin with.
“A lot of times, these edibles either come in a package of multiple cookies or in, like, a large candy bar,” he says. “They can put as much THC in that as they want, but then just identify the serving size differently.”
With a large chocolate bar, for example, the packaging might say that it contains a total of five servings of 10 mg each. Or a package of six cookies might contain 10 mg per cookie. And teens, not necessarily known for carefully reading labels, might consume the entire package — as with one tragic incident from several years ago, when a 19-year-old died after eating an entire large cookie containing six servings of THC and jumping from a building.
Another factor with taking too much, Fahrenkamp explains, is that the high of edibles not only lasts a lot longer than that of smoking (up to 12 hours or more, compared to about four hours), but it also takes a longer time to kick in: While smoking takes effect immediately and peaks in about 20 to 30 minutes, edibles can take about an hour or longer to get you high, peaking at around the two- to four-hour mark.
“So let's say that they're waiting 30 minutes and are like, ‘Oh, I don't feel anything, maybe I need to take more.’ And then they take more and more, and then it starts hitting them. Then they've already taken too much,” he explains.
Add in the fact that edibles are typically in the form of tempting, colorful sweets, and it's easy to understand overdoing it. “I mean, give me a bag of M&Ms or gummies — not with cannabis — but, you know, it's with any sweet,” says Halpern-Felsher. “You're popping it. It's hard not to.”
Risks of overdosing
Negative reactions may start with the person “freaking out,” or having very high levels of anxiety, says Fahrenkamp. Other possible effects: an altered perception of reality, disorientation, panicking or feeling paranoid to the point of hallucinations or delusions, poor coordination, chronic vomiting in the form of CHS or excessive sleepiness with brief moments of not breathing. Then there are the secondary effects, he says, with teens putting themselves into unsafe situations, such as driving while high or walking into traffic.
When kids who take too much cannabis are rushed to the hospital, it's typically to have their symptoms managed with medications — although people with a higher risk of anxiety, substance use disorders or psychosis because of a family history can experience anxiety and paranoia that's much longer lasting, he says.
And contrary to popular belief, especially for parents who grew up in the ’80s or earlier, one can become addicted to cannabis, says Fahrenkamp. That's because the drug has a similar reward pathway as other substances of abuse, providing plenty of opportunity for people's brains, especially adolescents’, to become addicted, resulting in cannabis use disorder.
For kids already struggling with psychiatric issues, including anxiety and depression, these problems can become exacerbated, and a teen with a family history of psychological disorders, especially schizophrenia or bipolar psychosis, will become more apt to develop them with cannabis use.
Long-term effects of such abuse, he adds, can be impaired memory and concentration, as well as changes in brain development and cognitive decline, including a lowered IQ, that can sometimes be permanent. And we'll soon know even more, as a landmark longitudinal study is currently underway — the National Institute of Mental Health's Adolescent Brain Cognitive Development Study of nearly 12,000 youth looks at factors including drug use.
For now, parents like Naomi are witnessing the effects firsthand. “Once she ate the gummies and she got that high, she didn’t like it,” she says of her daughter. “But she didn’t hate it so much that it kept her from using again.”