Thread by @MyHarmReduction

A thread 🧵

On Monday, JAMA Pediatrics published a new study about the time from drug use initiation to substance use disorder among young people 12-17 and 18-25 for different drugs.

Some politicized it's findings. But they're complicated.

jamanetwork.com/journals/jamap…

It's tricky to design a study that looks at someone's drug use independent of all their life circumstances and to draw a straight line from that use to the development of a substance use disorder.

Drug use doesn't occur in a bubble.

Though they controlled for some variables like gender, race, family income, ever having a depressive episode, and other substance use disorders, that may not capture other pre-existing personal, social, familial, and environmental factors that may surround a person's drug use.

These studies that use data from the NSDUH also do this messy thing where they collapse 12 to 17 year olds into a single category and 18 to 25 year olds into a category, meaning that people who may be quite developmentally different are lumped together.

So what did they find?

6.6% of 12-17 year olds who tried cigarettes had dependence within a year,
6% had dependence between 1st-2nd year,
11.6% had dependence between 2nd and 3rd year, and
11.7 % had dependence after 3+ years from the first time they smoked.

And they did this for cigarettes, alcohol, marijuana for 12-17 year olds and the 18-25 year olds.

For each these 3 drugs, the vast majority of young people who had tried any of them never developed a substance use disorder from the drug in the first 3 yrs since they tried them.

But there was something a little different about the marijuana findings from 12-17 year olds. And it didn't hold even hold true for the 18-25s.

And it was so telling to me how the authors spun that it was clear they were trying to make a point.

They found that 12-17 year olds who ever tried marijuana, 10% met criteria for a cannabis use disorder within the first year and 20% met criteria at the 3 year point (This is troubling!).

But they found that 18-25 year olds had rates half this at the 1 and 3 year points.

In the NYTimes piece that ran on Monday that highlighted the study, Volkow, one of the study's authors spoke about the dangers of high-potency marijuana on the brain.

But here's the thing - you CAN'T blame the high potency marijuana if it's the same weed the 18-25s used too!

You also can't blame the 'vulnerable' 12-17 year old brain for extra vulnerability to addiction because those who tried alcohol or cigarettes had lower prevalence of 1 yr and 3 yr dependence compared the the 18-25s who had HIGHER rates with those same drugs at 1st and 3rd year.

Here's the thing.

1) I don't see evidence that these drugs 'created' dependence through exposure alone for either age bracket;
2) I don't see evidence that the 12-17s were necessarily more likely to see an expedited SUD trajectory compared to the 18-25s.

Studies like this with overly simplistic hypotheses trying to link one predictor (trying a drug ever) to one very complex outcome variable (addiction) create more questions than answers.

Questions like,
-Why?
-What else was going on?

But many studies funded by NIDA and written by Volkow adhere to this simplistic narrative that exposure = risk. Even when exposure is simply one of infinite variables in our lives that may lead us down the path of repeated or frequent use, or problematic use.

I have a lot of questions about what was happening with those 12-17 year old teens who tried marijuana and the portion who developed CUD within 3 years.

Clearly something ELSE was going on, maybe quite a few things in their lives. And likely those things predated use.

But people may try and use a study like this to say that marijuana is uniquely risky for teens, rather than maybe there are some key factors that differ in the lives of young people who seek it out & why they use it.

Here's the other thing about this study- it is not an indictment of marijuana laws. This study did not evaluate whether these trajectories differed by state policy. They lumped all states together.

We know that 12-17s don't use at increased rates in legalized states.

It never hurts to encourage anyone to abstain or delay use until they've thought it through.

But on the flip side, we should be able to tell youth that if they try something, they should be mindful of when, why, how much, and with whom. (Real considerations when building habits)

Okay this got long. I'm done. Goodnight!

This is also why NIDA spends millions of our tax dollars on "drug vaccines" so that we can prevent people from experiencing the psychoactive effects of a drug and thereby are less likely to use again. drugabuse.gov/news-events/ni…