Are teens ditching alcohol for cannabis? Study reveals major shifts in substance use

A 20-year US study points to major shifts in teenage substance use trends, with alcohol abuse declining while the consumption of cannabis edibles climbs.

Adolescent cannabis abuse has increased 245% since 2000 in the US, according to a new study, while alcohol abuse has steadily declined over the same period.

The national, peer-reviewed study tracked intentional substance misuse and abuse reported to the National Poison Data System (NPDS) over a 20-year period up until 2020.

Findings, published in the peer-reviewed journal Clinical Toxicology, find over 338,000 instances of intentional substance abuse or misuse amongst American children aged 6-18.

The majority of ingestions occurred in males (58.3%), and more than 80% of all reported exposure cases occurred in young people aged 13 to 18. In total, over 32% of instances resulted in ‘worse than minor clinical outcomes’.

The new report demonstrates a change in patterns over time. Dextromethorphan was the most reported substance over the study period, however this peaked in 2006 and has decreased since.

In addition, in 2000 the largest number of abuse cases involved exposure to ethanol, yet since then child alcohol abuse has also steadily declined over the years.

Alcohol vs cannabis 

Cannabis exposure cases remained relatively stable from 2000 to 2009, then steadily rose from 2011, with a more dramatic rise in cases from 2017 to 2020.

Experts analysing the data attribute the rise in cannabis use to the increased popularity of edible cannabis products, now widely available across the country.

“Ethanol abuse cases exceeded the number of marijuana cases every year from 2000 until 2013,” says Dr Adrienne Hughes, Assistant Professor of Emergency Medicine at Oregon Health & Science University, one of the authors of the study.

“Since 2014, marijuana exposure cases have exceeded ethanol cases every year, and by a greater amount each year than the prior.”

While rates of all cannabis misuse increased, edibles showed the highest average monthly increase compared with all other forms, suggesting that adolescents have moved away from smoking onto alternative modes of consumption. Extracts, such as those used in cannabis vaping products, were also increasingly popular.

“These edible and vaping products are often marketed in ways that are attractive to young people, and they are considered more discrete and convenient,” says Hughes.

“Compared to smoking cannabis, which typically results in an immediate high, intoxication from edible forms of marijuana usually takes several hours, which may lead some individuals to consume greater amounts and experience unexpected and unpredictable highs.”

The dramatic increase in child cannabis use since 2017 coincides with a wave of decriminalisation legislation in the US. As of 2022, cannabis is legal for adult recreational use in 19 states and for medical use in 36 states.

While cannabis is only legal for adults and not children, the authors of the study argue that it has rendered the drug more accessible to children and adolescents and contributed to a perception that the drug is safe.

“Our study describes an upward trend in marijuana abuse exposures among youth, especially those involving edible products,” says Hughes.

“These findings highlight an ongoing concern about the impact of rapidly evolving cannabis legalisation on this vulnerable population.”

Over-the-counter medication misuse 

As well as cannabis, the study reveals high levels of over-the-counter medication abuse amongst teenagers. 

Between 2001- 2016, the highest number of drug abuse cases related to Dextromethorphan, an over-the-counter cold and cough medicine. Oral antihistamines were also among the most commonly misused substances in this study.

Deaths from drug abuse were rare, occurring in 450 young people (0.1% of cases). Deaths were more common in males, and in older teens aged 16-18. They were also most likely to occur after abusing opioids.

Although there were 57,488 incidents involving children aged just six to 12 , these cases did not usually include ‘traditional’ drugs but rather vitamins, plants, melatonin, hand sanitizers and other objects.

Limitations of the research were limited to exposure cases being classified as abuse or misuse. 

“It is possible that additional misuse or abuse cases were classified otherwise and thus were missed,” authors report.

They concluded: “The substances most commonly misused/abused are more widely available substances such as over-the-counter medications, household products and pharmaceuticals commonly prescribed to youth. Differences in age and sex were evident, with males and adolescents more likely to abuse and misuse substances.

“Our study describes an upward trend in marijuana misuse/abuse exposures among youth, especially those involving edible products.” 

Conflicting data?

The findings appear to be in contrast with a study published in November by the University of Washington with funding from the National Institutes of Drug Abuse (NIDA) in America.

The research paper, published in the American Journal of Preventive Medicine, examined whether cannabis legalisation predicted changes in the probability of cannabis use among those aged 13–18 years.

According to the paper the change in legislation was ‘not significantly related to within-person change in the probability or frequency of self-reported past-year cannabis use’ among adolescents.

Young people who spent more of their adolescence in states where cannabis was legal were ‘no more or less likely to have used cannabis at age 15 years’ than those who spent ‘little or no time’ in such a state. 

The authors concluded that rates of adolescent cannabis use are ‘holding steady after non-medical cannabis legalisation for adults’.

• Cannabis legalisation not linked to substance abuse – study
• MPs back campaign to end ’50 years of failure’ on UK drug laws
• Most Americans view cannabis as less harmful than alcohol
• Study: Could cannabis be a useful intervention in tackling alcohol abuse?
• Legalisation linked with drop in teenage cannabis use