The Other 60 Percent

Research shows adverse effects of marijuana on teens as drug use among students appears to be rising

He’s 16 but his baby face makes him look a little older than 10, his age when he first tried marijuana.

A Colorado Springs high school student, who declined to be identified, during a recent lunch break at downtown Acacia Park next to Palmer High School. Behind him is Indispensary, a medical marijuana dispensary. All photos by Joe Mahoney / I-News

“I smoke marijuana every single day all day long,” the teen said during a lunch period spent hanging out in a park outside his downtown Colorado Springs high school.

“It develops brain cells. That is a complete and true fact,” he said. “It kills weak brain cells. It does affect your lungs … but it’s better than smoking cigarettes.”

Dozens of students interviewed across Colorado as part of an investigation by Education News Colorado, Solutions and the I-News Network made similar statements:

Marijuana is healthy. It helps me focus in class. And, hey, it’s better than alcohol or cigarettes.

“It’s less damaging to smoke weed,” said a 15-year-old girl getting high over lunch near her Denver high school. “I’m not trying to mess with my body.”

The investigation found a 45 percent increase in drug violations reported by schools statewide in the past four years, even as violations in nearly every other category – including alcohol and tobacco use – declined.

School officials and health care workers repeatedly cited the location of medical marijuana dispensaries near schools and the saturation of marijuana in surrounding communities.

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They say Colorado’s thriving cannabis industry and its advertising —online and on storefronts at more than 700 dispensaries — have emboldened young people to justify abuse and claim health benefits from marijuana.

But contrary to perceptions among students, doctors say marijuana is especially harmful to kids for two key reasons:

First, new research shows adolescence is a crucial time for brain development and marijuana use can permanently change the teen brain. Second, young people who start using marijuana before age 18 are much more likely than adults to become addicted to the drug.

“It’s an ironic play of events that use is going up at the same time that the science is coming out about its possible brain toxicity,” said Dr. Chris Thurstone, an adolescent psychiatrist who runs a substance abuse treatment program at Denver Health.

“We need to tell people that youth are the most likely to become addicted to marijuana and that when they become addicted, they are at higher risk for every bad outcome a teenager can face.”

Doctors interviewed across the spectrum, from vocal marijuana opponents to those who recommend it for patients, agreed that marijuana can be addictive. And the diagnostic bible for health providers, the Diagnostic and Statistical Manual of Mental Disorders, lists cannabis abuse and cannabis dependence as possible diagnoses.

“There is no debate in the scientific community,” Thurstone said. “It’s physically and mentally addictive.”

Research findings grim for young cannabis users

Few teens heed such warnings, however. While adolescents have always been impulsive thrill seekers, Thurstone and other researchers have found that all the most dangerous behaviors escalate when teens use marijuana.

It’s no different than when they use alcohol or other drugs.

The more often teens use and the greater the dose, the more reckless their behavior becomes. So regular marijuana use puts them at greater risk for dropping out of school, engaging in risky sex behaviors and getting in accidents, the leading cause of death for adolescents.

Research paints a grim picture for marijuana users who start at a young age:

  • Teens using marijuana before age 18 are two to four times more likely to develop psychosis as young adults compared to those who do not.
  • The teen brain is much more vulnerable to addiction. One in 6 kids who try marijuana before age 18 will either abuse it or become addicted to it compared with 1 in 25 adults.
  • Studies show that heavy doses of THC, the key chemical in marijuana, during adolescence change the way the brain develops. In particular, marijuana’s harmful effects strike the hippocampus, which is critical for learning and memory.

“We know that adolescents who start using marijuana between the ages of 14 and 22 – and stop by 22 – have many more cognitive deficits at age 27 compared to non-using peers,” said Dr. Paula Riggs, director of the Division of Substance Dependence in the psychiatry department at the University of Colorado School of Medicine.

“It affects brain processing, decision-making, impulsivity and memory.”

Dr. Christian Thurstone, right, counsels a patient in Denver Health's STEP substance abuse program on Feb. 1. I-News photo

Riggs said there’s little question among doctors that marijuana can be beneficial for a small percentage of patients who have cancer, multiple sclerosis, glaucoma or nausea from HIV treatment.

But that doesn’t mean it’s safe or healthy for kids.

“There’s no medical indication for medical marijuana in young people at all,” she said. “It’s not a medication. There are 400 other chemicals and many carcinogens in smoked marijuana.”

The revolution in brain science has only increased concerns about harm to the teen brain.

Experts used to think that the brain was fully formed by about age 6.

But new brain scan research has found that nerve cells don’t finish developing until young people reach their mid-20s. Teen brain cells don’t have as much of a fatty coating called myelin which helps messages travel from neuron to neuron efficiently. The brain also sheds unnecessary connections during adolescence.

It turns out that one of the last parts of the brain to fully mature is the prefrontal cortex, which governs complex decision-making and analysis.

“In other words, the adolescent brain craves pleasure, but it doesn’t know how to weigh risks, determine and plan for consequences or say ‘enough is enough,’” said Thurstone, who is conducting a five-year study on medical marijuana in Colorado for the National Institute on Drug Abuse.

Debating a rise in marijuana use among teens

Blaming marijuana for increasing risky teen behavior is a leap, said Dan Rees, an economics professor at the University of Colorado Denver.

“It turns out that kids who use marijuana also drink alcohol and get in car accidents and have sex without condoms. It’s impossible to distinguish the effect of the marijuana and the effect of personalities,” said Rees, who has been studying the impacts of marijuana legalization throughout the United States.

Quotes on marijuana

“It develops brain cells. That is a complete and true fact.”
–Colorado Springs teen

“It’s less damaging to smoke weed.”
–Denver high school student

“There is no debate in the scientific community. It’s physically and mentally addictive.”
–Dr. Christian Thurstone

“There’s just no evidence that medical marijuana affected the percent of youth who said they smoked marijuana in the last month.”
–Dan Rees, CU prof

“They often come in and say, ‘It’s not addictive. It’s natural. It’s an herb.’ But you wouldn’t go out and pick poisonous mushrooms, would you?”
–Dr. Paula Riggs

“It’s certainly not healthy like eating an apple and probably not healthy in teenagers, not in someone who is still developing.”
–Dr. Alan Shackelford

He’s not surprised if young people are now getting medical marijuana rather than street weed. But he’s not convinced that overall use is up among kids or that marijuana is any more dangerous than other drugs that kids abuse.

Several studies show that alcohol use declines when marijuana use increases. One of Rees’ studies found that traffic fatalities went down by nine percent in 13 states, including Colorado, that have legalized medical marijuana. The researchers don’t know why. It’s possible that people drive more when they’re drunk than stoned.

The study used data through 2009, just as dispensaries began spreading across Colorado. So it’s unclear how the boom in dispensaries has affected marijuana use or driving here.

Another study by Rees shows that, in states that have legalized medical marijuana, use increases dramatically among young adults. But that did not hold true for those under 18.

Rees described the finding as “puzzling.” The study, which is not yet published, also used data through 2009.

“My strong suspicion is that there’s diversion from the legal market to the illegal market. The fact that kids are ending up with marijuana that was originally intended for the legal market doesn’t surprise me,” he said.

“There’s just no evidence that medical marijuana affected the percent of youth who said they smoked marijuana in the last month.”

Surveys in Colorado and nationally, however, appear to indicate marijuana use is rising.

In Colorado, a survey of more than 27,000 students through the Adams County Youth Initiative found a jump in use. In 2008, 19 percent of students in various Adams County middle and high schools said they had used marijuana in the last month. That number increased to 22 percent in 2009 and 30 percent in 2010.

And the Monitoring the Future study, the largest national survey of students and drug use, found in 2011 that marijuana use has risen for the fourth straight year after consistent declines in the past decade. The study also found one in 15 high school seniors now uses marijuana daily. That marked a 30-year peak for daily use, a finding that sparked great concern for Riggs.

“People will say, ‘I smoked in the ‘60s and I didn’t become addicted,’” she said. But, “Adolescents who are daily users are at much higher risk for becoming dependent. And the marijuana, by and large, is more potent today.”

State-by-state data for marijuana use should be available for the first time in the next couple of years. Riggs said that information will be critical because, unlike Rees, she suspects access to marijuana in the 16 states that have legalized it may be driving the increased use found in national survey results.

Here in Colorado, teens that Riggs sees through her clinical trials often repeat claims such as marijuana helps them “focus.” When she probes further, she finds their grades are going down.

“What they mean is ‘I’m totally lost. I can tolerate sitting there lost (in class),’” Riggs said. “It’s zoning them out.”

“They often come in and say, ‘It’s not addictive. It’s natural. It’s an herb.’ But you wouldn’t go out and pick poisonous mushrooms, would you?”

Recreational pot for teens ‘absolutely’ not healthy

Dr. Alan Shackelford recommends marijuana to some of his patients and advises lawmakers around the country on medical marijuana legislation. He maintains a business and website, Amarimed of Colorado, devoted to medical marijuana.

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In very rare cases, Shackelford said he has recommended marijuana for children, including a toddler who was dying of a brain tumor.

“Her oncologist at Children’s was in complete agreement. We know that cannabis makes opiates much more effective. Judicious cannabis use allowed the parents to decrease the amounts of morphine and also got rid of horrific pain,” Shackelford said.

Recommending marijuana to some patients, however, and endorsing recreational use among kids is not the same thing.

“Do I think kids ought to say that it’s healthy and use it recreationally? Absolutely, I do not,” Shackelford said.

But he believes a narrow focus on marijuana abuse among kids distracts from the more harmful effects of other drugs they’re using, including tobacco, alcohol and prescription medications.

“Cannabis is much safer than those things,” Shackelford said. “I’m not demonizing alcohol or opiate prescription medications. Used correctly, alcohol can be no more lethal than Percocet. But both have the potential to kill people.”

Shackelford says marijuana is a valuable tool for some patients. He has found it particularly helpful for patients with migraines and elderly patients with rheumatoid arthritis.

He never recommends that patients smoke it and declines to say how many recommendations he gives per year for medical marijuana or what percentage of his patients seek it.

And he has a message for young people who claim marijuana is healthy.

“Don’t kid yourselves. Don’t use terms to rationalize something when we don’t know what the consequences are,” he said.

“It’s certainly not healthy like eating an apple and probably not healthy in teenagers, not in someone who is still developing.”

The same applies to abuse of Ritalin, Percocet, alcohol or methamphetamine, all of which Shackelford views as much more dangerous.

While debate is fierce over the relative harm of various drugs, Thurstone said the No. 1 drug his patients are abusing is marijuana. He has treated patients as young as 11 for its use.

Nationally, in substance abuse treatment programs, two-thirds of patients are dealing with marijuana abuse or dependence. At Thurstone’s Denver Health program, the figure is 95 percent.

“Many lives are being destroyed by this,” Thurstone said. “(Teens) are dropping out of life. They’re dropping out of school or if they’re not, they’re doing really badly.

“They’ve dropped away from their family, their friends and their sports to smoke marijuana every day, all day. We see that all the time.”

Contact Katie Kerwin McCrimmon at katherine.mccrimmon@ucdenver.edu.

chronically absent

One in four students are chronically absent in Tennessee’s state-run district. Here’s what educators are doing about it.

PHOTO: (Lance Murphey, Memphis Daily News File Photo)
About 25 percent of students at Humes Preparatory Academy Middle School were chronically absent last year, a drop of 6 percent from 2017.

More than one in four children in Tennessee’s state-run turnaround district were chronically absent from school last year. Until recently, Armani Fleming, an eighth-grader in Memphis, risked being among them.

Armani struggled with attendance until a student support specialist with Communities in Schools, a Memphis nonprofit focused on wrap-around services for children, worked with him to identify and resolve barriers keeping him from class at Humes Middle School, apart of the Frayser Community Schools charter network.

“I realized Mr. B really cared about me, and he’s helped me make sure I come,” Armani said of the support specialist, Cadarius Buckingham. “He’s more of a counselor to me. I come and talk to him about everything, he’s the person I come to when I need help … and me coming to school has gotten a lot better.”

In the Achievement School District, getting kids to show up at school matters. Recent research has shown that when students have more “familiar faces” around them in class, they’re less likely to be chronically absent. Which is why nonprofits like Communities in Schools are sending staff members into local schools to connect with students like Armani.

Tennessee created the Achievement School District in 2012 to fix its lowest-performing schools by turning them over to charter organizations, but it has struggled to move the needle. Last year, 27.4 percent of the district’s students were chronically absent — representing a 2.4 percent drop from the previous year, but still alarmingly high. Now composed of 30 schools, the district faces higher rates of student mobility and poverty, contributing to its challenges with absenteeism.

Statewide, more than 13 percent of students are chronically absent, defined as having missed 10 percent of the school year, which is typically 18 or more days, for any reason (including excused absences and suspensions), but the average rate was significantly higher, 21 percent, for students who live in poverty.

The stakes are high for improving attendance numbers. Chronic absenteeism is now a major part of Tennessee schools are held accountable by the federal government. And research shows that children who are chronically absent from school are often academically below grade-level, more likely to drop out of school, and more frequently involved in the criminal justice system.

Communities in Schools is now in 19 Memphis schools, eight of them state-run. Those schools have seen, on average, a 5 percent reduction in chronic absenteeism, according to Michael Russom, the group’s director of operations and communications.

One school, Cornerstone Prep Denver Elementary, saw even more dramatic results: an 18 percent drop in chronic absenteeism year-over-year. Last year, just 13.7 percent of the school’s students were chronically absent.

What made the difference? Capstone Education Group, the charter school operator that runs Cornerstone schools, has a staff member dedicated to improving attendance and a partnership with Communities in Schools, said Drew Sippel, executive director of Capstone, which runs two state-run schools in addition to Denver that also had low absenteeism numbers.

“Whenever a parent expresses some concern related to regular attendance, [Patricia] Burns works to resolve impediments to consistent attendance,” Sippel said of the school’s Manager of Student Information and Business Systems. “These impediments range from transportation, homelessness, and inability to purchase school uniforms.”

Untreated health issues is sometimes another factor.

Denver Elementary’s principal also worked with Capstone staff to increase the number of meetings with parents, and therefore, to pinpoint the root causes of students’ absences.

Agape, Whitney Elementary, Memphis
PHOTO: Caroline Bauman
Two of Agape’s staff members work with students on reading at Whitney Achievement Elementary School. The staff members, though employed by the Memphis nonprofit, are integrated into school life.

“There’s often an assumption or judgment with parents, ‘Why don’t you just make your kids go to school?’” said David Jordan, CEO of Agape, a Christian nonprofit that has also seen success in reducing chronic absences in Memphis schools. “We keep data on this, and it’s not that parents don’t care. There’s a lot of issues that can prevent students from making it to class.”

The program has grown every year from when it began in 2013 with 113 students. Now, more than 550 students are a part of Agape programs in 16 schools throughout Memphis — and all students they work with are now at school for at least 85 percent of the school year. This is just shy of the group’s goal for Agape students: to attend more than 90 percent of the year.

For its part, Communities in Schools hopes to expand onto additional Memphis campuses, but for now, the focus is the schools they are already serving. And they have added additional staff to some of the highest-needs schools.

One such school is Fairley High School, an Achievement District school run by the charter operator Green Dot Public Schools. There, about 56 percent of students were chronically absent last year, a 19 percent increase from 2017. Russom said they placed two full-time support specialists within Fairley earlier this school year.

Last year, absences spiked at Fairley amid a change of leadership at the school, and it took time for the new principal to gain students’ trust, said Zachary Samson, Green Dot’s area superintendent.

“That’s one huge piece of chronic absenteeism that’s hard to quantify,” Samson said. “It makes such a difference when a student walks in the door, and I as a school leader am able to greet them by name. I know their mom. It’s students feeling seen and appreciated.”

To improve attendance, Samson said his staff is working with Communities in Schools to create an incentive program for students, in which students who meet their attendance goals can attend school parties. He added that they are also focusing on their communication with parents, as many parents may not be aware their children are chronically absent or of the consequences.

Samson said he’s confident attendance can improve at Fairley because he’s seen it happen at another Green Dot school – Wooddale Middle School. About 15 percent of students were chronically absent at Wooddale last year, a drop of 3 percent from the previous school year.

Communities in Schools has a full-time staff member at Wooddale, and that has made an enormous difference, Samson said, noting: “For schools where budgets are very, very tight, having another passionate educator in your school whose big focus is to address attendance and behavior with students – that’s a huge help.”

Update: This story has been updated to clarify that the state defines chronic absenteeism as missing 10 percent of attended school days, which is typically 18 or more days for the school year.

Correction: This story has been corrected to say that one in four students in the Achievement School District were chronically absent last school year, not one in three.

behind the budget

Surprise: Most funding for New York City’s ‘community schools’ going to academics, not social services

PHOTO: Alex Zimmerman/Chalkbeat
Principal Asya Johnson of Longwood Preparatory Academy, a community school, corrals a student between classes.

When Mayor Bill de Blasio promised a new “community schools” program during his 2013 campaign, it was in part a repudiation of his predecessor’s focus on improving academic results.

Rather than punishing schools when students struggle, the theory went, the city should flood schools with services to combat the problems that hold students back from succeeding. The city has included schools with a range of academic performance levels in the program, and officials have said their main goal is to increase equity, not test scores.

So it’s surprising that just a small fraction of this year’s extra spending at the city’s 239 official community schools is going toward physical and mental health services, while about 60 percent of the $198.6 million being spent on the program is going to academic services.

That’s according to a new analysis by the city’s Independent Budget Office, which looked at school-level spending plans produced for the first time this year under a new state transparency law.

The city education department is disputing the budget office’s methodology but not the conclusion that community schools are spending heavily on academic services. Community schools choose which programs and services to offer, based on their students’ needs; the academic services category includes spending on anything beyond traditional classroom instruction, including gifted programs, extra tutoring, and services for students with disabilities.

The spending analysis offers important context for an external evaluation of New York City’s program by the Rand Corporation, which is expected in 2019. It could potentially add to an existing body of research suggesting that efforts to combat poverty by providing “wraparound services” in schools often — though not always — generate improved test scores. The research has so far not answered the question of what makes some programs more successful than others, so knowing that New York City’s results come after spending heavily on academic services will add an important data point.

Early in the program’s development, some advocates pressed the city to tackle academics in addition to social challenges. But how much the community schools model is boosting academic improvement remains an open question locally, and the spending analysis offers important context for an external evaluation of New York City’s program that is expected in 2019.

Education department spokesman Doug Cohen said the state’s fiscal reporting requirements don’t reflect the city’s “holistic” approach to supporting schools. He said the discrete spending categories obscure the reality inside schools, where various programs interact in complex ways.

After-school programs, for example, might offer emotional support for students, Cohen said, adding that the overlap is an important feature of the community schools model.

“If we were only doing mental health alone,” he said, “it wouldn’t really be a community schools strategy.”