Carolyn Barth began using cannabis after surgery and other measures failed to manage the neck and back pain stemming from a car accident a decade ago.

That doesn’t mean the Ellicott City artist and pet care provider plans to tolerate use by her 10- and 13-year-old children. Her medical cannabis is locked in a box.

“I explained to my kids that I had to work with a doctor, that she suggested specific strains for my issues that wouldn’t induce anxiety,” she said. “We talked about the risks, how it’s not OK to drive, the amount that I use, that it’s really not appropriate for children because their brains are still developing.”

Her push to educate and protect her kids may need reinforcement beginning July 1, when Maryland joins nearly half of U.S. states in legalizing marijuana possession. Maryland’s recreational cannabis law applies to those age 21 and older and comes nearly a decade after the General Assembly legalized medical marijuana.

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Some experts and educators are concerned cannabis could be more available and appear more acceptable and harm-free to kids. A quarter of Maryland high schoolers already report having used it.

Legalization “will likely lead some students to believe that all use of marijuana is legal,” said Brian Bassett, a spokesman for Howard County Public Schools. “We expect that this misperception, combined with potentially easier access to cannabis, might cause an increase in use among our student population.”

The school system is planning an update to the health curriculum, as well as other messaging about consequences for students who use the drug illegally.

Experts point to research suggesting cannabis use could harm kids and say that needs to be conveyed.

“I believe that we have to be thoughtful and evidence-based in our approach to educating teens about the risks of cannabis use,” said Leah Sera, program co-director of the University of Maryland’s Graduate Studies in Medical Cannabis Science and Therapeutics program.

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“Cannabis doesn’t carry the same risks of overdose and death that drugs like heroin and fentanyl do,” she said. “However, there are real short-term and long-term risks associated with using cannabis — risks associated with driving under the influence, developing cannabis use disorder, and the potential for long-term cognitive effects with memory and concentration.”

Sera, also an associate professor in Maryland’s School of Pharmacy, said she wants to ensure medical cannabis remains available to those who need it. But she also called for enforcement of restrictions on certain products and advertising geared toward children, in much the same way tobacco is limited.

She also said there needs to be safe storage education and child-resistant packaging to prevent unintentional ingestion. Also, she said, the state needs to collect data on teen use and access.

The Maryland Cannabis Administration, at the General Assembly’s direction, has already conducted a baseline survey and made recommendations.

The report found during the 2021-22 school year, 26% of high school students reported ever using cannabis, and by 12th grade, nearly 40% had tried the drug. About 15% of high schoolers currently use cannabis — more than the 10% of adults who reported currently using cannabis.

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Though data on problematic use is limited, teens currently using cannabis were 50% more likely to describe their mental health as poor than non-users.

The report recommended adding local surveys on adolescent use, access and risk perception. Plus, it called for establishing mass media campaigns, assessing protective measures, training retail workers to comply with the sales laws to youths, assessing the link to mental health and providing mental health treatment.

It’s not clear how much, if at all, use will rise. Cannabis use among teens has long been flat, said Renee M. Johnson, a Johns Hopkins University associate professor in the Center for Adolescent Health and the Center for Mental Health and Addiction Policy.

“Despite the widespread loosening of cannabis prohibition, adolescent cannabis use has remained remarkably stable,” she said.

That’s even though most teens, who grew up during the opioid overdose epidemic, don’t think using cannabis occasionally comes with the same risk as drinking, smoking or using other drugs. But Johnson said some risks may be less obvious.

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“I’d recommend that youth, and adults, be critical about their use and reflect on their emotional state,” Johnson said.

They should consider how frequently they use cannabis and look for other coping mechanisms, if needed, such as playing sports or tapping behavioral health services. Cannabis use on a daily basis “is likely to cause problems in school, with family and in other areas of life,” she said.

While she said much of the rhetoric about cannabis and the developing brain is overstated, and most cannabis users don’t go on to use heroin or cocaine, it is a psychoactive drug. It can lead to disruptions in memory, attention, coordination and motivation. More frequent use, particularly to manage bad feelings, can train the brain to need it.

She advised parents to talk to their kids, as she’s done with her own 15-year-old. She said research shows, for example, just talking to your children about sex delays sex by a couple of years. But you’re the parent and make your rules clear, she said.

Schools across the region say they are preparing for legalization for adults largely with education but also reminders that cannabis possession remains a violation of school policy and the law for those under age 21.

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Carroll County Public Schools plans to work with the local health department and state’s attorney’s office to educate students and families on the risks of substance use and available resources, said Carry Gaddis, spokeswoman for the schools.

Gboyinde Onijala, spokeswoman for Baltimore County Public Schools, said the system would also focus on prevention and education, but noted that the student handbook outlines the range of consequences for possessing cannabis.

Minors can be approved for medical marijuana, but when it comes to recreational use, legal consequences depend on the amount in possession.

Local jurisdictions likely have some enforcement leeway, said Mathew Swinburne, an expert in cannabis law at the University of Maryland Francis King Carey School of Law. He said minors in possession of a “personal use amount” that is legal for adults can be subject to a civil fine of up to $100, meaning no criminal repercussions.

Possessing a bit more, a “civil use amount,” subjects anyone in possession, adults or minors, to a civil fine of up to $250, but still no criminal penalty. Minors could also face drug education for the first two levels of possession, said Swinburne, also associate director of the Network for Public Health Law, Eastern Region, housed at the university.

A larger amount could lead to normal criminal procedures for both adults and minors.

It’s not clear if the repercussions would deter use. And some parents say they are more focused on education.

Andra Broadwater said she’s already had many conversations about cannabis with her four teenagers, ranging in age from 13 to 18.

“We’ve talked about the biological effects on the brain, especially the adolescent brain that is still developing,” said Broadwater, who is also health and safety committee chair of the Baltimore County Parent-Teacher Organization. “One of our messages has always been that you may want to try this, but wait until your brain is done.”

Broadwater’s 16-year-old daughter, Amber, doesn’t think that legalization will change much about how her peers at Catonsville High School use marijuana.

”There’s already a bunch of people who use marijuana,” she said. “In health class, they told us what happens to a developing brain, but the main thing is, don’t use it.”

Broadwater’s oldest child, who just completed her first year at the University of Maryland, chose to live in substance-free housing, because, Broadwater said, “She didn’t want her first college experience to smell like her high school experience.”

Broadwater said, however, she remains concerned about a general uptick in marijuana use because edible cannabis products can easily be mistaken for candy — “They can look like gummy bears.”

In a panel discussion hosted by the University of Maryland Medical Center on Tuesday, emergency physician Dr. Daniel Gingold said that pediatric visits to the emergency room for accidental cannabis ingestion has been on the rise in states that have already legalized cannabis.

The risk is greatest for kids ages 2 to 4, who may accidentally consume cannabis in food, like cookies, brownies or candy, which are often sold in unlabeled packaging. He said serious health risks, like seizures, are very rare, but if the child is unable to communicate what they ingested, doctors often run a series of time-consuming and costly tests to determine what may be wrong. “It’s highly stressful for the family, too,” Gingold said.

“As parents, we need to be really careful and clear, just the way adults are encouraged to put alcohol on the top shelf,” Broadwater said. “Just like any other substance that alters behavior and brain activity, adults need to model good decision making.”

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