It’s a parent’s nightmare. In November, students at a Baltimore high school ended up in a hospital emergency department. After students reacted to consuming edibles, medical staff stabilized their symptoms and then sent them home — but the story could have ended much differently.

Maryland legalized cannabis for adult use in 2023, joining other states. The legalization of cannabis is one of many ways that drug culture has changed in recent decades. Teen use of alcohol and cigarettes is lower compared to previous generations, which is good news. On the other hand, there has been an emergence of electronic cigarettes and a rise in misuse of prescription medications, including stimulants (e.g., Adderall), pain relievers (e.g., OxyContin or Vicodin) and sedatives (e.g., Xanax or Klonopin).

It’s not yet clear how cannabis legalization will affect school-age children in Maryland, but information from other states might offer clues. Despite the loosening of cannabis laws, the prevalence of use among adolescents has remained relatively stable. Health surveillance data from 2021 shows that 15% of high school students in Maryland reported cannabis use during the previous 30 days, a statistically significant decline since 2011. Notably, there have been changes in how cannabis is consumed, with increasing use of dabs, vape devices and edibles.

Findings from national surveys of adolescents suggest that teens know about the many risks associated with alcohol, tobacco and illicit drugs such as cocaine, heroin and methamphetamine. They are less likely to understand the potential harms posed by cannabis; many believe it is completely safe and that it has health benefits. The reality is that there are risks associated with cannabis use, and those risks are higher for high-potency products.

Factory-developed edibles pose risks for overingestion. It can take 30 to 45 minutes to begin to feel the effect of an edible, so it’s easy to accidentally consume too much. Too high a dose of cannabis can cause acute reactions, such as rapid heart rate, panic, confusion and even hallucinations. There is also the potential for psychosocial reactions as well, including poor school performance and other behavioral problems.

There have been changes in drug policies, in the availability of drugs and ways to consume them, in the risks posed by drugs and in patterns of drug use. What has not changed is the need for parents to have open, honest and fact-based conversations about drug use with their teens. Open communication about drug use and drug risks is critical to keep teens safe as they navigate social situations where there are drugs. Parents have the important responsibility of helping young people make informed and healthy decisions.

First, let your child know that you expect them not to use alcohol, tobacco/nicotine, cannabis or any other drug. It is appropriate to discuss the risks from using these different drugs, but stay true to the facts. Exaggerating the risks posed by use of cannabis or other drugs can cost parents credibility in the long term, which then results in teens going to other teens (or the internet) for information. You can highlight that some drugs can be deadly, some can send you to the hospital, and some have strong potential to lead you away from your goals in life (e.g., being good in sports, going to college, or becoming an artist or activist). Drugs can lead to regrettable actions that harm friendships and school or social standing.

You can also talk about what drugs don’t do — they don’t help you improve difficult life circumstances. You can share healthy ways of coping, such as taking a walk or talking things out. It is also helpful to be clear about your own relationship with drugs and drug use. Rather than taking a “do as I say, not as I do” approach, parents could share their expectations by saying, “I smoked weed and I wish I hadn’t. I do not want you to smoke.”

It is useful to talk with your children about family members or others who struggle with drugs. Although it is important not to stigmatize people or put them down, parents can talk about the devastating effects of drug use on families and communities. An example might be, “When Auntie goes overboard with alcohol, it hurts our whole family.”

Regardless of what parents do or say, the decision to use cannabis or other drugs is ultimately up to the individual. Recognizing this, parents need to prepare teens to be safe if they do use drugs.

Engaging in adult behavior means children need to make adult choices. Following these eight guidelines can lower the risk associated with use of cannabis or other drugs:

• Do not use at school, on the bus or other places where you could get into trouble; school suspension or other types of sanctions can disrupt your future plans.
• Do not take drugs from or with people you don’t know, or in places that are unfamiliar.
• You always need to know what you are taking and be careful about not overdoing it; going slowly is safest.
• Do not give anyone else a pill or drug without their knowledge. No one should give anyone drugs or medications without their consent, no matter what. That is dangerous and illegal.
• Do not drive after use or get into a car with someone who has used cannabis, or any drug. This too is dangerous and illegal.
• Do not have sex with someone who has used drugs, or while you are under the influence. Consent and safe sex practices are more difficult to navigate while under the influence of any drug.
• If someone is hurt while under the influence of any drug, call 911 as soon as possible. Maryland’s Good Samaritan law means you cannot get into trouble even if you also had participated in an illegal drug use.
• Learn about naloxone, a medicine that swiftly treats someone experiencing an opioid overdose. Teens — and the rest of the population — are legally permitted to access naloxone.

The teen years have long been a period of exploration as they transition from childhood to adulthood. Young people need parental guidance. Shutting down the conversation will not change their urge to talk about it — it just means they talk to peers, or worse, adults who hang out with teens. Parents need to make it clear that they are available to talk about drug use openly and honestly.

Renee M. Johnson is a professor in the Department of Mental Health and Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health.