The Context of Using Marijuana for Relief
The teens situated their use of marijuana for relief of health problems in the context of difficult life events and illness experiences marked by a lack of supportive family networks, unexpected and sometimes traumatic losses of close friends or family members, and difficulties at school. Many indicated that they had few people to turn to help them; for some their parents were having difficulty coping with their own situations of unemployment, substance use, and marriage breakdowns and offered little support. Those living in households with a parent and step-parent had difficulty coping with unresolved feelings towards their estranged biological parent. Finally, several teens who made frequent moves with their families experienced social isolation at school and were subject to being bullied and teased.
Experiences with the medical system to address their health problems consistently fell short of the teens' expectations; their problems were either not taken seriously or the solutions offered were not helpful. For example, youth who reported they had been prescribed drugs such as Ritalin, Prozac or sleeping pills, stopped using them because they did not like how these drugs made them feel or found them ineffective. Despite visits to doctors, prescribed treatments and, for a few, hospitalizations, many of these teens perceived that they did not receive the help they needed from doctors.
A final contextual feature to these teens' lives were their observations of others' use of marijuana to deal with difficult circumstances or symptoms, including, in a few cases, parents and other significant adults in their life. For example, one young man reported that his mother was using marijuana while receiving cancer treatment. As he observed, "It helped her sleep and calmed her down." Others described how they were given advice from other teens about how marijuana could "help." Together these circumstances created a context where teens routinely turned to marijuana to manage physical and psychological problems in their lives. Marijuana was readily available, used by others in their network, and was perceived to provide an effective solution not offered to them from the medical system.
Regular Relief:Patterns of Using Marijuana for Persistent Problems
Most of the participants who consistently used marijuana for relief, smoked it when alone, often several times a day. For some, their day began and ended with using marijuana; they smoked before leaving home for school and prior to going to bed. Some indicated that they needed to smoke marijuana during the school day to manage symptoms, and when this occurred it was often in the company of friends. A few participants smoked marijuana for relief in adult company that included relatives and "older" friends who supported their need to use marijuana to manage symptoms.
There were two patterns of marijuana use for relief: intermittent and chronic. With intermittent use, youth routinely relied on marijuana to deal with short-term problems such as stressful situations or limited periods of physical pain. One 14 year old male described non-daily use occurring whenever he had a "really bad day." In the case of chronic use, daily marijuana was used for the relief of identified conditions such as depression, ADHD and to routinely settle at night or manage sleeplessness. Young people's descriptions of marijuana use for relief were imbued with language common to using pharmaceuticals. A number of these youth indicated how they carefully titrated their intake; others described their use as "moderate," involving a "few puffs," or just a "certain amount." Through experience, they had learned to hone ways of using the right amount of marijuana to achieve a state of relief. As one male elaborated, he regulated his intake by mixing his marijuana with tobacco so as to get "just enough" marijuana to relieve regular states of agitation and high levels of stress. Along with skills at monitoring their intake of marijuana, these youth confidently shared in-depth knowledge of the strength and associated effects of different strains of marijuana.
Explaining the Need to Use Marijuana for Relief
The young people in the sub-sample were particularly articulate in describing their "need" to use marijuana. They were adamant and confident that marijuana provided relief from their health problems. The decision to smoke marijuana was stated in a straight forward fashion (e.g., "I started it to make myself feel better") and justified because they had a "reason for it." Participants also framed their marijuana use in a positive manner; in so doing, gave credence to the claim that this was the right course of action. As one girl elaborated on her daily use, "Pot helps me be me." Several described unpleasant physical sensations such as feeling "jittery" associated with the absence of marijuana. For these youth, regular marijuana use allowed them relief from these unpleasant symptoms so that they were able to feel "normal." One 18-year old male who used marijuana everyday indicated, "If anything, it makes you more normal." Of note, he had first started to use marijuana at the age of 13, and smoked it regularly for 5 years typically 4 times a day.
For these youth, the purpose of smoking marijuana was not specifically about getting high or stoned, nor was marijuana used for "pleasure." In fact, participants tended to differentiate their own use from peers who were recreational users who smoked marijuana when they were "partying" or "socializing." As one 16-year old male described his use, "I don't get a strong sense of euphoria, I just calm down a bit, that's just how it is for me." However, there were a few instances when female participants did smoke "to get high" for the purpose of "escaping reality," a strategy used to remove themselves temporarily from the challenging circumstances that accompanied their daily lives. The participants also distinguished themselves from the "stoner" stereotype, whose preferred activities were watching movies or listening to heavy metal music while smoking marijuana.
Some explanations of using of marijuana to feel better were further bolstered with a focus on use for described "health" reasons. As one 16-year old female indicated, her daily use of marijuana was "more of a health thing, than to get high." She reflected on her history of "mild depression" and her difficulties with antidepressants that had resulted in insomnia and a loss of appetite. She suggested that these health issues would re-surface in the absence of marijuana, thereby providing solid rationale for her continued use of marijuana. One male situated his marijuana use within a perspective that medications are used to help deal with problems.
I bet you if I had never been put on Ritalin at a younger age, I might not have had the same opinion of drugs growing up, you know, because I was taught growing up that you take drugs to help you out with your problems, you know. [18 years, non-daily use]
Often, marijuana was compared to other substances in a way that suggested marijuana was the best option, further supporting ongoing use of marijuana for relief purposes. Some constructed marijuana as a "natural" substance that was preferable and considered "safer" than many pharmaceutical alternatives. One 14-year old female discovered that marijuana was a better option than dealing with the side effects of pharmaceuticals stating, "Well, my body, I have to be careful what pills I take. I have bad reactions to some medications. My body rejects it and I get really sick." Interestingly, one 18-year old who smoked twice a day on 21 days during the last month, went as far to describe himself as a "healthy marijuana user" adding, "It's not good for you, but then again, neither is MacDonald's and a lot of other things." The health claims in these descriptions served to explain the ongoing use of marijuana for relief.
Painful Lives: Types of Symptoms and Distress Requiring Relief
In the interviews the teens directly linked their use of marijuana with the management of difficult feelings (including depression, anxiety and stress), sleep problems, problems with concentration and physical pain. Each of these will be described in the following sections.
Although some teens described using marijuana to deal with instances of being angry, experiencing a significant disappointment (e.g., with exam results), being afraid, or to forget the past, the most frequent uses were associated with dealing with depression, and managing stress and anxiety.
Six participants indicated they were using marijuana specifically to deal with depression and several others reported knowing teens that were doing the same. Dealing with difficult personal circumstances was a common theme for this group of teens and was linked to the loss of significant people in their lives, a family history of depression, financial worries at home, "fights" with parents, abuse, and too much "shit" in their lives. Several reported receiving treatment for depression in the form of antidepressants and counseling, sometimes over extended periods, yet with little relief. For others, these options were not available in part because "nobody wanted to listen" to them. As a last resort, these teens had opted to try smoking marijuana. In a relatively short time, marijuana helped them to feel better about themselves, happier and more like the person they "wanted to be" as well as alleviate other problems associated with depression (poor appetite, difficulty concentrating, poor sleep).
Not all participants agreed about the use of marijuana for depression. One 16-year old male used marijuana to deal with his unhappiness surrounding the conflict between his mother and father, and worried that he might be using pot too frequently. He reasoned that being happy all of the time was not natural, and that there was nothing wrong with being sad and confused sometimes. As a result, he tried to limit using marijuana to weekends with friends. Others believed that marijuana should only be used for certain types of depression because of the possibility of becoming more depressed by smoking pot:
I think it depends on the level of depression that you have. If it's like depressed because you are sick, then pot is helping you. It's making you happier. But if you're depressed about killing yourself, I don't think that it's a good idea to smoke pot just because it could bring you down more. It's hard to say, though, it's different for every person, right? That just how it makes me feel. [Female, 17 years, daily use]
Stress and anxiety
The use of marijuana to manage stress and anxiety was described by 12 teens in our sample. Dealing with bullying at school, heavy demands of school work, taxing shifts at work, and just "giving as much as you can" along side difficult relationships with parents or guardians, and receiving threats from neighbors all took its toll on these youth. For some, these experiences contributed to high levels of stress and anxiety, and for others uncomfortable levels of anger – both were difficult to manage. Although some had friends they could turn to, marijuana provided an additional source of stress relief that was ready at hand.
Lots of people know me, know I do pot and they think that I'm a pot head but really the thing they don't realize is that I have a reason for it. It's for my stress and an antidepressant. I get really upset. It [pot] helps me feel better about myself, because you know people don't do that [help me], like my friend [name] can, but nobody else can. [Female, 14 years, non-daily use]
There was general agreement among the teens that marijuana calmed them down, and helped them feel "not so nervous" and "not so uptight about everything." One teen recognized, however, that despite the fact that marijuana could be a very effective stress reliever, it might not work for everyone:
Well as far as pot goes, the good thing is that it's definitely a stress reliever, hands down. I know lots of people who would be just a complete wreck if they weren't smoking pot but then there's also people who are a complete wreck because they do smoke pot, so it's kind of a hard thing. [Male, 16 years, non-daily use]
Nine teens in our sample described using marijuana to help them sleep. The "trouble" they had with sleeping was a constant problem that many had experienced for years. One 16-year old, who also experienced mild depression, indicated that she "stopped sleeping for two years." Not only did the problem affect their school performance, but it was deeply disturbing to them. As another female described,
I have a really hard time sleeping. I can lay there for about four to five hours, just laying there. And I just finally had it, and I just feel like screaming I don't want to wake anyone up. So I go downstairs and ask my gran or my brother [for some marijuana] or I have a roach or two sitting around. [16 years, non-daily use]
Although one teen indicated that she had spoken to her mother about her problems sleeping, others indicated that the adults in their lives did not offer any support.
I have trouble going to sleep and waking up...My mum wanted to get the doctor to put me on sleeping pills but he said at such a young age it would cause like an addiction to them...I've had these problems since elementary school...I just, I can't go to sleep at night and then I like to sleep during the day. [Female, 14 years, non-daily use]
Many teens turned to pot and found almost immediate benefits in helping them sleep. Likened to a "magic sleeping pill" by one young male, the teens found it calmed their "busy minds," helped them relax and fall asleep quickly.
Three teens reported using marijuana to improve their concentration. They explained that they had difficulty focusing at school and that this affected their school performance. As one male explained:
Personally, I'm a very fast paced guy and my mind is always rushing, hard to gather my thoughts. I think a lot faster than I can speak. I get distracted very easily. In social studies last year, I would talk and wouldn't do any work. But if I had just a little bit of pot, I could really focus my work. I could sit there and I'd work all day and finish everything and have no homework and be done by the end of class. [16 years, non-daily use]
These young people believed they could "think better" when they used marijuana because it allowed them to focus their thinking, and, slow it down in a way that was preferable. All suggested that these cognitive changes were linked to improved school performance. One teen, who self-identified as a having "attention deficit, hyperactive disorder" shared the difficulties he experienced on Ritalin. He began smoking pot when he was 12 years of age and still on Ritalin.
Usually my mind is in over gear, right? I'm usually going about a mile a minute and my hands are moving way too fast, and I'm really fidgety. But if I have a puff of marijuana in a moderate use, by moderate I mean one to three to four puffs, depending on the quality....being toned down a bit I find really helps me....If I try to do homework at home without smoking pot, I just can't focus. I'll be looking at my schoolwork and for me with my ADHD this is how it's always been for me. Like school was just a constant story of this scenario before I smoked marijuana. [17 years, non-daily use]
Five teens indicated they used marijuana to obtain pain relief, and several others shared similar stories about other youth. One male used marijuana to deal with pain associated with rehabilitation after a muscle injury, another used marijuana following an accident where he sustained 3rd degree burns and yet another because of plates in his back due to a car injury. Others suggested that marijuana reduced muscle pain after a hard day of skiing and helped with headaches, and that girls used marijuana for menstrual cramps. One 17-year old male used it daily and explained that marijuana "numbs your systems or senses [and] relaxes your muscles."
Considering the Risks of Using Marijuana for Relief
In spite of experiencing personal benefits from using marijuana for relief, some participants wrestled with their use of marijuana. One girl noted her own problematic use of marijuana that had quickly evolved into relying on it to deal with the regular stress in her life. As she pondered, she commented knowingly that it would be preferable to use it only when her stress level was "really" high.
I mean I started it, and I'm doing it for the wrong reasons...I think if I cut back and only did it when I was really stressed out or something, then, you know, really cut back, I think it would be okay. [14 years, non-daily use]
Although knowing that it was "harmful" to her body, she added that she found it difficult to quit using marijuana. Most youth were aware of the health consequences associated with marijuana use in general and their own use in particular. They noticed physical symptoms such as decreased stamina and shortness of breath with physical activities, while others worried about weakened immune systems and how it affected their energy level. Some recognized that they were addicted to marijuana. One male who had been using marijuana for six years framed it as something that he would address at a later date. "I'm trying to get through school and then worry about my dependency issue with marijuana."
Others noted that their marijuana use was linked to difficulties that they were having at school. One male concluded, "I think it brings marks down in one way and sometimes you don't understand things maybe as easily." Others recognized how their use had affected their memory. For a number of the participants, their knowledge of the risks of smoking marijuana was limited and, at times, incorrect. For example, as one 14-year old male who had started smoking marijuana in the past year to relieve muscle pain noted, "It's bad for your lungs, just it's 400 times lower than tobacco."
In what appeared to be an effort to minimize their use in the face of health risks, the teens emphasized that they were not using marijuana "in excess." One 18-year old summed up six years of using marijuana by saying, "I don't feel that I have a problem," adding that "it doesn't really have that many side effects." Some suggested that the benefits of smoking marijuana outweighed the risks. As noted, for those with difficulties sleeping at night, not being able to function the following day when sleep deprived was agonizing; marijuana use at night was preferable and provided a solution to that quandary. However, one male pondered both sides of his use of marijuana in dealing with his depression and was less optimistic:
Well, in some ways, it's helped me and some ways it hasn't. It's good when it's there, but when it's not, it kind of makes me sad. So it's hard like to try to keep up with staying happy all the time.[18 years, daily use]
Several participants made reference to the contradictions that they saw in their world regarding other licit substances and used that argument to make sense of and praise the benefits of marijuana over the risks.
And the thing is that if it's already used, they're already growing it for people that need it for medical help, then like why not.... Like no one has ever overdosed on marijuana, but people die everyday from alcohol, everyday from cigarettes and everyday from vast amounts of things that the government has legalized, but they just won't legalize marijuana for some reason. It's never killed anyone, never really hurt anyone, it saves people's lives and they could make a good amount of money from it and drop crime rates, why don't they do it? [Male, 14 years, non-daily use]