As a growing number of states legalize marijuana use for medical purposes, schools are having to decide whether to allow students to take cannabis on campus as medication.
Thirty-seven states, three territories, and the District of Columbia allow the use of medical marijuana overall, and 17 states permit the prescription of cannabidiol to minors, according to the National Conference of State Legislatures. But only 11 states—California, Colorado, Delaware, District of Columbia, Illinois, Maine, Maryland, Oklahoma, Pennsylvania, Virginia, and Washington—allow students to take medical marijuana during the school day as part of their treatment.
States differ on medical cannabis
The issue arose recently in Massachusetts, where the state legislature passed the cannabis reform bill at the end of this year’s session. The legislation includes a provision to conduct a study on the “possession, administration, and consumption of medical marijuana,” at public or private schools.
The act is awaiting Gov. Charles Baker’s approval and has provoked opinions for and against. The study would help inform officials whether or not to pass further legislation allowing students to take medical marijuana as part of their treatment in Massachusetts schools.
In California, a law approved in January 2020, called “Jojo’s Act,” which was named after a San Francisco teenager who suffered from epilepsy, allows parents and guardians to give medical marijuana to their children at public K-12 campuses, but prevents the “possession and administration of smokable or vapable” cannabis.
It is similar to laws in Illinois, Colorado, Maine, and New Jersey, which also only permit non-smokable cannabis on school grounds, provided it is administered by a parent, a guardian, or school nurse.
“In Colorado, the school nurses are [among those who are] supposed to administer the medical cannabis and students don’t need to leave the campus, [while] in California, I believe that the policies are up to individual school districts,” said Abbey Roudebush, the director of government affairs at Americans for Safe Access, a nonprofit that supports and advocates on behalf of medical cannabis patients.
She said most states have not passed laws about administering cannabis on school grounds, leaving the decision to individual schools and school districts.
That means “a burden really falls on the parents’ shoulders and on the children’s shoulders to have to fight to get approval for their medication, which is a hard fight,” Roudebush said.
Medical professionals weigh in
The American Academy of Pediatrics “opposes the use of ‘medical marijuana’ outside the regulatory process of the U.S. Food and Drug Administration,” according to its official policy statement.
In schools where medical marijuana is allowed, students should only take FDA-approved cannabis medication, provided they have a prescription and parental consent.
This point is underscored by others who work in school-based health.
“There are FDA-approved medications that should be processed as all school medications are in the school setting,” said Donna Mazyck, executive director of the National Association of School Nurses.
One of these medications is Epidiolex, used to treat seizures.
“The FDA approved Epidiolex, which is a form of the cannabidiol substance CBD used to treat seizures, and it has been approved for use in children, one year and older,” Mazyck said. “And the FDA has concluded that that particular drug product is safe and effective for use, and some school nurses see that medication prescribed for use in schools.”
But the AAP also warns that marijuana use can have a negative impact on developing brains, a sentiment echoed by The American Academy of Child and Adolescent Psychiatry. It says that adolescents are especially vulnerable to the ill effects of marijuana.
According to its official statement, there is growing evidence adolescents often access medical marijuana for recreation, and that with the increasing legalization of cannabis, teenagers are less likely to look at it as harmful and more likely to partake in it.
The AACAP has therefore encouraged more research weighing the risks and benefits of dispensing medical marijuana to adolescents.
However, the pediatricians’ group also acknowledged that medical pot could be an option for minors in life-threatening or debilitating situations, when “current therapies are inadequate.”
Advocates make a case for on-campus use
Cannabis can help with a range of medical conditions, according to its advocates, though the empirical research on use in children is limited.
“Medical cannabis is sort of the last-ditch effort to try to receive any kind of benefit from a medication, so by the time children are on medical cannabis, a lot of times that means that’s because other medications didn’t work,” said Roudebush.
Since students with chronic illnesses are more likely to miss classes than the average student, restricting access to their cannabis medication could impede their learning, she added.
“There are other policies in some places where schools allow parents to come to the school and they have to take the students out of school and off campus to administer their medication,” Roudebush said. “And that is detrimental to students, because they end up missing more school and instruction time everyday to be able to take their medication, and it’s also a big burden on the parents and caregivers as well.”
According to Alissa Lee, chairperson and founder of Cannabis for Children International, an organization dedicated to facilitating education around the safe and responsible use of marijuana in children, medical marijuana can help with refractory seizures, which are seizures that cannot be controlled through traditional medicine, aggressive behaviors caused by autism, as well as managing pain and symptoms of some cancers.
“It is something that’s treating people for conditions of cancers, self aggression, and autism, and treating people like me, I have epilepsy with tonic-clonic seizures (seizures that involve the stiffening and violent contractions of muscles),” she said.
A study by Pediatrics found that tetrahydrocannabinol (THC), a chemical found in marijuana, helped improve symptoms of nausea and vomiting for minors undergoing chemotherapy, while cannabidiol, another chemical in marijuana, helped manage seizures.
However, the AACAP advocates against the use of medical cannabis for symptoms and emotional/behavioral problems in minors with autism spectrum disorder, due to a lack of scientific evidence in medical literature.
And the AAP says there is no clear evidence specifically examining the effectiveness of medical marijuana in teens, so many of the variables such as appropriate dosing and side effects are unknown.
The only data available about medical marijuana and minors is “limited to its use in children with severe refractory seizures,” according to the AAP.
The concern from many legislators, anti-marijuana groups, and parents is that widespread acceptance of marijuana use in schools could lead to greater substance abuse among young people. Research has linked marijuana intake to “impaired short-term memory and decreased concentration, attention span, and problem-solving skills,” while the use of cannabinoids can lead to dizziness, dysphoria, and clouded senses.
Despite these risks, a 2020 National Survey on Drug Use and Health found that only about a quarter of respondents age 12 and over “perceived great risk from smoking marijuana once or twice a week.”
In situations of substance abuse, Lee said, “There should be counseling services [in schools] that address patients and students that are exposed to cannabis. It shouldn’t be taboo to have supportive services in place for these individuals.”
And Roudebush pointed out that it is very hard for adolescent students to acquire medical marijuana for the wrong reasons.
“In order for students, anyone under 18 or really, anyone under the age of 21 to have access to [medical] cannabis, they have to have a physician’s recommendation. And oftentimes, their parents are involved as well, if they’re under 18,” she said. “You just do not find teenagers who get a medical card or get a medical registration to use for recreational purposes.”
Comprehensive school-based health education programs also include information about risks associated with substance abuse, Mazyck said.
Her organization recommends that school nurses be knowledgeable regarding their state laws and policies related to administering medical marijuana in schools, and they need to be aware of “safe and informed nursing care of students who are having that medication in school.”
